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Josef Pretzl, Siegfried Priglinger, Nicole Klaida, Matthias Bolz; Characterization of degenerative clinically significant diabetic macular edema. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4430.
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Aim of the study was to analyze and further characterize the sub-type of degenerative clinically significant diabetic macular edema in low vision patients.
71 eyes of 50 patients with clinically significant DME were examined with macular map OCT scans and fluorescence angiography using Spectralis HRA and OCT (Heidelberg Engineering©). Visual acuity was performed according to the ETDRS protocol (early treatment of diabetic retinopathy study) on the same day. All imaging data was evaluated by 2 readers according to a grading protocol abbreviated “SAVE” that was previously presented, whereas “S” stands for “subretinal fluid”, “A” for “area” (planimetric dimension), “V” for “vitreo-retinal abnormalities” and “E” for edema type (focal, non-focal, ischemic, degenerative). All data of low vision patients (visual acuity less than 6/18 and a history of chronic DME) were further analyzed in order to improve the definition of a degenerative DME.
There was a good inter-grader agreement regarding the graded categories of the SAVE grading protocol. Four characteristic findings could be identified in OCT that were typically seen in all low vision DME patients, either solely or in combination: 1. A disruption of the ellipsoid line in the central millimetre as a sign of a significant photo receptor alteration, 2. absence of Mueller cells usually visible as “pseudo-septae” between the cysts in DME, 3. atypical intra-retinal cyst disposition disregarding retinal layer architecture, 4. The presence of angled cysts.
Characteristic criteria were found further describing the sub-type of degenerative DME typically found in low vision patients. These findings can serve as a prognostic factor in DME patients in clinical routine, improve treatment decisions and can be used as inclusion or exclusion criteria in clinical trials.
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