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Objective To observe the imaging features of cystoid macular edema (CME) in multicolor imaging (MC),and to evaluate the value of MC in the diagnosis of CME.Methods Descriptive case series study.From August 2017 to June 2018,42 eyes of 37 patients with CME diagnosed in the people's Hospital of Wuhan University were included in the study.Among them,there were 24 males and 13 females,with an average age of 48.51 ± 10.29 years.There were 14 eyes with diabetic retinopathy,14 eyes with central retinal vein occlusion,8 eyes with branch retinal vein occlusion,4 eyes with uveitis,and 2 eyes with Eales disease.The macular color fundus photography (CFP) was performed with Visucam 200 non-mydriatic fundus camera of Zeiss company in Germany.MC,frequnce domainoptical OCT (SD-OCT) and FFA were examined by Spectralis HRA2 + OCT of Heidelberg company in Germany.According to the MC standard method,five images,including 488 nm blue reflection (BR),515 nm green reflection (GR),820 nm infrared reflection (IR) imaging and standard MC and blue-green enhancement (BG),were obtained at the same time.Compared with SD-OCT,CFP and MC images were scored.Friedman M test and Wilcoxon signed rank test were used for statistical analysis.Results The standard MC and BG images showed blue-green uplift area or petal-shaped appearance,surrounded by green reflection areas with clear boundaries.BR image can be seen in the low reflexes area.On the GR image,there were patches or cystic low reflection areas,surrounded by a slightly high reflection.On the IR image,patches or cystoid high reflexes can be seen,surrounded by low reflection dark areas with clear boundaries.The average scores of CFP,standard MC,GB,IR,GR and BR were 1.20± 0.94,3.05± 0.99,2.90± 1.04,2.55± 1.27,2.00± 0.94,0.51 ± 0.85 respectively,and the differences were statistically significant (χ2=151.61,P=0.000).The score of CFP were significantly lower than that of standard MC (Z=-5.421),BG (Z=-5.354),IR (Z=-4.714),GR (Z=-4.438) and higher than that of BR (Z=-3.435).The differences were statistically significant (P=0.000,0.000,0.000,0.000,0.001).Conclusions The quality of MC imaging is better than that of CFP.Combined with SD-OCT,it can be used as an assistant method to diagnose CME.
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Diabetic macular edema (DME) is the main cause of visual impairment in diabetic retinopathy patients.It mainly includes focal DME and diffuse DME,while DME of clinical significance needs timely intervention treatment.Optical coherence tomography is currently recognized as the most sensitive method to accurately diagnose DME.Currently,the common treatments of DME include intravitreal injection of anti-vascular endothelial growth factor (VEGF) or glucocorticoid and laser photocoagulation.Among them,anti-VEGF injection is becoming the first-line therapeutic,and corresponding individual treatment or combined treatment strategy should be selected according to the characteristics of DME and the specific conditions of patients.During the diagnosis and treatment of DME,attention should be paid to the systemic treatment of diabetes and the effect of diabetes-related neuroretinopathy on the therapeutic effect of DME.With the appearance of heterogeneity in the efficacy of anti-VEGF drugs,it remains to be further studied how to choose alternative therapeutics and when to replace them.
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Objective To investigate the distribution patterns of diabetic macular edema (DME) based on optical coherence tomography (OCT),and explore its correlation with diabetic retinopathy (DR) stages and systemic factors.Methods A total of 135 patients (242 eyes) with type 2 diabetes were included in this retrospective study.There were 75 males (138 eyes) and 60 females (104 eyes),the ages were from 29 to 83 years,with an average age of (5 8.8± 11.1) years.The general information such as height,weight,smoking history and blood glucose [such as glycosylated hemoglobin (HbA1 c)],blood pressure,blood lipid,24 hours urine protein and other examinations were collected.The diagnosis of DR and DME were made,and the staging of DR and typing of DME were performed based on fundus color imaging and OCT.DR were divided into mild nonproliferative DR (NPDR),moderate NPDR,severe NPDR and proliferative DR (PDR).DME were categorizedinto 4 types including sponge-like retinal swelling (SME),cystoid macular edema (CME),serous retinal detachment (SRD) and posterior hyaloid traction (PHT).The correlation between DME types and DR staging were analyzed by x2 test and Fisher exact test.Multivariate logistic regression analysis was used to analyze the correlation between DME types and systemic factors.Results In 242 DR eyes the proportions of mild,moderate,severe NPDR and PDR were 30.99％,32.64％,23.14％ and 13.23％,respectively.There were 199 eyes (82.23％) with DME.There were statistically significant differences in the proportion of DME in different stages of DR (x2=21.077,P＜0.01).In the 199 eyes with DME,There were 165 eyes (68.18％) of SME,22 eyes (9.09％) of CME,7 eyes (2.89％) of SRD and 5 eyes (2.07％) of PHT.The distribution of DME patterns in different stages of DR was statistically significant (x2=156.273,P＜0.01).Logistic regression analysis showed that the duration of diabetes,HbA1c and macroalbummuria were independent risk factors for DME [odds ratio (OR)=1.090,1.510,4.123;P＜0.05],and were also independent for SME (OR=1.092,1.445,3.942;P＜0.05);HbA1c wasanindependentriskfactorforSRD(OR=2.337,P＜0.05).Canclusions There are differences in the distribution of different DME types in each stage of DR.The duration of diabetes,HbA 1c and macroalbuminuria were independent risk factors for DME and SME,and macroalbuminuria and HbA1c for CME and SRD.
