Yalçın Gökçen, Özdek Şengül, Baran Aksakal Fatma Nur
Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
Gazi University Faculty of Medicine, Department of Public Health, Ankara, Turkey
Turk J Ophthalmol. 2019 Dec 31;49(6):315-322. doi: 10.4274/tjo.galenos.2019.22687.
To describe cystoid macular degeneration (CMD), which has no clear definition in diabetic macular edema (DME), and examine its features in optical coherence tomography (OCT) and fundus fluorescein angiography (FFA).
This study was conducted using OCT images of patients who were followed in Gazi University between November 2011 and March 2015. A total of 259 eyes (187 patients) found to have cystic changes on OCT were included. Macular ischemia, peripheral ischemia, and type of edema were identified on FFA. Vitreomacular interface abnormalities, foveal contour integrity, internal reflectivity of the cysts, and outer retinal layer defects were analyzed from OCT images. The horizontal and vertical diameters of the largest cyst within 1000 μm of the foveal center were measured for the definition of CMD. Cut-offs for these values were determined by receiver operating characteristic curve analysis. Cystoid macular edema (CME) and CMD groups were created and their characteristics were analyzed.
The horizontal and vertical diameters of the largest cyst were moderately positively correlated with visual acuity (rs=0.349, r=0.419, respectively). Eyes with horizontal diameter of the largest cyst ≥450 μm were classified as CMD; in this group, sensitivity in the prediction of visual acuity ≤20/60 was 58%. Eyes with horizontal diameter of the largest cyst <450 μm were classified as CME; in this group, specificity in the prediction of visual acuity >20/60 was 73%. For the threshold of 300 μm determined for vertical diameter of the largest cyst, sensitivity was 62% and specificity was 69%. The CME and CMD groups were formed according to these cut-off values. Compared to the CME group, the CMD group had greater central subfield thickness and higher prevalence of outer retinal damage, severe disruption of foveal contour, macular ischemia, and diffuse/mixed type edema.
In eyes with DME, CMD can be defined as the largest cyst within 1000 μm of the foveal center having a horizontal diameter of ≥450 μm and vertical diameter ≥300 μm, especially if associated with macular ischemia, outer retinal damage, loss of foveal contour, and diffuse/mixed type edema.
描述在糖尿病性黄斑水肿（DME）中尚无明确定义的黄斑囊样变性（CMD），并在光学相干断层扫描（OCT）和眼底荧光血管造影（FFA）中检查其特征。
本研究使用2011年11月至2015年3月在加齐大学随访的患者的OCT图像。总共纳入了259只眼（187例患者），这些眼在OCT上发现有囊性改变。在FFA上确定黄斑缺血、周边缺血和水肿类型。从OCT图像分析玻璃体黄斑界面异常、黄斑中心凹轮廓完整性、囊肿的内部反射率和外层视网膜缺损。测量黄斑中心凹中心1000μm范围内最大囊肿的水平和垂直直径以定义CMD。通过受试者工作特征曲线分析确定这些值的截断值。创建黄斑囊样水肿（CME）和CMD组并分析其特征。
最大囊肿的水平和垂直直径与视力呈中度正相关（rs分别为0.349和r为0.419）。最大囊肿水平直径≥450μm的眼被分类为CMD；在该组中，预测视力≤20/60的敏感度为58%。最大囊肿水平直径<450μm的眼被分类为CME；在该组中，预测视力>20/60的特异度为73%。对于最大囊肿垂直直径确定的300μm阈值，敏感度为62%，特异度为69%。根据这些截断值形成CME和CMD组。与CME组相比，CMD组有更大的中心子野厚度以及更高的外层视网膜损伤患病率、黄斑中心凹轮廓严重破坏、黄斑缺血和弥漫/混合型水肿。
在DME眼中，CMD可定义为黄斑中心凹中心1000μm范围内最大囊肿的水平直径≥450μm且垂直直径≥300μm，特别是如果伴有黄斑缺血外层视网膜损伤、黄斑中心凹轮廓丧失和弥漫/混合型水肿。
