Murali, M (2008) Optical coherence tomographic features of macular pathologies in diabetic retinopathy. Masters thesis, Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli.
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Abstract
INTRODUCTION: High resolution cross sectional imaging of retina is useful for identifying ,monitoring and quantitatively assessing macular disease . Optical Coherence Tomography (OCT) Is a new medical diagnostic imaging technology which can perform high resolutional cross sectional tomographic imaging in biological tissues. Cross sectional images of retina are obtained at the resolution 10 microns. OCT uses low coherence or white light interferometry to perform high resolutional measurements and imaging. The infra red light beam has a wave length of 820nm Macular pathologies in diabetic retinopathy consists of 1) Macular edema which may be localized , diffuse , CSME and ischemic which may show on OCT as (a) Sponge like thickening (b) Cystoid macular edema (c) Subfoveal serous detachment (d) Taut posterior hyaloid membrane (e) Foveal tractional retinal detachment OCT offers an objective method for qualitative identification and quantitatively monitoring and evaluation of patients with diabetic maculopathy which are not seen clinically and by FFA AIM OF THE STUDY: To study the OCT features of various macular pathologies in diabetic retinopathy. To compare these features with clinical features and fundus fluorescein angiographic features. To compare foveal thickness by OCT with visual acuity. To quantitatively monitoring the response by measuring the foveal thickness by OCT in various types of diabetic macular pathologies after Intra vitreal triamcinolone acetonide [IVTA] MATERIALS AND METHODS: Patients with diabetic maculopathy who presented to the Retina Clinic of Institute of Ophthalmology Joseph Eye Hospital Trichy between July 1st 2006 to June 30th 2007 are included in this study PATIENTS: Sixty three eyes of forty patients with diabetic retinopathy INCLUSION CRITERIA: All patients with clinical diagnosis of diabetic maculopathy whether NPDR or PDR EXCLUSIONCRITERIA: Patients with diabetic retinopathy NPDR or PDR with out maculopathy Patients with other causes of maculopathy METHODS: A standard protocol was used to collect and document all details regarding the cases included in this study RESULTS: In this prospective comparative case series study 63 eyes of 40 patients with diabetic maculopathy who presented at retina clinic of Institute of Ophthalmology Joseph Eye Hospital Trichy between July 1st 2006 to June 30th 2007 was included in this study GENDER : In this study there were 28 male (70%) and 12 female (30%) AGE : In this study the mean age was 57.75 years(range 35 to 70 years) and Maximum number of patients were in 51 to 60 yrs range 21 patients (52.7%), and 61 to 70 yrs 14 patients (35%) , and 41 to 50 yrs 2 patients (5%) ,and 31 to 40 yrs 3 patients (7.5%) TYPE OF DIABETES MELLITUS; In this study there were 37 patients with NIDDM (92.5%),and 3 patients with IDDM (7.5%). DURATION OF DIABETES MELLITUS: In this study duration of diabetes was 10 to 15 years in 28 patients (70%), and 5 to 10 yrs in 6 patients (15%), and less than 5 years in 6 patients (15%). ASSOCIATION WITH SYSTEMIC DISEASES: In this study Hypertension was associated with diabetes in 5 patients, and Nephropathy in 1 patient DISCUSSION: Optical coherence tomography is a novel, objective test for the qualitative and quantitative evaluation of patients with diabetic maculopathy who may not be so precisely evaluated clinically and by fundus fluorescein angiographically In this study 63 eyes of 40 patients were examined clinically, by FFA and by OCT . On comparison between them, OCT precisely delineated more types of maculopathy than clinically and by FFA and so OCT is a more sensitive method of diagnosis in diabetic maculopathy. This is similar to the study conducted by David J Browing et al (11,12) (Ophthalmology,2004. AJO 2005) in which they Showed 4 abnormalities (1) increased total macular volume (2) increased foveal zone thickness (3) increased inner parafoveal zone thickness and (4) increased outer parafoveal zone thickness. And so the diagnosis of diabetic macular edema by stereoscopic slit lamp biomicroscopic examination of fundus with diagnosis by OCT showed slit lamp diagnosis of DME is less sensitive than OCT. In this study on comparison between FFA findings and OCT findings, OCT showed more types of maculopathy and so OCT is a useful tool to diagnose the type of maculopathy and as an adjuvant to FFA. This is similar to the study conducted by SE WOONG KANG et al (13)(AJO FEB 2004) in which 145 eyes of 91 patients were categorized by FFA into 3 