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Background Cystoid macular edema (CME) is caused by many fundus diseases.The noninvasive clinical diagnosis methods for CME are conventional color fundus photography up to now.However,these images can not display the CME range well.Confocal scanning laser ophthalmoscope (cSLO) based retinal imaging can provide clear picture with high contrast.However,whether cSLO imaging is feasible in the quantitative assessment of CME remains unclear.Objective This study was to image the boundary of CME and assess the quantification of CME image from cSLO imaging technology.Methods A series case-observational study was designed.This study protocal was approved by Ethic Committee of Beijing Tongren Hospital.cSLO based retinal imaging technology was carried out on consecutive 24 eyes of 24 patients with clinically diagnosed and OCT confirmed CME in Beijing Tongren Eye Center from August to December 2015 under the informed consent of each individual.The radial scan range was 45°× 45 ° and the line scan level was 49 at macula area.The pseudocolar image,green light reflective image (532 nm) and infrared reflective image (785 nm) were collected.The imaging was analyzed by EasyScan software (version 1.2.2).Fundus color photography and SD-OCT were carried out in each patient.The images were graded by specialists according to the SD-OCT cross sectional results.Results The primary causes of CME included epiretinal membrane (10 eyes),branch retinal vein occlusion (BRVO) (6 eyes),central retinal vein occlusion (CRVO) (4 eyes),diabetic retinopathy (DR) (3 eyes) and CRVO with BRVO (1 eye).A CME image was exhibited on the fundus color photogram with the obscure boundary;while the clear range of CME was displayed by the cSLO imaging.The mean score of CME from pseudocolar image,green light reflective image and infrared reflective image was 3.21±0.78,2.67±0.96 and 2.54±0.83,respectively,which was significantly higher than 1.33±0.82 from the fundus color photography (all at P＜0.01).Conclusions In CME patients,the imaging quality from cSLO-based retinal imaging technology is better than that from traditional fundus color photography.Combined with SD-OCT sectional scan analysis,cSLO-based retinal imaging technology may offer a method to observe and record more fundus details for CME diagnosis.
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@#AIM: To investigate the diagnostic value of fundus fluorescein angiography(FFA)and optical coherence tomography(OCT)in the diagnosis of diabetic macular edema(DME). <p>METHODS: From January 2015 to January 2016, selected 62 patients(101 eyes)with diabetic retinopathy(DR)in our hospital, underwent FFA and OCT respectively. We compared the results of the two methods. <p>RESULTS: The detection rate of DME by FFA was 84.2%, and the detection rate of DME by OCT was 77.2%, the difference was not statistically significant(<i>P</i>>0.05). In 101 eyes, OCT and FFA all showed macular edema in 76 eyes, and no macular edema in 14 eyes, the diagnostic accuracy of OCT and FFA was 89.1%, Kappa was 0.653, and the consistency was higher(<i>P</i><0.05). Macular central retinal thickness difference was statistically significant in patients with different FFA features(<i>P</i><0.05), the diffuse edematous retinal thickness was 301.43±62.44SymbolmA@m, which was significantly thicker than the other patients. <p>CONCLUSION:OCT can objectively examine the structural changes of the macular area in diabetic patients, but it cannot replace the role of FFA in the diagnosis of macular edema, the combination of the two methods is helpful in the diagnosis of DME.
