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S. G. Coupland, D. Al-Breiki, B. Hurley, B. C. Leonard, J. Brownstein, F. Noei; Sensitivity and Specificity of Functional Correlates in Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3257.
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Diabetic macular edema (DME) is associated with the breakdown of the blood-retinal barrier and subsequent increase in retinal volume and hence retinal thickness. Microperimetry (MP) has previously been used to investigation retinal sensitivity in DME. Multifocal electroretinography (mERG) can also provide objective quantification of electroretinal function from within the macular region. This investigation compared sensitivity and specificity of MP and mERG in detecting retinal thickness in DME.
75 eyes of 43 diabetic patients with cystoid macular edema or CSME were investigated. Retinal thickness and MP was measured using a OCT/SLO-7 system (OPKO/OTI Instruments). A 3.5 mm CSME grid was superimposed on the macular thickness map to calculate mean retinal thickness from 9 sectors within the central 10°. MP was measured with the polar three pattern within the central 10°, with a Goldman size III 200 msec stimulus presented at 1-second interval and a 4-2 staircase strategy. Mean retinal sensitivity was determined from 9 sectors within the central 10°. Multifocal ERG (Veris-EDI) was recorded using a 61 hexagonal stimulus using a combined fundus imaging/stimulator system. Mean mERG response amplitude of the P1 component was calculated from those mERGs falling with the central 10°.
Retinal sensitivity as measured by MP was significantly inversely correlated with retinal thickness (p =0.02). The P1 amplitude of the mERG was also found to be inversely correlated with retinal thickness (p <0.01). In those patients with severe retinal thickening (>375 microns) MP was found to have a sensitivity of 0.80 and specificity of 0.64. The mERG was found to have a sensitivity of 0.85 and specificity of 0.67 in those same patients.
MP and mERG provide objective functional assessment of retinal sensitivity and electroretinal function that was significantly correlated with retinal thickness in patients with DME. Both functional measures have sufficient sensitivity and specificity to have clinical utility in the diagnosis and treatment of patients with DME.
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