Lima-Gómez V, Razo Blanco-Hernández DM

Language: Spanish
References: 30
Page: 109-114
PDF size: 224.93 Kb.

ABSTRACT

Background: The tomographic cut-off point to detect macular edema uses an international reference of retinal thickness, which is greater than that in our population. We undertook this study to identify the expected value of central subfield mean thickness (CSMT) in Mexican patients with diabetes with clinically significant macular edema (CSME) and the proportion in which using only the tomographic cut-off point for clinical macular edema (›300 µm) could overlook the diagnosis.
Methods: We carried out an observational, analytical, crosssectional and prospective study. Eyes of diabetic patients with CSME (January 2006-June 2007) with a fluorescein angiography and optical coherence tomography were included. The sample was divided according to angiographic type: monofocal (group 1), multifocal (group 2), or diffuse (group 3). The mean of CSMT of each group was weighed by the proportion represented by each group to calculate the all-type expected value. The proportion of eyes with CSMT ≤300 µm was identified.
Results: Ninety three eyes were included. Mean age was 60.9 years; there were 57 females (61.3%). Forty one eyes were assigned to group 1 (44.1%, CSMT 210.63 µm), 31 to group 2 (33.3%, CSMT 279.65 µm), and 21 to group 3 (22.6%, CSMT 327.14 µm). The expected value of CSMT was 259.9 µm, 37.75% over the normal reference in the study population and 23% over the American reference. CSMT was ‹300 µm in 79.6% of the eyes (95% CI 71.4-87.8).
Conclusions: The expected value of CSMT in Mexican patients with diabetes with CSME was within the range internationally regarded as subclinical. Using local references of CSMT is recommended to avoid overlooking the diagnosis of CSME and overestimating its treatment effect.

REFERENCES

1. Klein R, Knudtson MD, Lee KE, Gangnon R, Klein BE. The Wisconsin Epidemiologic Study of Diabetic Retinopathy XXIII: the twenty-five-year incidence of macular edema in persons with type 1 diabetes. Ophthalmology 2009;116:497-503.

2. Varma R, Choudhury F, Klein R, Chung J, Torres M, Azen SP. Fouryear incidence and progression of diabetic retinopathy and macular edema: the Los Angeles Latino Eye Study. Am J Ophthalmol 2010;149:752-761.

3. Asociación Mexicana de Retina, Sociedad Mexicana de Oftalmología, Asociación Panamericana de Oftalmología. Resultados del día Panamericano de detección de retinopatía diabética (3 de julio de 1999, día D). Rev Mex Oftalmol 2005;798:88-92.

4. Bhagat N, Grigorian RA, Tutela A, Zarbin MA. Diabetic macular edema: pathogenesis and treatment. Surv Ophthalmol 2009;54:1-32.

5. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol 1985;103:1796-1806.

6. Voo I, Mavrofrides EC, Puliafito CA. Clinical applications of optical coherence tomography for the diagnosis and management of macular diseases. Ophthalmol Clin North Am 2004;17:21-31.

7. Polito A, Del Borrello M, Isola M, Zemella N, Bandello F. Repeatability and reproducibility of fast macular thickness mapping with Stratus optical coherence tomography. Arch Ophthalmol 2005;123:1330-1337.

8. Browning DJ, Glassman AR, Aiello LP, Bressler NM, Bressler S, Danis RP, et al. Optical coherence tomography measurements and analysis methods in optical coherence tomography studies of diabetic macular edema. Ophthalmology 2008;115:1366-1371.e1.

9. Chan A, Duker JS, Ko TH, Fujimoto JG, Schuman JS. Normal macular thickness measurements in healthy eyes using Stratus optical coherence tomography. Arch Ophthalmol 2006;124:193-198.

10. Virgili G, Menchini F, Dimastrogiovanni AF, Rapizzi E, Menchini U, Bandello F, et al. Optical coherence tomography versus stereoscopic fundus photography or biomicroscopy for diagnosing diabetic macular edema: a systematic review. Invest Ophthalmol Vis Sci 2007;48:4963-4973.

11. Campbell RJ, Coupland SG, Buhrmann RR, Kertes PJ. Optimal optical coherence tomography-based measures in the diagnosis of clinically significant macular edema. Retinal volume vs foveal thickness. Arch Ophthalmol 2007;125:619-623.