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Background Cystoid macular edema (CME) is a manifestation secondary to multiple fundus diseases and often leads to the decline of visual acuity.Optical coherence tomography (OCT) is a common diagnostic method for CME,but it can not reflect the metabolism information of retinal pigment epithelium (RPE).Shortwave autofluorescence (SW-AF)may find the abnormality of macula,but its clinical value remains to be confirmed.Objective This study was to investigate the value of SW-AF in the diagnosis of CME.Methods One hundred and eighty-nine eyes of 140 patients who have the relative diseases to CME or received intraocular surgery were included from May 2010 to August 2011 in Lihuili Hospital of Ningbo city.SW-AF,infrared autofluorescence (IRAF),fundus fluorescein angiography (FFA) and OCT were performed in all the eyes under the informed consent of each patient.The sensitivity,specificity and other indicators in diagnostic test of SW-AF for CME were evaluated and compared with OCT.Results SW-AF had certain accuracy in diagnosis of CME with the sensitivity 78.29％,specificity 96.67％,Youden index 0.75,positive predictive value 98.06％,negative predictive value 67.44％.The area under curve (AUC) of SW-AF for the diagnosis of CME was 0.875 with the 95％ confidence interval (CI) 0.823-0.926 (P＜0.001).Compared with OCT,the differences of SW-AF and IR-AF in the diagnosis for CME was statistically significant(x2 =22.53,91.35,both at P＜0.001),and agreement coefficients of diagnosis result between SW-AF、IR-AF or FFA and OCT were 0.67,0.12 and 0.85.Conclusions SW-AF can be used as a new rapid,non-invasive,ancillary technique in diagnosis of CME with certain accuracy,and the diagnostic agreement of SW-AF with OCT is lower than FFA but is higher than IR-AF.
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@#Objective To assess the value of Heidelberg retina tomograph-Ⅱ(HRT-Ⅱ)and optical coherence tomography(OCT)on making a diagnosis of macular edema in patients with background diabetic retinopathy.Methods Eighty eyes of 40 patients with background diabetic retinopathy were divided into the macular edema group and non-macular edema group according to examination of fluorescein fundus angiography(FFA).Macular thickness was measured by OCT and edema index was invested by HRT-Ⅱ.The results were analyzed by statistics test.Results The Kappa value of OCT examination on diagnosis for macular edema of background diabetic retinopathy was bigger than the HRT-Ⅱ.Making FFA as the diagnosis standard of macular edema,OCT examination showed P=0.0001,HRT-Ⅱ examination showed P=0.0856.Conclusion OCT and HRT-Ⅱ can be used to quantitate the macular edema of the diabetic retinopathy patients.OCT is better in the final diagnosis for macular edema than HRT-Ⅱ,and HRT-Ⅱ has higher misdiagnosis rate and lower missed diagnosis rate.HRT-Ⅱ can be used to screen macular edema patients with diabetic retinopathy.
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Objective To observe the characteristics of the images of optical coherence tomography (OCT) performed on the patients with macular edema, and investigate relationship between the retinal thickness at the central fovea and the best-corrected visual acuity. Methods Fourty-seven patients (54 eyes) with macular edema diagnosed by direct and indirect ophthalmoscopy, three mirror contact lens, or fundus fluorescein angiography (FFA) underwent OCT which was also performed on 50 healthy individuals as the control. The examination focused on the horizontal and vertical planes crossing the central fovea to measure the thickness of the fovea. The correlation between retinal thickness at the central fovea and best-corrected visual acuity was analyzed, and the images of OCT in the patients with macular edema were classified according to the macular configuration. Results Significant difference of the macular configuration and best-corrected visual acuity was found between the control and macular edema group. Three characteristics were found in the images of OCT in the patients with macular edema: sponge-like retinal swelling in 20 eyes (37.1%), macular cystoid edema in 26 eyes (48.1%), and serous retinal detachment in 8 eyes (14.8%). The statistical analysis showed that there was a negative correlation between the thickness at the central fovea and best-corrected visual acuity of affected eyes (r=-0.569, P=0.000). Conclusions The images of OCT in macular edema include 3 types: sponge-like retinal swelling, macular cystoid edema, and serous retinal detachment. The retinal thickness at the central fovea of the eyes with macular edema was thicker than that of the normal ones, and the thicker the fovea is, the poorer the visual acuity will be.