Optical Coherence Tomographic Evaluation of Foveal Hard Exudates in Patients with Diabetic Maculopathy Accompanying Macular Detachment

Ota, Megumi; Nishijima, Kazuaki; Sakamoto, Atsushi; Murakami, Tomoaki; Takayama, Kohei; Horii, Takahiro; Yoshimura, Nagahisa

doi:10.1016/j.ophtha.2010.06.019

Cited by 121 publications

(104 citation statements)

References 27 publications

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“…However, the continuous IS/OS lines had varying reflectivity, and it was difficult to differentiate fragmented IS/OS lines from RPE hyperplasia, hyperreflective foci, or degenerative processes in the neuroglial tissue. 26,31,32 All these conditions might be associated with photoreceptor damage, which prompted us to categorize them as disrupted IS/OS, and would correspond to the absent or discontinuous IS/OS lines reported previously. 19,20 We also evaluated the transverse length of the discontinuous IS/OS, which should depend on the signal intensity, which might have led us to reach erroneous conclusions compared with the clinical relevance in the qualitative analyses.…”

Section: Discussionmentioning

confidence: 96%

“…30 Concomitantly, blood constituents or inflammatory cells might migrate into the outer retinal layers and exacerbate photoreceptor degeneration, which possibly is supported by the association between the hyperreflective foci in the outer retinal layers and the disrupted photoreceptors. 31 Furthermore, because Müller cells function as living optical fibers, 36 their damage might lead to the reduced transparency of the retina, which explains the reflectivity error in outer retinal layers and visual dysfunction. On the contrary, we had to consider the possibility that photoreceptor degeneration might contribute to the pathogenesis of CME, because retinitis pigmentosa, whose primary lesions are in photoreceptors and RPE, is sometimes accompanied with cystoid spaces.…”

Section: Discussionmentioning

confidence: 99%

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Optical Coherence Tomographic Reflectivity of Photoreceptors beneath Cystoid Spaces in Diabetic Macular Edema

Murakami

Nishijima

Akagi

et al. 2012

Invest. Ophthalmol. Vis. Sci.

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121

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PURPOSE.To investigate the relationship between the cystoid spaces in the outer plexiform layer (OPL) and the characteristics of the photoreceptors beneath the cystoid spaces in patients with diabetic macular edema (DME). METHODS. In this observational cross-sectional study, 123 eyes of 96 consecutive patients with clinically significant macular edema were retrospectively reviewed. The characteristics of the photoreceptors on optical coherence tomography (OCT) images represented by the external limiting membrane (ELM) and the junction between inner and outer segments (IS/OS), and their association with the overlying cystoid spaces were investigated. RESULTS. The areas beneath the cystoid spaces in the OPL had a longer transverse length of disrupted or faint IS/OS and disrupted ELM lines than those without cystoid spaces (P Ͻ 0.001, P Ͻ 0.001, and P ϭ 0.009). The IS/OS lines beneath the cystoid spaces had higher reflectivity than those in areas without cystoid spaces (P Ͻ 0.001). Enlarged cystoid spaces extending from the inner nuclear layer to the OPL were associated with disrupted IS/OS or ELM but not faint IS/OS (P Ͻ 0.001, P Ͻ 0.001, and P ϭ 0.467). The transverse length of disrupted IS/OS at the fovea was correlated with the logarithm of the minimum angle of resolution (logMAR) more than the association between foveal thickness and logMAR (r ϭ 0.49, P Ͻ 0.001 vs. r ϭ 0.28, P ϭ 0.002). The ELM descended to the RPE more frequently in eyes with single-lobulated fluorescein pooling in the foveal avascular zone than those with multilobulated pooling (P Ͻ 0.001). CONCLUSIONS. OCT showed that the cystoid spaces in the OPL were accompanied by photoreceptor damage beneath the cystoid spaces in DME. (Invest Ophthalmol Vis Sci. 2012;53: 1506 -1511) DOI:10.1167/iovs.11-9231 D iabetic retinopathy (DR) often leads to severe visual impairments especially in patients of working age. Diabetic macular edema (DME), which is caused by the breakdown of blood-retinal barrier (BRB), deteriorates the neuroglial function in the macula and concomitantly the visual acuity (VA). 1-4Despite intensive effort, complete resolution of DME has not been achieved, and research into the pathogenesis and treatments must continue. 5-9Although DME was diagnosed originally as macular thickening based on the biomicroscopic examination, optical coherence tomography (OCT) has enabled quantification of the retinal thickness and evaluation of the pathohistologic findings of the neuroglial components. The macular thickness is correlated modestly with poor VA in DME, suggesting that, despite its clinical relevance, mechanisms other than retinal thickening remain to be elucidated.10 Several pathomorphologic findings have been seen on OCT images (i.e., cystoid macular edema; CME), serous retinal detachments (SRDs), and sponge-like retinal swelling, all which contribute to macular thickening. 11Cystoid spaces especially are seen often in the inner nuclear layer (INL) and the outer plexiform layer (OPL) on OCT images.12-16 Those investigators have speculated...

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Optical Coherence Tomographic Reflectivity of Photoreceptors beneath Cystoid Spaces in Diabetic Macular Edema

Murakami

Nishijima

Akagi

et al. 2012

Invest. Ophthalmol. Vis. Sci.

