Association between perifoveal hyperfluorescence and serous retinal detachment in diabetic macular edema

Abstract

Purpose: Diabetic macular edema (DME) has three major patterns of pathomorphology; cystoid macular edema (CME), serous retinal detachment (SRD), and sponge-like retinal swelling. However, it remains ill-defined how SRD develops in DME. Here we investigated how SRD is related to hyperfluorescence.

Methods: Consecutive 91 eyes of 69 patients with center-involved DME on whom fluorescein angiography (FA) image and optical coherence tomography (OCT) images were obtained by HRA2 and Spectralis (Heidelberg Engineering) respectively were included in this study. We first calculated the relative fluorescein leakage. Briefly, the mean fluorescein intensity in individual sectors in Early Treatment Diabetic Retinopathy Study (ETDRS) grid was measured in fluorescein angiography (FA) images. The mean intensity in the late phase was corrected using that in the early phase and the the fluorescein intensity of major vessels. We then investigated the association between fluorescein intensity in individual sector and foveal pathomorphology in OCT images.

Results: Eyes with SRD had significantly higher fluorescein intensity in the nasal or inferior quadrant of the parafovea (1-3mm) than those without SRD (p<0.001 or p=0.014), whereas fluorescein intensity in the superior or temporal quadrant did not differ. Further, fluorescein leakage in the nasal, superior, and inferior subfield of the perifovea (3-6mm) was more severe in eyes with SRD than those without SRD (p=0.002, p<0.001, and p<0.001, respectively). However, there were no differences in fluorescein intensity in any quadrants of the perifovea between eyes with CME and those without CME.

Conclusions: The relationship between foveal SRD and fluorescein leakage suggests the pathogenesis of SRD in DME.

Keywords: 499 diabetic retinopathy • 550 imaging/image analysis: clinical