types ,focal leakage type ,diffuse leakage type, cystoid leakage type and by OCT into 4 types, Type 1-thickening with homogenous optical reflectivity, Type 2-thickening with markedly decreased optical reflectivity in outer retinal layer, Type 3a-foveolar detachment with out traction, Type 3b- foveolar detachment with traction and showed (a) The prevalence of OCT type 1 was higher in focal leakage type and diffuse leakage type than in cystoid leakage type (b) The prevalence of OCT type 2 and 3a was higher in cystoid leakage type than in focal and diffuse leakage type and they concluded that there was a correlation between features of FFA and OCT In this study there is no correlation between foveal thickness by OCT and visual acuity. In this study there is a definite increase in visual acuity after IVTA in all three groups but was statistically more significant in eyes with CME group. In this study there is a significant reduction in foveal thickness after treatment with IVTA for diabetic macular edema. The above three results are similar to the study conducted by JORGEN LARSSON et al (14) AJO APRIL 2005 in which they showed that 24 eyes with diabetic macular edema treated by IVTA had reduction in foveal thickness from mean of 462 +/- 154 microns to 257 +/- 114 microns ( p value < 0.0001)after 3 months and the log MAR average visual acuity increased from 60.5+/-10.5 to 65.5 +/-11.1 (p value =0.0001) 3 months after IVTA treatment. In this study eyes with CME group showed more improvement in visual acuity after IVTA than Sponge like thickening group and Sub foveal serous detachment group showed very little improvement In this study eyes with both CME group and Sponge like thickening group showed significant reduction in foveal thickness after IVTA. Sub foveal serous detachment group showed very little reduction in foveal thickness after IVTA. SUMMARY: In this prospective comparative study 63 eyes of 40 patients with Diabetic maculopathy were included. All underwent examination clinically, by FFA, and by OCT. Optical coherence tomography precisely showed four types of diabetic maculopathy (a) Cystoid macular edema 32 eyes (b) Sponge like thickening 21 eyes (c) Subfoveal serous detachment 9 eyes (d) Foveal tract ional retinal detachment 1 eye, which were not seen clinically and by FFA. The foveal thickness was measured by OCT in all patients at presentation and intravitreal triamcinolone acetonide is given to 62 eyes (except one eye with vitreo macular traction for which the treatment is mainly surgical) and after 6 months foveal thickness measured by OCT. The foveal thickness in diabetic macular edema reduced after intravitreal triamcinolone acetonide. More significantly in Cystoid macular edema group and Sponge like thickening group than in subfoveal serous detachment group. There is no correlation between foveal thickness and visual acuity. But there is a increase in visual acuity after treatment with intravitreal triamcinolone acetonide. More significantly in Cystoid macular edema group. OCT with its high resolution imaging of retina has a role in diagnosis of different types of diabetic maculopathy and to monitor the thickness of fovea before and after treatment with intra vitreal triamcinolone acetonide. CONCLUSION: Optical Coherence Tomography a non contact, non invasive investigation is slowly emerging as an important diagnostic tool in differentiating various types of diabetic maculopathy. In comparison with clinical assessment and FFA it is definitely turning out to be a superior and more useful method of evaluating and monitoring Diabetic Maculopathy either as a single procedure and may be more useful when used in conjunction with fundus fluorescein angiography. OCT is a useful tool to quantitatively monitor the response of different diabetic macular pathologies to intra vitreal triamcinolone acetonide by measuring the pre treatment foveal thickness and post treatment foveal thickness and there is a significant reduction in foveal thickness after intra vitreal triamcinolone acetonide. There is no correlation between thickness of fovea measured by OCT and visual acuity. Option for surgical intervention in cases of Diabetic Maculopathy with macular traction and taut posterior hyaloid membrane depends mainly on the OCT images which will clearly delineate accurately.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Optical coherence tomographic features; macular pathologies; diabetic retinopathy |
| Subjects: | MEDICAL > Ophthalmology |
| Depositing User: | Devi S |
| Date Deposited: | 02 Jan 2018 07:56 |
| Last Modified: | 02 Jan 2018 07:56 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5061 |
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