Risk factors for microcystic macular oedema in glaucoma

Abstract

Background/aimsTo identify clinical characteristics and factors associated with microcystic macular edema (MME) in patients with primary open-angle glaucoma (POAG).MethodsWe included 315 POAG eyes between 2010 and 2019 with good-quality macular volume scans that had reliable visual fields (VF) available within 6 months in this observational retrospective cohort study. Eyes with retinal pathologies except for epiretinal membrane (ERM) were excluded. The inner nuclear layer was qualitatively assessed for the presence of MME. Global mean deviation (MD) and Visual Field Index (VFI) decay rates, superior and inferior MD rates and pointwise total deviation rates of change were estimated with linear regression. Logistic regression was performed to identify baseline factors associated with the presence of MME and to determine whether MME is associated with progressive VF loss.Results25 out of 315 eyes (7.9%) demonstrated MME. The average (±SD) age and MD in eyes with and without MME was 57.2 (±8.7) versus 62.0 (±9.9) years (p=0.02) and −9.8 (±5.7) versus −4.9 (±5.3) dB (p<0.001), respectively. Worse global MD at baseline (p=0.001) and younger age (p=0.02) were associated with presence of MME. ERM was not associated with the presence of MME (p=0.84) in this cohort. MME was not associated with MD and VFI decay rates (p>0.49).ConclusionsMore severe glaucoma and younger age were associated with MME. MME was not associated with faster global VF decay in this cohort. MME may confound monitoring of glaucoma with full macular thickness.

Glaukomassoziierte Makulopathien

“…Whether patients with MME have a higher rate of VF defect progression, meaning that MME can be considered a marker for glaucoma progression, remains a topic of debate in the literature. Mahmoudinezhad et al were not able to demonstrate a correlation between the presence of MME and the progression of visual field defects [73]. In contrast, in a study of 133 glaucoma patients in an Asian population, Hasegawa et al were able to determine that the rate of progression was higher in the eyes with MME compared to the eyes without MME.…”

“…senden superior liegenden GF-Defekten [72,73]. Diese Lokalisation steht im Gegensatz zu den Patient*innen mit MS, bei denen das MMÖ hauptsächlich in den nasalen und temporalen Quadranten gefunden werden kann.…”

“…From the study population, 12.6 % of the glaucoma patients were found to have MME. The two main risk factors for MME developing in glaucoma patients are young age and advanced glaucoma damage, with a primarily poor baseline mean defect (MD) in the visual field (VF) [73].…”

“…With glaucomatous optic neuropathy, MME occurs in 84 % of cases, located in the parafoveal area of the lower hemisphere of the macula [72]. The location in the lower half of the retina corresponds to damage that frequently occurs in the inferior optic nerve head, and the associated VF defects that manifest in a superior location [72,73]. In contrast, MME in MS patients is mainly located in the nasal and temporal quadrants.…”

“…Unter ihnen konnte in 12,6% der Glaukompatient*innen ein MMÖ identifiziert werden. Zu den beiden Hauptrisikofaktoren für die Ausbildung eines MMÖ bei Glaukompatient*innen zählen junges Lebensalter und fortgeschrittener Glaukomschaden mit primär schlechtem Baseline Mean Defect (MD) im Gesichtsfeld (GF) 73 .…”