Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Ophthalmology. 2012 May;119(5):1047-55. doi: 10.1016/j.ophtha.2011.10.030. Epub 2012 Feb 11.
To study the characteristics of the reflectivity of the cystoid spaces and serous retinal detachment (SRD) on spectral-domain optical coherence tomography (SD-OCT) and the correlation with fluorescein findings in diabetic macular edema (DME).
Retrospective, observational, cross-sectional study.
Consecutive 134 eyes of 114 patients with clinically significant macular edema for whom SD-OCT and fluorescein angiography (FA) were performed on the same day.
Fluorescein angiography using Heidelberg Retina Angiograph 2 (Heidelberg Engineering, Heidelberg, Germany) and OCT images using Spectralis OCT (Heidelberg Engineering) were obtained. The reflectivity of the cystoid spaces and SRD on the OCT images was evaluated qualitatively and quantitatively and compared with the fluorescein pooling intensity on FA images.
The relationship between the fluorescein pooling and the reflectivity characteristics of the cystoid spaces on SD-OCT images.
A total of 141 cystoid spaces in 101 eyes were delineated on OCT images, and 138 spaces (97.9%) had fluorescein pooling. Fifty-five cystoid spaces (39.9%) with marked fluorescein pooling intensity had lower reflectivity on OCT images than those with modest pooling (12.1±10.4 vs. 22.0±15.4, P < 0.001). The heterogeneity of the reflectivity of the cystoid spaces on the OCT images was associated significantly (P < 0.001) with modest fluorescein pooling. The hyperreflective foci in the cystoid spaces were correlated significantly with modest fluorescein pooling and higher or heterogeneous reflectivity on OCT images (P < 0.001, P < 0.001, and P=0.005, respectively). In addition, the cystoid spaces with microaneurysms had higher or heterogeneous reflectivity on OCT images more frequently than those without microaneurysms (P < 0.001 and P=0.019, respectively). The reflectivity levels in the SRD were significantly (P=0.005) lower than in the cystoid spaces, and only 1 eye (3.3%) had heterogeneous reflectivity on OCT images.
The results provided a novel interpretation of fluorescein pooling and OCT characteristics of cystoid spaces and SRD in DME and suggested several mechanisms by which the blood-retinal barrier is disrupted and concomitant edematous changes develop.
研究频域光相干断层扫描（SD-OCT）中囊性空间和浆液性视网膜脱离（SRD）的反射率特征，并与糖尿病性黄斑水肿（DME）中的荧光素发现相关联。
回顾性、观察性、横断面研究。
连续纳入 114 例 134 只临床显著黄斑水肿患者的 134 只眼，这些患者同一天接受了 SD-OCT 和荧光素血管造影（FA）检查。
使用海德堡视网膜血管造影仪 2 型（Heidelberg Engineering，海德堡，德国）进行荧光素血管造影，使用 Spectralis OCT（海德堡工程）获取 OCT 图像。对 OCT 图像上的囊性空间和 SRD 的反射率进行定性和定量评估，并与 FA 图像上的荧光素积聚强度进行比较。
FA 上的荧光素积聚与 SD-OCT 图像上的囊性空间反射率特征之间的关系。
在 OCT 图像上共描绘了 101 只眼中的 141 个囊性空间，其中 138 个（97.9%）有荧光素积聚。55 个（39.9%）具有明显荧光素积聚强度的囊性空间在 OCT 图像上的反射率低于中度积聚的空间（12.1±10.4 与 22.0±15.4，P<0.001）。囊性空间 OCT 图像上反射率的异质性与中度荧光素积聚显著相关（P<0.001）。囊性空间中的高反射性灶与中度荧光素积聚和 OCT 图像上的高反射率或异质性反射率显著相关（P<0.001，P<0.001 和 P=0.005，分别）。此外，有微动脉瘤的囊性空间在 OCT 图像上更常出现高反射率或异质性反射率，而非微动脉瘤的囊性空间（P<0.001 和 P=0.019，分别）。SRD 的反射率水平显著低于囊性空间（P=0.005），仅有 1 只眼（3.3%）在 OCT 图像上呈现异质性反射率。
这些结果为 DME 中囊性空间和 SRD 的荧光素积聚和 OCT 特征提供了新的解释，并提出了几种血视网膜屏障被破坏和伴随的水肿性改变发生的机制。
