Sandeep Singh¹, Balbir Singh², Ashok Aggarwal³, Paavan Kalra⁴, Harwinder Nagpal¹, Anand Aggarwal¹*, Shubham Mittal¹, Surmila Meena¹ and Divya Tara¹

¹Department of Ophthalmology, Government Medical College, Patiala, India
²Director, Guru Teg Bahadur Superspecialty Eye Hospital, Patiala and Member Legislative Assembly, Vidhan Sabha Punjab, Chandigarh, India
³Consultant, Harnam Satsangi Clinic, Ludhiana, India
⁴Director, B R Kalra Eye Hospital, Yamunanagar, Haryana, India

*Corresponding Author: Anand Aggarwal, Department of Ophthalmology, Government Medical College, Patiala, India.

Received: May 06, 2022; Published: May 17, 2022

Abstract

Purpose: To assess the pattern of diabetic macular edema using optical coherence tomography and to evaluate relevant risk factors.

Design: This was a cross sectional, open labelled observational study. 

Setting: Outpatient Department of Ophthalmology, Government Medical College, Patiala.

Materials and Methods: 100 patients above 18 years of age diagnosed with diabetic macular edema (DME) were enrolled in the study. Only one eye of one patient with worse visual acuity was considered in this study. Eye with good visual acuity was excluded from study. After ocular examination, Optical Coherence Tomography was performed on patients. Using the retinal thickness map analysis protocol, macular thickness was determined and compared with normative data. 

Statistical Analysis: The data was collected from patients using a proforma. Data was compiled in excel format. Data was subjected to statistical analysis using SPSS version 22 (SPSS Inc., Chicago, Illinois, USA).Pearson Chi Square test and ANOVA Analysis was used for assessment of level of significance. p value of less than 0.05 was taken as significant.

Results: Majority of the patients in our study had spongy DME (47%) followed by cystoid (39%), Serous Macular Detachment (9%), Mixed (5%). Among 9 patients of serous macular detachment (SMD) 7 were males. Maximum mean Cental Macular Thickness (CMT) was observed in Cystoid (523.82 µm) followed by Mixed (496.4 µm, SMD (380.22 µm), and spongy (328.91 µm) variants. Maximum mean Central Macular Volume (CMV) was observed in mixed (0.49 mm³) followed by cystoid (0.45 mm³), SMD (0.41 mm³), and spongy (0.36 mm³) variants. Low visual acuity was observed in Cystoid macular edema and serous macular detachment while patients having spongy macular edema had relatively good vision. On comparison of mean age, duration of diabetes mellitus, CMV and CMT in different patterns of macular edema a statistically significant difference was found. Highest mean age (77.67 years), highest mean duration of DM (14.56 years), highest FBS level (198.89 mg/dl), highest triglyceride level (257.00 mg/dl) was observed in SMD. Highest mean hba1c level was observed in cystoid (9.32%) followed by SMD (9.22%). Cystoid macular edema was more common in females and spongy macular edema was more common in males. Spongy macular edema (78.12%) was predominantly present in patients with duration of diabetes mellitus ≤5 years while in patients with duration of diabetes mellitus between 5-10 years cystoid macular edema (53.19%) was predominantly present. Proportion of cystoid macular edema (50.90%) was more in patients having hba1c >8.5% while proportion of spongy macular edema (62.22%) was more in patients having HbA1c <8.5%.. Among 9 patients of Serous Macular Detachment 7 patients had hba1c>8.5%. Proportion of cystoid macular edema (44.28%) was more in patients having Fasting Blood Sugar (FBS) >125 mg/dl while spongy macular edema (63.33%) was more in patients having FBS < 125 mg/dl. In patients having triglyceride >200 mg/dl major proportion of patients had cystoid macular edema (49.02%) while in patients having triglyceride level <150 mg/dl major proportion of patients have spongy macular edema (72.22%). Statistically the difference in distribution of macular edema with respect to gender, habit of smoking, duration of diabetes mellitus, treatment of DM, visual acuity, grading of diabetic retinopathy, FBS and HbA_1c and Triglyceride was significant with p value = 0.016, 0.02, 0.02, 0.02, 0.01, 0.018, 0.004, 0.01 and 0.03 respectively. A significant negative correlation of visual acuity was present with grading of DR, CMT, CMV, HbA1c, FBS. The correlation between age, alcohol consumption, type of DM, Family history of DM, IOP, SBP, DBP, BMI, statin use, Cerebro Vascular Disease (CVD), LDL, HDL with pattern of DME was not statistically significant (p value = 0.87, 0.95, 0.12, 0.85, 0.17, 0.004, 0.779, 0.243, 0.46, 0.30, 0.179 and 0.21 respectively).

Conclusion: The pathophysiology of DME remains unknown and different patterns of DME can be caused by different ocular or systemic risk factors. The patients with chronic hyperglycemia, hyperlipidemia have more proportion of cystoid macular edema which leads to worsening of visual acuity. The foundation of treatment and prevention of DME progression lies in the strict control of chronic hyperglycemia, hypertension and hyperlipidemia.

Keywords: DR; DME; OCT; Cystoid Macular Edema; Spongy Macular Edema; Mixed Macular Edema; Serous Macular Detachment

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Citation

Citation: Anand Aggarwal., et al. “A Study to Assess the Pattern of Diabetic Macular Edema Using Optical Coherence Tomography (OCT) and to Evaluate the Relevant Risk Factors".Acta Scientific Ophthalmology 5.6 (2022): 53-67.

Copyright

Copyright: © 2022 Anand Aggarwal., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.