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121

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“…The HRD may also be present in different retinal diseases, such as retinal vein occlusion, diabetic macular edema or uveitis [11,12,13,14,15,16,17]. The HRD are scattered, punctiform, small in size, mainly located in the outer retinal layers and/or around pockets of fluid accumulation and are typically not confluent (fig.…”

Section: Discussionmentioning

confidence: 99%

Hyperreflective Dots: A New Spectral-Domain Optical Coherence Tomography Entity for Follow-Up and Prognosis in Exudative Age-Related Macular Degeneration

et al. 2012

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Purpose: Spectral-domain optical coherence tomography (SD-OCT) enables high-resolution analysis of retinal layers and previously unseen hyperreflective dots (HRD). HRD morphological characteristics, evolution, possible origin and prognostic value are discussed. Methods: We conducted a prospective study of 100 patients with exudative age-related macular degeneration (AMD), who were treated and followed up with monthly imaging examinations. Statistical correlations between visual acuity (VA) and pre-/post- treatment HRD characteristics were evaluated. Results: HRD were present in all cases, mainly in the outer retinal layers but also elsewhere. After treatment, HRD regressed in a few days, 1 month (p < 0.04) and 3 months (p < 0.01). Regression was evident in all VA and morphological subsets. Resolution was associated with better final VA (p < 0.001). Conclusions: Presence of initial/recurrent HRD, rapid treatment response and the growing role that early biological inflammatory reaction plays in AMD suggests HRD are activated microglia cells. The correlation between VA and HRD could make HRD a clinical marker for early decisions about treatment and retreatment.

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“…The results of several studies [28,[30][31][32] suggest that the fluid pumping capabilities of the RPE are reduced during hypoxia and that RPE impairment plays an important role in SRD development. Furthermore, when the ELM is disrupted, fluid accumulates anterior to the ELM, inducing outer retinal swelling and eventually SRD [33]. In this study, IL-6 was related to the development of SRD.…”

Section: Serous Retinal Detachmentmentioning

confidence: 51%

“…Previous work has shown that IL-8 levels are higher in the vitreous of patient with proliferative diabetic retinopathy [33], which can result from hypoxia and promote neovascularization [34]. It has also been reported that vitreous levels of IL-8 were higher in patients with active proliferative diabetic retinopathy than inactive stage proliferative diabetic retinopathy [35].…”

Section: Inflammatory and Anti-inflammatory Cytokinesmentioning

confidence: 96%

Different Concentrations of Aqueous Cytokines According to Diabetic Macular Edema Patterns as Determined Optical Coherence Tomography

Jeong¹

2014

J Clin Exp Ophthalmol

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Objective: To evaluate the relationship between various cytokine levels in aqueous humor and diabetic macular edema (DME) types as determined by optical coherence tomographic (OCT) patterns. Methods:The study examined 76 patients with DME at early phase. Ten patients who underwent cataract surgery served as controls. Eyes with DME were divided into four groups, based on OCT patterns of DME, prior to intravitreal bevacizumab injection (IVB). Patterns included sponge-like diffuse retinal thickening (SDRT) (n=27), cystoid macular edema (CME) (n=18), serous retinal detachment (SRD) (n=15), and combined CME and SRD (n=16). Visual acuity, central macular thickness (CMT) through OCT, and aqueous cytokine concentrations of interleukin (IL)-6, IL-8, IL-10, IL-13, monocyte chemo attractant protein-1 (MCP-1), vascular endothelial growth factor (VEGF) were measured in all subjects. The odds ratio (OR) between aqueous cytokines and each DME pattern were calculated using multivariate regression analysis.Results: After IVB, CMT was reduced in all groups, but the highest reduction ratio occurred in eyes with SDRT and CME. Aqueous analyses showed that VEGF was associated with development of SDRT (P=0.003, OR=1.043, 95% CI=1.015-1.072). IL-6, MCP-1 were related with CME (P<0.001, OR=1.025, 95% CI=1.011-1.039; P<0.001, OR=1.003, 95% CI=1.001-1.004, respectively). IL-6 was also associated with SRD (P=0.045, OR=1.018, 95% CI=1.006-1.030). Furthermore, IL-6, VEGF were related with Combined pattern (P=0.031, OR=1.013, 95% CI=1.002-1.024; P=0.038, OR=1.014, 95% CI=1.014-1.043, respectively).Conclusion: Specific aqueous cytokines may play an important role in developing each DME pattern based on OCT.

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Optical Coherence Tomographic Evaluation of Foveal Hard Exudates in Patients with Diabetic Maculopathy Accompanying Macular Detachment

Cited by 121 publications

References 27 publications

Optical Coherence Tomographic Reflectivity of Photoreceptors beneath Cystoid Spaces in Diabetic Macular Edema

Optical Coherence Tomographic Reflectivity of Photoreceptors beneath Cystoid Spaces in Diabetic Macular Edema

Hyperreflective Dots: A New Spectral-Domain Optical Coherence Tomography Entity for Follow-Up and Prognosis in Exudative Age-Related Macular Degeneration

Different Concentrations of Aqueous Cytokines According to Diabetic Macular Edema Patterns as Determined Optical Coherence Tomography

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