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      Optical Coherence Tomographic Assessment of Diabetic Macular Edema: Comparison with Fluorescein Angiographic and Clinical Findings

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          Purpose: To compare the optical coherence tomographic (OCT) features with clinical and fluorescein angiographic (FA) findings in patients with diabetic retinopathy. Methods: In a retrospective study ophthalmologic examination together with FA and OCT images were obtained from 195 eyes of 110 patients with different stages of diabetic retinopathy and OCT images were obtained from 40 eyes of 20 control subjects. Fluorescein leakage characteristics were organized into five groups: no leakage (1), focal (2), diffuse (3), combined focal + diffuse leakage (4) and cystoid (5). The Pearson correlation test was used to test the correlation between visual acuity and central foveal thickness and ANOVA was used for the statistical comparison between the groups. Results: The OCT images demonstrated retinal swelling in 66.1% of eyes, cystoid macular edema (CME) in 11.8% of eyes, serous foveal detachment + swelling in 6.2% of eyes, serous foveal detachment + swelling + CME in 3.6% of eyes and normal foveal structure in 12.3% of eyes. The best-corrected visual acuity was significantly correlated with central foveal thickness (r: –0.528, p < 0.01). There was 77% agreement between clinical examination and OCT results. CME was detected with OCT in 15.4% of eyes in our study, 40% of which was not detected with slit-lamp biomicroscopy and 63.3% of which was not evident in FA. None of the serous foveal detachments could be detected during slit-lamp biomicroscopy or FA. Conclusions: OCT-3 provided objective documentation of foveal structural changes in eyes with diabetic retinopathy. Best-corrected visual acuity provided a significant correlation with the retinal thickness at the central fovea. These results indicate that OCT can facilitate deciding on the treatment protocol (surgical or medical) and follow-up of diabetic patients, which is especially important in the early stages of diabetic maculopathy when the structural changes are not yet evident with slit-lamp biomicroscopy or angiographically.

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          Most cited references 9

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          Topography of diabetic macular edema with optical coherence tomography

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            Detection of diabetic foveal edema: contact lens biomicroscopy compared with optical coherence tomography.

            To compare contact lens biomicroscopy with optical coherence tomography (OCT) for the detection of diabetic foveal edema. Study participants consisted of a convenient cohort of consecutive patients with diabetes mellitus seen at the Wilmer Eye Institute's Retinal Vascular Center, Baltimore, MD. Case characteristics were recorded and eyes were examined by 1 of 4 retina specialists by means of contact lens biomicroscopy. Edema involving the center of the macula was assessed as definitely present, questionably present, or definitely not present. The OCT testing was performed and interpreted by trained technicians, masked to the physicians' assessment of foveal edema. Agreement between OCT and contact lens examination for the absence or presence of foveal edema was evaluated. One hundred seventy-two eyes of 95 patients with diabetes were enrolled in August and September 2002. Foveal thickness was objectively measured by OCT in 170 (99%) of 172 cases. We found excellent agreement between OCT and contact lens examination for the absence or presence of foveal edema when OCT thickness was normal ( 300 microm). However, agreement was poor when foveal thickness was mildly increased on OCT (201-300 microm). Agreement between contact lens examination and OCT for the detection of diabetic foveal edema is poor when OCT thickening is mild. This suggests that contact lens biomicroscopy is relatively insensitive for the detection of mild foveal thickening apparent on OCT. Additional studies are needed to investigate the natural course of cases with mildly increased foveal thickness on OCT that do not appear thickened clinically.
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              Comparison of the clinical diagnosis of diabetic macular edema with diagnosis by optical coherence tomography.

              To compare the diagnosis of diabetic macular edema (DME) by stereoscopic slit-lamp biomicroscopic examination of the fundus with a 78-diopter noncontact lens with diagnosis by optical coherence tomography (OCT). Prospective, double-masked, noninterventional diagnostic study. Analysis of slit-lamp biomicroscopic findings compared with OCT measurements. Patients with DME from a private retina practice. Presence or absence of macular thickening. The reference range for this clinic was comparable to reference ranges published from other clinics. The clinical detection of DME was less than detection by OCT. Chance-corrected agreements (kappa statistic) of the 2 methods were 0.63 for the foveal zone and 0.36 to 0.42 for the 4 parafoveal zones. The errors committed in clinical examination were primarily of the type in which clinical examination did not detect DME but OCT did (58%-90%) for the 5 zones analyzed. Reference ranges for OCT seem to be similar for different clinical settings, suggesting the usefulness of OCT in multicenter studies. The current standard of care for DME detection, stereoscopic slit-lamp examination of the fundus, is less sensitive than OCT for detection of DME. Because the principal therapy for DME, focal laser photocoagulation, is mainly sight preserving and not sight restoring, the wider use of OCT may beneficially impact visual disability from DME.

                Author and article information

                S. Karger AG
                April 2005
                24 March 2005
                : 219
                : 2
                : 86-92
                Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
                83266 Ophthalmologica 2005;219:86–92
                © 2005 S. Karger AG, Basel

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                Page count
                Figures: 6, Tables: 1, References: 25, Pages: 7
                Original Paper


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