Analysis of Optical Coherence Tomographic Patterns and Clinical Courses in Diabetic Macular Edema after Treatment

Jong Hoon Lim; In Hyuk Kim; Gi Hyun Bae; Ha Kyoung Kim; So Hyun Bae

doi:10.3341/jkos.2014.55.2.222

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Lim, Kim, Bae, Kim, and Bae: Analysis of Optical Coherence Tomographic Patterns and Clinical Courses in Diabetic Macular Edema after Treatment

Original Article

J Korean Ophthalmol Soc 2014;55(2):222-229.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.2.222

Analysis of Optical Coherence Tomographic Patterns and Clinical Courses in Diabetic Macular Edema after Treatment

Jong Hoon Lim, MD¹, In Hyuk Kim, MD¹, Gi Hyun Bae, MD¹, Ha Kyoung Kim, MD, PhD², So Hyun Bae, MD²

¹Department of Ophthalmology, Sahmyook Medical Center, Seoul, Korea

²Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

Address reprint requests to So Hyun Bae, MD Department of Ophthalmology, Hallym University Kangnam Sacred Heart Hospital, #1 Singil-ro, Yeongdeungpo-gu, Seoul 150-950, Korea, Tel: 82-2-829-5193, Fax: 82-2-848-4638, E-mail: vitric79@naver.com

Received 8 June 201310 October 2013 Accepted 20 December 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the optical coherence tomographic patterns and clinical courses of patients with diabetic macular edema (DME) after treatment.

Methods

The charts of 65 patients with DME were retrospectively reviewed. Baseline optical coherence tomographic patterns of DME were categorized into the 4 groups: group 1 (9 eyes, 13.8%) showed diffuse retinal thickening, group 2 (21 eyes, 32.3%) had cystoid macular edema (CME), group 3 (13 eyes, 20.0%) demonstrated serous retinal detachment (SRD) and group 4 (22 eyes, 33.9%) had combined CME and SRD. Treatments for DME included intravitreal bev-acizumab/triamcinolone injection, focal laser photocoagulation and vitrectomy. During 12 months of follow-up, changes in the patterns of DME were assessed. Additionally, the central retinal thickness (CRT) and best-corrected visual acuity (BCVA) were measured at baseline, 6 and 12 months.

Results

During 12 months of follow-up, 21 eyes (32.3%) showed changes in the DME pattern: 2 eyes (22.2%) in group 1, 3 (14.3%) in group 2, 4 (30.8%) in group 3 and 12 (54.5%) in group 4. A significantly greater proportion of eyes with changes in DME pattern underwent vitrectomy compared with those without changes in DME pattern (p = 0.012). There was a significant difference in CRT among the 4 groups; group 4 demonstrated the largest CRT at baseline, 6 and 12 months (p < 0.001, 0.002 and 0.029, respectively). However, there were no significant differences in BCVA among the 4 groups at baseline, 6 or 12 months (p = 0.879, 0.375 and 0.246, respectively).

Conclusions

Clinical courses varied according to the tomographic patterns of DME after treatment, and the poorest ana-tomic outcome was found in group 4. Change in tomographic pattern of DME was correlated with the treatment of DME, which might suggest a poorer outcome in those patients than in the patients who maintained their DME patterns.

Keywords: Diabetic macular edema, Optical coherence tomography, Prognosis, Treatment

References

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Figure 1.

The optical coherence tomographic patterns of diabetic macular edema. (A) Diffuse retinal thickening without cyst-like cavities, (B) Cystoid macular edema with decreased optical reflectivity in the retinal layer, (C) Serous retinal detachment, (D) Combination of cystoid macular edema and serous retinal detachment.

Figure 2.

Changes of central retinal thickness (CRT) according to the optical coherence tomographic patterns of diabetic macular edema. Bars indicate averaged CRT in each group. Error bars indicate standard deviations. Asterisks mean statistically significant difference between parameters (p < 0.05). CME = cystoid macular edema; DRT = diffuse retinal thickening; SRD = serous retinal detachment.

Figure 3.

Changes of best-corrected visual acuity (BCVA) according to the optical coherence tomographic patterns of diabetic macular edema. Bars indicate averaged BCVA in each group. Error bars indicate standard deviations. Asterisk means statistically significant difference between parameters (p < 0.05). CME = cystoid macular edema; DRT = diffuse retinal thickening; SRD = serous retinal detachment.

Table 1.

Baseline characteristics according to the optical coherence tomographic patterns of diabetic macular edema

	DRT (n = 9)	CME (n = 21)	SRD (n = 13)	CME+SRD (n = 22)	p-value
Age (years)	56.9 ± 6.4	57.0 ± 9.4	55.2 ± 8.9	52.5 ± 12.2	0.493
Sex (male:female)	5:4	10:11	5:8	8:14	0.737
Duration of diabetes (years)	11.3 ± 7.7	10.3 ± 7.9	8.7 ± 7.1	9.1 ± 8.7	0.849
Combined proliferative diabetic retinopathy (n, %)	1 (11.1)	10 (47.6)	7 (53.8)	13 (59.1)	0.104
Central retinal thickness (μm)	336.7 ± 50.8	488.8 ± 137.4	390.5 ± 56.0	643.4 ± 149.9	<0.001
Best-corrected visual acuity (log MAR)	0.49 ± 0.40	0.51 ± 0.36	0.54 ± 0.31	0.58 ± 0.29	0.879

Values are presented as mean ± SD.

DRT = diffuse retinal thickening; CME = cystoid macular edema; SRD = serous retinal detachment.

Table 2.

Changes in optical coherence tomographic patterns of diabetic macular edema after treatment

	DRT (n = 9)	CME (n = 21)	SRD (n = 13)	CME+SRD (n = 22)
Maintain (n, %)	7 (77.8)	18 (85.7)	9 (69.2)	10 (45.4)
Change (n, %)	2 (22.2)	3 (14.3)	4 (30.8)	12 (54.6)
DRT		1 (4.8)	1 (7.7)	0 (0)
CME	1 (11.1)		2 (15.4)	8 (36.4)
SRD	0 (0)	0 (0)		4 (18.2)
CME+SRD	1 (11.1)	2 (9.5)	1 (7.7)

DRT = diffuse retinal thickening; CME = cystoid macular edema; SRD = serous retinal detachment.

Table 3.

Comparisons of treatment modalities between two groups according to the maintenance of diabetic macular edema pattern using optical coherence tomography

	Maintain (n = 44)	Change (n = 21)	p-value
Bevacizumab (n^*)	2.7 ± 1.9	2.1 ± 1.4	0.353
Triamcinolone (n^*)	0.3 ± 0.6	0.3 ± 0.6	0.962
Focal/grid laser photocoagulation (n^*)	0.2 ± 0.4	0.4 ± 0.5	0.061
Vitrectomy (n, %)^†	5 (11.4)	8 (38.1)	0.012

Values are presented as mean ± SD.

^* The mean number of each treatment

^† The number of patients who underwent vitrectomy.

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