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P.G. Massin, I. Zundane, A. Erginay, R. Benosman, M. Laloi–Michelin, C. Boutron, A. Suzanna, E. Vicaut, P.–J. Guillausseau, A. Gaudric; Spontaneous Evolution of Diabetic Macular Edema . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1470.
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Purpose: Macular edema (ME) is the main cause of visual impairment in diabetic patients. Few data on its spontaneous evolution in the short term are available, due to the absence, until recently, of an objective method of assessing macular thickness. Optical Coherence Tomography (OCT) now allows sensitive reproducible measurements of macular thickness. The aim of our study was therefore to investigate using OCT, the spontaneous evolution of diabetic ME in the short tem, and its possible correlation with changes in glycemia and blood pressure Methods: 23 diabetic patients (4 type 1 and 19 type 2), aged 29 to 75 years, with clinically significant diabetic ME involving the center of the macula, were included. Visual acuity using the ETDRS chart, and macular thickness using OCT were measured every two weeks, for 3 months. On one occasion, they were also measured 4 times on the same day. Glycemia and blood pressure were measured at each visit, and were also recorded continuously for 24 hours on one day Results: Mean central macular thickness was 384±117 (256–668) µm at baseline and the mean ETDRS score was 63±12. There was a siginificant correlation between macular thickness and visual acuity (p=0.0007).The mean variation in central macular thickness was 88±71 µm (range, 21–356) during the 3–month follow–up period, and 32.±20µm (8–87) when measured 4 times during the same day. The mean coefficients of variation of these two measurements were 9.2 (5.6–12.5) and 4.04 (3–5) respectively. Sixteen patients exhibited, at least once, a 10% variation relative to their median macular thickness during the 3–month follow–up period, and 3 patients did so relative to this thickness during the same day. No correlation was observed between changes in macular thickness and those in glycemia and blood pressure. Conclusions: This study demonstrates that ME fluctuates spontaneously with time. This spontaneous variability and its quantification are important for the design of clinical protocols for diabetic ME treatment using OCT to determine the efficacy of therapeutic agents
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