Mahdjoubi Amir, Bousnina Youcef, Bendib Fatma-Samia, Bensmaine Faiza, Idlefqih Wafa, Chahed Sadri, Ghezzaz Amina
Department of Ophthalmology, Centre Hospitalier Victor Dupouy, 69 Rue du Lieutenant-Colonel Prudhon, 95100, Argenteuil, France.
Department of Ophthalmology, Hôpital Simone Veil, Eaubonne, France.
Int J Retina Vitreous. 2021 Mar 6;7(1):19. doi: 10.1186/s40942-021-00289-6.
To evaluate the contribution of large-cube 30° × 25° optical coherence tomography (OCT) in the characterization of diabetic macular edema (DME) by assessing its extent and the presence of additional retinal edemas and to evaluate the factors that influenced their occurrence.
This retrospective study enrolled patients with diabetes who presented with retinal edema detected by horizontal large-cube 30° × 25° (8.7 × 7.3 mm) OCT. Two individualized areas were selected from the thickness map: the area within the 6-mm Early Treatment of Diabetic Retinopathy Study (ETDRS) grid, and that outside the ETDRS grid. Retinal edemas located within the ETDRS grid were designated as "main DME" and those located outside the ETDRS grid were designated as "peripheral retinal edemas." For each area, OCT features were assessed while the extent of the main DME and the presence of peripheral retinal oedema were analysed in the area outside the ETDRS grid. Finally, part of included eyes was followed by the same protocol, of which a part benefited from intravitreal injections.
Peripheral events were detected outside the ETDRS area in 279 eyes (74.4%) of the 375 eyes of the 218 patients included in this study: an extension of the main DME outside ETDRS grid in 177 eyes (47.2%) and/or the presence of peripheral retinal edemas in 207 eyes (55.2%). The analysis of associations between main DME and peripheral retinal edemas patterns did not find an association for retinal cyst localization (P = 0.42) while a week association was found fort cyst size (Cramer's V = 0.188, p = 0.028). Nevertheless, a moderate association was found for the presence of microaneurysms (Cramer's V = 0.247, p < 0.001) and strong association for hard exudates (Cramer's V = 0.386, p < 0.001), The binary logistic regression analysis retained the following influencing factors of the occurrence of peripheral events: advanced DR stage (Odds ratio OR = 2.19, p = 0.03), diffuse DME (OR = 7.76, p < 0.001) and its location in outer fields (OR = 7.09, p = 0.006). Likewise, the extension of the main DME outside the ETDRS area in was influenced by the same factors in addition to CMT (OR = 0.98, p = 0.004) while the presence of peripheral retinal edema was influenced by the same factors except the outer location of the Main DME. Finally, from the 94 eyes treated by intravitreal injections, extension of the main DME outside the ETDRS grid was detected in 54 eyes (56.44%) at baseline visit and still remained detectable in 37 eyes (39.36%) after treatment initiation.
Large-cube 30° × 25° OCT allowed for more precise assessment of DME extension and better detection of retinal thickening mainly in the advanced stages of diabetic retinopathy with significant DME whether at the baseline visit or during follow-up. The combination of this protocol with a wider ETDRS grid would enhance DME detection and topography.
通过评估大视野30°×25°光学相干断层扫描（OCT）在糖尿病性黄斑水肿（DME）特征描述中的作用，包括其范围以及是否存在额外的视网膜水肿，并评估影响其发生的因素。
本回顾性研究纳入了通过水平大视野30°×25°（8.7×7.3毫米）OCT检测出视网膜水肿的糖尿病患者。从厚度图中选择两个个体化区域：糖尿病视网膜病变早期治疗研究（ETDRS）6毫米网格内的区域和ETDRS网格外的区域。位于ETDRS网格内的视网膜水肿被指定为“主要DME”，位于ETDRS网格外的视网膜水肿被指定为“周边视网膜水肿”。对于每个区域，评估OCT特征，同时分析ETDRS网格外区域主要DME的范围和周边视网膜水肿的存在情况。最后，对部分纳入的眼睛按照相同方案进行随访，其中一部分眼睛接受了玻璃体腔内注射治疗。
在本研究纳入的218例患者的375只眼中，279只眼（74.4%）在ETDRS区域外检测到周边病变：177只眼（47.2%）主要DME扩展至ETDRS网格外和/或207只眼（55.2%）存在周边视网膜水肿。对主要DME与周边视网膜水肿模式之间的关联分析发现，视网膜囊肿定位无关联（P = 0.42），而囊肿大小存在弱关联（Cramer's V = 0.188，p = 0.028）。然而，微动脉瘤的存在存在中度关联（Cramer's V = 0.247，p < 0.001），硬性渗出物存在强关联（Cramer's V = 0.386，p < 0.001）。二元逻辑回归分析确定了以下周边病变发生的影响因素：糖尿病视网膜病变晚期（比值比OR = 2.19，p = 0.03）、弥漫性DME（OR = 7.76，p < 0.001）及其在外周区域的位置（OR = 7.09，p = 0.006）。同样，主要DME扩展至ETDRS区域外还受中心黄斑厚度（CMT）影响（OR = 0.98，p = 0.004），而周边视网膜水肿的存在受相同因素影响，但不包括主要DME的外周位置。最后，在94只接受玻璃体腔内注射治疗的眼中，基线检查时54只眼（占56.44%）检测到主要DME扩展至ETDRS网格外，治疗开始后37只眼（占39.36%）仍可检测到。
大视野30°×25° OCT能够更精确地评估DME扩展，并且在糖尿病视网膜病变晚期伴显著DME时，无论是基线检查还是随访期间，都能更好地检测视网膜增厚。该方案与更宽的ETDRS网格相结合将增强DME检测和地形图绘制。
