Thickness In Macular Edema Research Articles

Three-dimensional diabetic macular edema thickness maps based on fluid segmentation and fovea detection using deep learning.

To explore a more accurate quantifying diagnosis method of diabetic macular edema (DME) by displaying detailed 3D morphometry beyond the gold-standard quantification indicator-central retinal thickness (CRT) and apply it in follow-up of DME patients. Optical coherence tomography (OCT) scans of 229 eyes from 160 patients were collected. We manually annotated cystoid macular edema (CME), subretinal fluid (SRF) and fovea as ground truths. Deep convolution neural networks (DCNNs) were constructed including U-Net, sASPP, HRNetV2-W48, and HRNetV2-W48+Object-Contextual Representation (OCR) for fluid (CME+SRF) segmentation and fovea detection respectively, based on which the thickness maps of CME, SRF and retina were generated and divided by Early Treatment Diabetic Retinopathy Study (ETDRS) grid. In fluid segmentation, with the best DCNN constructed and loss function, the dice similarity coefficients (DSC) of segmentation reached 0.78 (CME), 0.82 (SRF), and 0.95 (retina). In fovea detection, the average deviation between the predicted fovea and the ground truth reached 145.7±117.8 µm. The generated macular edema thickness maps are able to discover center-involved DME by intuitive morphometry and fluid volume, which is ignored by the traditional definition of CRT>250 µm. Thickness maps could also help to discover fluid above or below the fovea center ignored or underestimated by a single OCT B-scan. Compared to the traditional unidimensional indicator-CRT, 3D macular edema thickness maps are able to display more intuitive morphometry and detailed statistics of DME, supporting more accurate diagnoses and follow-up of DME patients.

Results of Intravitreal Bevacizumab as an Adjunct to mETDRS Grid Laser in Diabetic Macular Edema

Purpose: To assess the efficacy of Intravitreal Bevacizumab as an adjuvant to grid laser photocoagulation in patients with diffuse macular edema (DME) in type II diabetes.
 Study Design: Quasi experimental study.
 Place and Duration of Study: Institute of ophthalmology, Liaquat University of Medical and Health Sciences, Jamshoro, from September 2016 to November 2018
 Methods: Ninety five patients with diffuse macular edema in type II diabetes were selected by convenient sampling. Group I patients were treated with ETDRS grid laser photocoagulation. Group II patients were treated with ETDRS grid laser photocoagulation followed by intravitreal bevacizumab after one week monthly for 2 months and then as per need. All patients were examined after 1st, 2nd and 3rd month and mean change in best corrected visual acuity (BCVA) and central macular thickness (CMT).Statistical analysis was done on SPSS version 20.0. Paired t-test was used to compare mean values and p valve < 0.05 was accepted as statistically significant.
 Results: The results of study were compared with the baseline values. The mean change in BCVA in group 1 was from 46 ± 18 letters to 52 ± 17. BCVA in group 2 was from 46 ± 18 letters to 56 ± 17 (P < 0.001). The decrease in macular edema thickness was more in group II than group I (P < 0.001).
 Conclusion: Macular Grid laser with or without Intravitreal Bevacizumab significantly improves vision and decreases macular edema but combined treatment led to more stable improvement in DME during follow-up.
 Key Words: Modified ETDRS laser, Bevacizumab, Macular edema, Anti-VEGF.

MON-669 Diabetic Macular Edema Thickness in Asians and Caucasians: Is There a Difference?

