Abstract
Purpose: :
To evaluate the potential use of optical coherence tomography (OCT) versus fluorescein angiogram for the diagnosis of post–operative cystoid macular edema (CME) in diabetic and non–diabetic patients.
Methods: :
Patients who were scheduled to undergo uncomplicated phacoemulsification were divided into diabetic and non–diabetic categories. All patients underwent macular evaluation with a 90–D lens at the slit lamp to exclude those patients with clinically significant macular edema. Patients with obvious clinically significant diabetic macular edema were excluded from the study. When possible, included patients underwent preoperative examination of the macula by fluorescein angiogram and OCT. All included patients underwent post–operative examination of the macula at one month by fluorescein angiogram and OCT.
Results: :
Eleven patients were evaluated in the study. There were five diabetic patients and six non–diabetic patients. All eleven patients underwent a post–operative OCT and fluorescein angiogram evaluation. These studies were performed at the four week post–operative visit. Four patients underwent a preoperative OCT for comparision. There were six patients who were noted to have evidence of angiographic CME. Four of these six patients were diabetics. The mean post–operative central macular thickness in these six patients was 261 um. The range of thickness in these patients was from 143 um to 464 um. The mean post–operative central macular thickness in patients without signs of angiographic CME was 184 um. The range of thickness in these patients was from 143 um to 282 um. The mean post–operative central macular thickness of the diabetic patients was 284 um. Three of six diabetic patients had signs of macular hemmorhages and exudates consistent with diabetic retinopathy. The mean post–operative central macular thickness of the non–diabetic patients was 177 um.
Conclusions: :
There is a potential benefit in diabetic patients in undergoing a preoperative OCT to document the pre–operative macular thickness. More specifically, our results suggest the OCT is a reliable first–line evaluation for post–operative CME. Our results also suggest that OCT alone is not adequate to evaluate post–operative CME in diabetic patients. Some patients may have a thickened macula from their diabetic history, which will give the false suggestion of CME. In addition, fluorescein angiogram results often show findings of diabetic macular edema that may limit the success of conventional treatment for post–operative CME.
Keywords: treatment outcomes of cataract surgery • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • diabetic retinopathy