Panozzo Giacomo, Cicinelli Maria Vittoria, Augustin Albert J, Battaglia Parodi Maurizio, Cunha-Vaz Josè, Guarnaccia Giuseppe, Kodjikian Laurent, Jampol Lee Merrill, Jünemann Anselm, Lanzetta Paolo, Löwenstein Anat, Midena Edoardo, Navarro Rafael, Querques Giuseppe, Ricci Federico, Schmidt-Erfurth Ursula, Silva Rufino Martins da, Sivaprasad Sobha, Varano Monica, Virgili Gianni, Bandello Francesco
Istituto Clinico Sant'Anna, Brescia, Italy.
Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Eur J Ophthalmol. 2020 Jan;30(1):8-18. doi: 10.1177/1120672119880394. Epub 2019 Nov 12.
To present an authoritative, universal, easy-to-use morphologic classification of diabetic maculopathy based on spectral domain optical coherence tomography.
The first draft of the project was developed based on previously published classifications and a literature search regarding the spectral domain optical coherence tomography quantitative and qualitative features of diabetic maculopathy. This draft was sent to an international panel of retina experts for a first revision. The panel met at the European School for Advanced Studies in Ophthalmology headquarters in Lugano, Switzerland, and elaborated the final document.
Seven tomographic qualitative and quantitative features are taken into account and scored according to a grading protocol termed TCED-HFV, which includes foveal thickness (T), corresponding to either central subfoveal thickness or macular volume, intraretinal cysts (C), the ellipsoid zone (EZ) and/or external limiting membrane (ELM) status (E), presence of disorganization of the inner retinal layers (D), number of hyperreflective foci (H), subfoveal fluid (F), and vitreoretinal relationship (V). Four different stages of the disease, that is, early diabetic maculopathy, advanced diabetic maculopathy, severe diabetic maculopathy, and atrophic maculopathy, are based on the first four variables, namely the T, C, E, and D. The different stages reflect progressive severity of the disease.
A novel grading system of diabetic maculopathy is hereby proposed. The classification is aimed at providing a simple, direct, objective tool to classify diabetic maculopathy (irrespective to the treatment status) even for non-retinal experts and can be used for therapeutic and prognostic purposes, as well as for correct evaluation and reproducibility of clinical investigations.
基于频域光学相干断层扫描技术，提出一种权威、通用且易于使用的糖尿病性黄斑病变形态学分类方法。
该项目的初稿是基于先前发表的分类以及关于糖尿病性黄斑病变频域光学相干断层扫描定量和定性特征的文献检索而制定的。此初稿被发送给一个国际视网膜专家小组进行首次修订。该小组在瑞士卢加诺的欧洲高级眼科学研究院总部召开会议，并精心制定了最终文件。
考虑了七个断层扫描的定性和定量特征，并根据一种名为TCED - HFV的分级方案进行评分，该方案包括黄斑中心凹厚度（T），对应于中心凹下视网膜厚度或黄斑体积、视网膜内囊肿（C）、椭圆体带（EZ）和/或外界膜（ELM）状态（E）、视网膜内层结构紊乱的存在（D）、高反射灶数量（H）、黄斑中心凹下积液（F）以及玻璃体视网膜关系（V）。该疾病的四个不同阶段，即早期糖尿病性黄斑病变、晚期糖尿病性黄斑病变、重度糖尿病性黄斑病变和萎缩性黄斑病变，基于前四个变量，即T、C、E和D。不同阶段反映了疾病的逐渐严重程度。
特此提出一种新的糖尿病性黄斑病变分级系统。该分类旨在提供一种简单、直接、客观的工具，即使对于非视网膜专家也能对糖尿病性黄斑病变进行分类（无论治疗状态如何），并且可用于治疗和预后目的，以及临床研究的正确评估和可重复性。