Background: Diabetic macular edema (DME) is a manifestation of diabetic retinopathy (DR) which can result in vision loss. DME affects over 750,000 US adults over the age of 40, costing 33% more in Medicare dollars than those patients without DME. Ethnicity plays a role in the development of DR but there are no studies about DME and HbA1c in Asians versus Caucasians. As Asians are the fastest growing ethnic group in the US and are at an increased risk of developing Type 2 Diabetes Mellitus (T2DM), there is a need for more knowledge about DME compared to Caucasians. Purpose: Evaluation of diabetic macular edema thickness between Asian and Caucasian Diabetic patients. Methods: A retrospective chart review (2017-2019) of consecutive diabetic patients were performed at California Retina Clinic. Inclusion criteria: DME thickness was measured by Optical Coherence Tomography (OCT) (Heidelberg Spectralis, Heidelberg, Germany), OCT +/- 3 months of their HbA1c lab test, control (C) non-diabetic patients=HbA1c <6.0%; For T2DM patients diagnosed by primary care physician: HbA1c ≥6.0%. Exclusion criteria: Age under 18 or over 90 years. Data analysis: R Project version 3.6.1 (R Foundation for Statistical Computing, Vienna, Austria). Two-way ANOVA was used to determine the difference between the four groups. The post-hoc test, Tukey’s HSD was used for p-values (<0.05). Results: Of 500 consecutive patients: 80 patients met inclusion criteria: T2DM Asian (ADM), T2DM Caucasian (CDM), C Asian (CA), C Caucasian (CC). n=80 pts, avg age=59.187 years (sd=15.42, range 23-89 years), Female=44, Male=36; ADM: n=20, avg age=60.90 years (sd=11.22, range 37-79 years), Female=10,Male=10, HbA1c range = 6.7-11.9%, Avg HbA1c = 7.59%, Avg DME=276.28 um (sd=25.93 um, range = 238.5-342 um); CDM: n=20, avg age=68.05 years (sd=10.54, range 46-87 years), Female=9, Male=11, HbA1c range = 6.0-11.5%, Avg HbA1c = 7.52%, Avg DME=298.68 um (sd=33.84 um, range = 253.5-397.5 um); HbA1c in ADM v CDM: p=0.8(ns) CA: n=20, avg age=52.85 years (sd=16.81 years, range 34-84 years), Female=10, Male=10, HbA1c range = 4.8-5.5%; Avg DME=267.05 um (sd=21.09 um, range = 230-310 um). CC: n=20, avg age=62.95 years (sd=13.47 years, range 40-89 years), Female=14, Male=6, HbA1c range = 4.8-5.6%, Avg DME=285.68 um (sd=16.58 um, range = 248.5-312.0 um).ADM v CDM and DME [F(1, 76)=13.267, p = 0.00049]. Tukey’s HSD post hoc tests were carried out. CDM v ADM had a significantly higher avg DME: 22.4 um (p=0.031). Body Mass Index (BMI): ADM patients (avg= 25.6) compared to CDM patients (28.5):(p=0.05, t-test). Conclusion: In this small study, T2DM Asians had less macular edema thickness than T2DM Caucasians with similar HbA1c. T2DM Asian patients had lower Body Mass Index than T2DM Caucasians. Body Mass Index may be an additional factor to consider in the evaluation of diabetic macular edema in Asians and Caucasian Diabetic patients.

Relation Between Retinal Vasculature and Retinal Thickness in Macular Edema.

This study has investigated the relationship of the retinal vasculature and the retinal thickness for Macular Edema (ME) subjects. Ninety sets of Fluorescein Angiograph (FA) and Optical Coherence Tomography (OCT) of 54 participants were analyzed. Multivariate analysis using the binary logistic regression model was used to study the association between vessel parameters and retinal thickness. The results reveal retinal vessel feature i.e. fractal dimension (FD) as the most sensitive parameter to the changes in retinal thickness associated with ME. Thus, indicating a direct relationship between the retinal vasculature and retinal thickness which is caused due to neovascular causing exudates, leakages and hemorrhages, with applications for alternate modality for detection of ME.

Retinal oximetry: Metabolic imaging for diseases of the retina and brain.

Retinal oximetry imaging of retinal blood vessels measures oxygen saturation of hemoglobin. The imaging technology is non-invasive and reproducible with remarkably low variability on test-retest studies and in healthy cohorts. Pathophysiological principles and novel biomarkers in several retinal diseases have been discovered, as well as possible applications for systemic and brain disease. In diabetic retinopathy, retinal venous oxygen saturation is elevated and arteriovenous difference progressively reduced in advanced stages of retinopathy compared with healthy persons. This correlates with pathophysiology of diabetic retinopathy where hypoxia stimulates VEGF production. Laser treatment and vitrectomy both improve retinal oximetry values, which correlate with clinical outcome. The oximetry biomarker may allow automatic measurement of severity of diabetic retinopathy and predict its response to treatment. Central retinal vein occlusion is characterized by retinal hypoxia, which is evident in retinal oximetry. The retinal hypoxia seen on oximetry correlates with the extent of peripheral ischemia, visual acuity and thickness of macular edema. This biomarker may help diagnose and measure severity of vein occlusion and degree of retinal ischemia. Glaucomatous retinal atrophy is associated with reduced oxygen consumption resulting in reduced arteriovenous difference and higher retinal venous saturation. The oximetry findings correlate with worse visual field, thinner nerve fiber layer and smaller optic disc rim. This provides an objective biomarker for glaucomatous damage. In retinitis pigmentosa, an association exists between advanced atrophy, worse visual field and higher retinal venous oxygen saturation, lower arteriovenous difference. This biomarker may allow measurement of severity and progression of retinitis pigmentosa and other atrophic retinal diseases. Retinal oximetry offers visible light imaging of systemic and central nervous system vessels. It senses hypoxia in cardiac and pulmonary diseases. Oximetry biomarkers have been discovered in Alzheimer's disease and multiple sclerosis and oxygen levels in the retina correspond well with brain.

