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Qisheng You, kotaro tsuboi, Yukun Guo, Christina J Flaxel, Steven Bailey, David Huang, Yali Jia, Thomas S Hwang; Automated central macular fluid volume as a treatment indication for diabetic macular edema. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2451.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the value of automated central macular fluid volume (CMFV) as treatment indication for diabetic macular edema (DME).
In this retrospective observational study, we consecutively enrolled adult diabetic patients who underwent comprehensive clinical examinations, 6x6-mm horizontal 19-line macular structural optical coherence tomography (OCT) raster scans (Spectralis, Heidelberg), and 6x6-mm macular OCT angiography (OCTA) volumetric scans (Avanti, OptoVue) at the baseline enrollment visit. Two retinal specialists reviewed the baseline raster OCT scans independently and diagnosed center-involved DME if intraretinal or subretinal fluid was detected with 1-mm of the foveal center. A third retinal specialist arbitrated any discrepancy. Mean central macular thickness (CMT) within the 1-mm circle was measured on Spectralis OCT scans using the embedded software. A deep-learning algorithm automatically quantified fluid volumes within the central 1-mm circles (CMFV) on the OCTA scans. All patients with DME were treated per standard of care.
We enrolled one eye for each of 215 diabetic patients (98 men) with a mean age of 60 years. Center-involved DME was diagnosed in 93 eyes. The area under the receiver operating characteristic curve (AROC) of CMFV for diagnosis of center-involved DME was 0.907 with a sensitivity of 78.5% at the specificity of 95%. Forty-eight eyes with center-involved DME underwent anti-VEGF injections at the enrollment visit, among whom 34 (71%) eyes fulfilled the DRCR.net treatment criteria (CMT ≥320mm in male or CMT≥305mm in female). Among the 14 treated eyes who were missed according to DRCR.net criteria, 6 (43%) of them would have been diagnosed as center-involved DME, and indicated a treatment, according to the CMFV. Four of these six eyes underwent focal laser treatment previously. Both CMFV and CMT were significantly correlated with best-corrected visual acuity (r=-0.303, P<0.001, and r=-0.339, P<0.001, respectively).
CMFV may be a useful biomarker for DME treatment decisions, particularly for those eyes previously treated with focal laser. A cohort study is indicated to assess the treatment response of CMFV.
This is a 2021 ARVO Annual Meeting abstract.
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