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L. Yeung, V. C. Lima, P. Garcia, G. Landa, R. B. Rosen; Loss of Inner Retinal Layers on Spectral Domain Optical Coherence Tomography Associated With Capillary Non-Perfusion on Fluorescein Angiography in Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1319.
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To evaluate the relationship between loss of inner retinal layers detected by Spectral Domain Optical Coherence Tomography (SD-OCT) imaging and the fluorescein angiography (FA) appearance in patients with diabetic macular edema (DME).
Retrospective, observational study. Seventy eyes from 59 patients with DME that had SD-OCT/scanning laser ophthalmoscopy (SLO) and FA performed on the same day were included in this study. The SLO image of the OPKO-OTI Spectral OCT/SLO (OPKO-OTI, Miami, Florida) corresponds to the exact origin and orientation of the SD-OCT scan. Relationship between SD-OCT and FA findings was evaluated by superimposing and aligning the SLO images onto the patient’s FA photos.
Loss of inner retinal layers in SD-OCT images was detected in 17 (24.6%) eyes. These eyes demonstrated both normal or increased retinal thickness. Capillary non-perfusion within the corresponding area on FA was present in 14 of 17 eyes. Loss of retinal layers on SD-OCT correlated highly with capillary non-perfusion demonstrated by FA (r=0.953, p<0.001). The other 3 eyes contained diffuse laser scars highlighted by FA. The appearance of the photoreceptor layer by SD-OCT was helpful for distinguishing between the two different causes of inner retinal layer loss. The hyper-reflective layer which identifies the inner / outer segment junction of photoreceptors appears preserved in SD-OCT images in capillary non-perfusion, while this line is typically lost in areas of fibrotic laser scars.
Loss of inner retinal layers appears to be a specific SD-OCT sign predictive of capillary non-perfusion, except in areas of the retina with diffuse scaring due to fibrosis or laser photocoagulation. This correlates well with the previous observation that preservation of inner retinal layers on OCT is a positive prognostic factor for eyes with DME.
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