Detection of Fovea-Threatening Diabetic Macular Edema by Optical Coherence Tomography to Maintain Good Vision by Prophylactic Treatment
Detection of Fovea-Threatening Diabetic Macular Edema by Optical Coherence Tomography to Maintain Good Vision by Prophylactic Treatment
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DOI：
10.1159/000362372
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发表时间：
2014-01-01
影响因子：
2.1
通讯作者：
Murata, Toshinori
中科院分区：
文献类型：
--
作者：
Hirano, Takao;Iesato, Yasuhiro;Murata, Toshinori
背景/目标：目的建立一种应用光谱域光学相干断层扫描（SD-OCT）筛查和治疗威胁黄斑中心凹的糖尿病黄斑水肿（DME）的方法。为了保持良好的视力（VA），焦点/网格激光治疗筛选威胁黄斑中心凹的DME进行了评估的基础上产生的黄斑厚度图图像SD-OCT。方法：在66例糖尿病患者的眼睛没有视力下降，不使用散瞳剂检测威胁黄斑中心凹的DME的SD-OCT的敏感性和特异性进行了测定。在散瞳下，使用带接触透镜的裂隙灯生物显微镜进行DME的明确诊断。然后对威胁黄斑中心凹的DME患眼进行预防性局灶/格栅激光治疗。主要结果指标为矫正视力和黄斑中心厚度（CMT）。结果如下：在66只眼睛中，5只眼睛被明确诊断为DME，而11只眼睛检测到黄斑增厚超过第99百分位数（Cirrus（R））或13 5只威胁黄斑中心凹的DME患眼的焦点/网格激光治疗成功地保持了良好的VA，为0.91 +/- 0.76（平均值：20/22; 0.04 +/- 0.12 logMAR），治疗后1年为0.89 +/- 0.70（平均值：20/22; 0.05 +/- 0.15 logMAR; p = 0.88）。焦点/网格激光照射前后的平均CMT分别稳定在302 +/- 29和329 +/- 55 μ m（p = 0.99）。结论：不使用散瞳剂，SD-OCT检测威胁黄斑中心凹的DME是可行的。预防性治疗，如局部/网格激光，可有效避免其他高度可能的中心凹受累，从而维持良好的VA。(C)2014年S. Karger AG，巴塞尔
Background/Aims: To establish a screening and treatment method for fovea-threatening diabetic macular edema (DME) using spectral-domain optical coherence tomography (SD-OCT). In order to maintain good visual acuity (VA), focal/grid laser treatment for screened fovea-threatening DME was evaluated based on macular thickness map images produced by SD-OCT. Methods: In 66 diabetic eyes with no visual deterioration, the sensitivity and the specificity of SD-OCT without the use of mydriatics for the detection of fovea-threatening DME were determined. A definite diagnosis of DME was made under mydriasis, using slitlamp biomicroscopy with a contact lens. Eyes with fovea-threatening DME then underwent prophylactic focal/grid laser treatment. The main outcome measures were corrected VA and central macular thickness (CMT). Results: A definitive diagnosis of DME was made in 5 of the 66 eyes, while macular thickening above the 99th percentile was detected in 11 (Cirrus (R)) or 13 (RS-3000 (R)) eyes by SD-OCT. The focal/grid laser treatment of the 5 eyes with fovea-threatening DME successfully maintained good VA, which was 0.91 +/- 0.76 (average: 20/22; 0.04 +/- 0.12 logMAR) before treatment and 0.89 +/- 0.70 (average: 20/22; 0.05 +/- 0.15 logMAR; p = 0.88) 1 year afterwards. The average CMT was stable before and after focal/grid lasering at 302 +/- 29 and 329 +/- 55 mu m, respectively (p = 0.99). Conclusions: The detection of fovea-threatening DME is feasible by SD-OCT without using mydriatics. Prophylactic treatment, such as with focal/grid lasers, was effective in maintaining good VA by avoiding an otherwise highly likely foveal involvement. (C) 2014 S. Karger AG, Basel