Abstract
Abstract: :
Purpose: To assess optical coherence tomographic (OCT) characteristics of eyes with persistent DME despite at least one laser treatment and compare these to other standard methods of ocular evaluation. Methods: 50 eyes with persistent DME after at least one focal laser treatment were prospectively enrolled and assessed by OCT. Fluorescein angiograms (especially leakage patterns: focal vs. diffuse), stereo fundus photographs, and clinical examinations were correlated with OCT. Results: Mean age in the study was 68 years (range 57–83). Mean VA was 20/100 (20/40–20/400). Mean number of previous focal treatments was 2.8 (1–7). At the time of abstract submission, scans of 27 eyes had been fully analyzed. Characteristics identified included intraretinal fluid: 89% (24/27), subretinal fluid 7% (2/27), shallow macular detachment 11% (3/27), and PVD 11% (3/27). Foveolar thickness, foveal thickness, and mass area were calculated. Interestingly, 52% (14/27) of eyes demonstrated anomalous vitreomacular interfaces which includes vitreal adhesions only (2/27), definite ERMs only (7/27), or both (5/27). An additional 15% had questionable ERMs only (3/27) or questionable vitreal adhesions only (1/27). OCT was statistically significantly more effective at detecting vitreomacular interface abnormalities (VMIA) than clinical examination, fundus photographs or FA (p=0.01). No significant correlation could be identified between prevalence of VMIA and either number of previous laser treatments (p=1.00) or fluorescein angiographic leakage pattern (focal vs. diffuse, p=0.29). Conclusions: Eyes with persistent DME are increasingly considered for alternative surgical or pharmacologic therapies. This prospective study found that OCT identified a high prevalence of VMIAs in these eyes, significantly more than clinical exam, photos or FA. This suggests an independent role for this imaging modality in elucidating the pathobiology of persistent DME, critically evaluating studies (previously published and future) addressing its treatment, and in the design of clinical trials. In such patients, treatment options directed at correcting VMIAs may be worthwhile.
Keywords: diabetic retinopathy • imaging/image analysis: clinical • macula/fovea