Subthreshold lasercoagulation (810 nm) for diabetic macular edema

Introduction. The threshold laser coagulation leads to irreversible damage of retinal structures, microscotomata appearance in the central visual field, contrast sensitivity decrease, and color vision impairment, being accompanied as well by the release of proinflammatory cytokines. For diabetic macular edema treatment, a method of high-density subthreshold laser coagulation (810 nm) was first developed, based on individualized choice of subthreshold parameters of laser irradiation, and permitting confluent application of laser impacts to the retina. Using multimodal diagnostic approach to the estimation of anatomic and functional treatment results, a minimally invasive character and safety of this DME treatment method were confirmed.&#x0D; Purpose. The aim of this study was to comparatively evaluate the efficacy of a diode laser (810 mn) subthreshold laser treatment using high-density laser impact application in diode laser coagulation (DLC) and diode microphotocoagulation (DMP) modes.&#x0D; Materials and methods. To compare the efficacy of subthreshold laser treatment methods (DLC and DMP), patients were divided into two groups, comparable in macular edema thickness and area. The first group (24 eyes) received a macular laser coagulation in grid pattern and MicroPulse diode laser (810 nm) regimen; biomicroscopically it was predominantly subthreshold high-density application of burns. The second group (29 eyes) received a macular laser coagulation in grid pattern and continuous diode laser (810 nm) regimen; biomicroscopically it was predominantly subthreshold high-density application of burns.&#x0D; Results. After DLC and DMP, there was no statistically significant difference between compared groups in best corrected visual acuity. There was also no significant difference in retinal edema maximal height dynamics, retinal edema area, and central thickness in 2 and 4 months.&#x0D; Conclusion. Subthreshold microphotocoagulation and laser coagulation methods at the same average power of laser exposure and other exposure parameters in the shortterm follow-up have comparable efficacy in the treatment of diabetic macular edema.

YC-1 Inhibits VEGF and Inflammatory Mediators Expression on Experimental Central Retinal Vein Occlusion in Rhesus Monkey

ABSTRACTPurposes: To investigate the therapeutic potential of YC-1 for experimental central retinal vein occlusion (CRVO) of rhesus monkey.Methods: Six adult rhesus monkeys were recruited in this study. Laser-induced CRVO was established in both eyes of all subjects. Intravitreal injection of YC-1 90 μl (200 μM with 0.01% dimethyl sulfoxide (DMSO) as vehicle) was administrated in right eye and 0.01% DMSO 90 μl in left eye respectively at 1 week after CRVO established. All eyes underwent routine examination at 1 day, 1 week, 2 week, and 1 month after intravitreal injection of YC-1 or DMSO. Meanwhile, vitreous fluid was collected at each time points to analyze concentration of VEGF, HIF-1α, IL-6, IL-8, and MCP-1 mediators by CBA or ELASA method.Results: The experimental CRVO was successfully established in six rhesus monkeys. As expected, the thickness of macular edema significantly decreased at 1 week and 2 weeks after YC-1 injection compared with that of DMSO injection. Subsequently, the central macular thickness in all eyes was recovered to the initial levels at 1 month after photocoagulation. Intraocular pressure (IOP) was not significantly different between two groups during all follow up. Meanwhile, the concentration of IL-6, IL-8, VEGF, and HIF-1α in vitreous fluid significantly decreased after YC-1 injection compared with that of DMSO injection, MCP-1 was not significantly different between both groups.Conclusions: Intravitreal injection of YC-1 significantly alleviated macular edema compared with that of DMSO control group. Meanwhile, both inflammatory factors and angiogenesis-related factors expression were inhibited in vitreous by YC-1 injection.