12. Goebel W, Franke R. Retinal thickness in diabetic retinopathy: comparison of optical coherence tomography, the retinal thickness analyzer, and fundus photography. Retina 2006;26:49-57.

13. Alasil T, Keane PA, Updike JF, Dustin L, Ouyang Y, Walsh AC, et al. Relationship between optical coherence tomography retinal parameters and visual acuity in diabetic macular edema. Ophthalmology 2010;117:2379-2386.

14. Brown JC, Solomon SD, Bressler SB, Schachat AP, DiBernardo C, Bressler NM. Detection of diabetic foveal edema: contact lens biomicroscopy compared with optical coherence tomography. Arch Ophthalmol 2004;122:330-335.

15. Browning DJ, Fraser CM. The predictive value of patient and eye characteristics on the course of subclinical diabetic macular edema. Am J Ophthalmol 2008;145:149-154.e3.

16. Scott IU, Danis RP, Bressler SB, Bressler NM, Browning DJ, Qin H. Effect of focal/grid photocoagulation on visual acuity and retinal thickening in eyes with non-center-involved clinically significant diabetic macular edema. Retina 2009;29:613-617.

17. Kim NR, Kim YJ, Chin HS, Moon YS. Optical coherence tomographic patterns in diabetic macular oedema: prediction of visual outcome after focal laser photocoagulation. Br J Ophthalmol 2009;93:901-905.

18. Browning DJ, Miller KM, Aiello LP, Beck RW, Bressler NM, Davis MD, et al. The course of response to focal/grid photocoagulation for diabetic macular edema. Retina 2009;29:1436-1443.

19. Lammer J, Scholda C, Prünte C, Benesch T, Schmidt-Erfurth U, Bolz M. Retinal thickness and volume measurements in diabetic macular edema: a comparison of four optical coherence tomography systems. Retina 2011;31:48-55.

20. Fernández-Muñoz EL, Leiazola-Fernández C, Quiroz-Mercado H. Correlación morfológica y funcional en edema macular diabético. Rev Mex Oftalmol 2007;81:65-70.

21. Lima-Gómez V, Osornio-Castro NA. Comparación del grosor retiniano en diabéticos sin retinopatía, con y sin fondo coroideo. Rev Mex Oftalmol 2006;80:301-305.

22. Sadda SR, Wu Z, Walsh AC, Richine L, Dougall J, Cortez R, et al. Errors in retinal thickness measurements obtained by optical coherence tomography. Ophthalmology 2006;113:285-293.

23. Bhavsar KV, Subramanian ML. Risk factors for progression of subclinical diabetic macular oedema. B J Ophthalmol 2011;95 (in press).

24. Kang SW, Park CY, Ham DI. The correlation between fluorescein angiographic and optical coherence tomographic features in clinically significant diabetic macular edema. Am J Ophthalmol 2004;137:313-322.

25. Danis RP, Scott IU, Quin H, Altaweel MM, Bressler NM, Bressler SB, et al. Association of fluorescein angiographic features with visual acuity and with optical coherence tomographic and stereoscopic color fundus photographic features of diabetic macular edema in a randomized clinical trial. Retina 2010;30:1627-1637.

26. Muquit MMK, Gray JCB, Marcellino GR, Henson DB, Young LB, Patton N, et al. Barely visible 10-millisecond Pascal laser photocoagulation for diabetic macular edema: observations of clinical effect and burn localization. Am J Ophthalmol 2010;149:979-986.

27. Asefzadeh B, Cavallerano AA, Fisch BM. Racial differences in macular thickness in healthy eyes. Optom Vis Sci 2007;84:941-945.

28. Kelty PJ, Payne JF, Trivedi RH, Kelty J, Bowie EM, Burger BM. Macular thickness assessment in healthy eyes based on ethnicity using Stratus OCT optical coherence tomography. Invest Ophthalmol Vis Sci 2008;49:2668-2672.

29. Kashani AH, Zimmer-Galer IE, Shah SM, Dustin L, Do DV, Elliot D, et al. Retinal thickness analysis by race, gender and age using Stratus OCT. Am J Ophthalmol 2010;149:496-502.

30. El-Ashry M, Hegde V, James P, Pagliarini S. Analysis of macular thickness in British population using optical coherence tomography (OCT): an emphasis on interocular symmetry. Curr Eye Res 2008;33:693-699.