Treatment of macular edema in diabetic retinopathy: comparison of the efficacy of intravitreal bevacizumab and ranibizumab injections

Aim: To compare the effects of the anti-VEGF treatments bevacizumab and ranibizumab on visual acuity and foveal thickness in macular edema due to diabetic retinopathy. Materials and methods: 50 patients received intravitreal bevacizumab (Avastin; Group 1) and 50 received intravitreal ranibizumab (Group 2). Patients were assessed before and every month for 12 months after injection. Foveal thickness values and best corrected visual acuity were obtained at each assessment. Patients were assessed at 12-month follow-up on BCVA and foveal thickness. Results: BCVA averages for both groups showed a significant increase in visual acuity from pretreatment to 12 month follow-up. The decrease in foveal thickness was also significantly different for both groups from pretreatment to 12 month follow-up. At 12 months, there were no significant between-group differences with respect to a decrease in foveal thickness or an increase in visual acuity. Conclusions: Bevacizumab, compared to ranibizumab, was effective with fewer injections.

Bevacizumab und Ranibizumab bei Makulaödem bei retinalen Venenverschlüssen

The effect of Bevacizumab (BE) (Avastin®) or Ranibizumab (RA) (Lucentis®) on the visual acuity (VA) and on the central foveal thickness (CFT) was evaluated in macular edema due to retinal vein occlusion. Eyes with a macular edema due to a central retinal vein occlusion or to a branch retinal vein occlusion were considered if at least 3 intravitreal injections of Bevacizumab (1.25 mg) or Ranibizumab (0.5 mg) had been performed. The visual acuity with ETDRS and the central foveal thickness with spectral optical coherence tomography (OCT) were measured. The 3-months follow-up and, if further injections were necessary, the 6-months follow-up were evaluated. After 3 months a significant improvement of the visual acuity was measured in both groups (p < 0.001) while during the same period the mean central foveal thickness diminished significantly (p < 0.001). At the 3-months follow-up there were no significant differences between the two groups for the mean visual acuity and for the mean central foveal thickness. The treatment was continued in 36 eyes and the visual acuity and the central foveal thickness were compared between the 3-months and the 6-months follow-up. No further improvements of the visual acuity or of the central foveal thickness were measured in both groups. A relapse of the macular edema was diagnosed in 30 eyes without a significant difference in the Bevacizumab group compared to the Ranibizumab group. Intravitreal injections of Bevacizumab and Ranibizumab improved the visual acuity and the central foveal thickness in macular edema due to retinal vein occlusion at 3 months. A further improvement was not measured if the treatment was prolonged to 6 months. There were no significant differences measured between Bevacizumab and Ranibizumab. The ratio of relapses is important to note.

A study on finding influencing factors on diabetic retinopathy among diabetic patients using Multiple Regression approach

Background: Diabetic retinopathy (DR) is retinal disease associated with diabetes. DR is the leading cause of blindness among working aged adults around the world. High blood pressure is an established risk factor for the development of macular edema and is associated with the presence of PDR. Objective: To find the influence of factors in the prediction of DR by using multiple regression analysis approach and find out the thickness of the center of retina (macula). Methods: 200 diabetic retinopathy patients were selected through simple random sampling by using pre-designed and pre-tested questionnaire. Macular edema thickness is to be measured by Optical Coherence Tomography (OCT) in the unit of μm and to find other influencing factors age, gender, duration of diabetics, level of hyperglycemia (HbA1c), HDL, triglycerides, family history, hypertension, LDL related to DR. Results: Out 200 patients, 133 (66.50%) were male and 67 (33.50%) were female. Mean age of the patients was 59.78 ± 11.31 years and range was 24 – 87 years. The mean thickness of the center of the retina (macula) was 452.30 ± 138.92 μm. In this paper, the influencing factors were indentified, gender and HDL were had no influence over for developing DR. Conclusion: The influencing factors have been indentified and on the basis of which prediction of DR for a person is identified. By finding the influencing factors of DR and one can protect themselves from the development of DR.

Intravitreal triamcinolone for macular edema in Lyme disease

To describe the outcome in a patient with macular edema caused by Lyme disease treated with injection of 4 mg intravitreal triamcinolone. The patient, 2 years after systemic Lyme disease treated with doxycycline for 4 weeks, developed macular edema with serous retinal detachment in one eye (visual acuity: 0.6). After unsuccessful therapy with intravenous ceftriaxone, indomethacin and acetazolamide, 4 mg intravitreal triamcinolone (IVTA) was injected via the pars plana. Visual acuity improved to 1.0 and macular thickness recovered over 1 month. No changes were found in intraocular pressure. No recurrence of macular edema was seen after 2 years. IVTA can restore visual acuity and reduce macular thickness in macular edema caused by Lyme disease. However, since borreliosis is a systemic disease, previous systemic antibiotic treatment is recommended.