Acta Scientific Ophthalmology (ISSN: 2582-3191)

Research Article Volume 5 Issue 6

A Study to Assess the Pattern of Diabetic Macular Edema Using Optical Coherence Tomography (OCT) and to Evaluate the Relevant Risk Factors

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


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 HbA1c 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


  1. Deshpande AD., et al. “Epidemiology of diabetes and diabetes-related complications”. Physical Therapy 11 (2008): 1254-1264.
  2. Lee R., et al. “Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss”. Eye Vision (Lond) 2 (2015): 17.
  3. Cohen SR and Gardner TW. “Diabetic Retinopathy and Diabetic Macular Edema”. Developments in Ophthalmology 55 (2016): 137-146.
  4. Aiello LM. “Perspectives on diabetic retinopathy”. American Journal of Ophthalmology1 (2003): 122-135.
  5. Ding J and Wong TY. “Current epidemiology of diabetic retinopathy and diabetic macular edema”. Current Diabetic Report 12 (2012): 346-354.
  6. Browning DJ., et al. “Diabetic macular edema: Evidence-based management”. Indian Journal of Ophthalmology12 (2018): 1736-1750.
  7. Romero-Aroca P. “Managing diabetic macular edema: The leading cause of diabetes blindness”. World Journal of Diabetes6 (2011): 98-104.
  8. Kiire CA., et al. “Medical management for the prevention and treatment of diabetic macular edema”. Survey on Ophthalmology5 (2013): 459-465.
  9. Aiello LP., et al. “Diabetic retinopathy”. Diabetes Care1 (1998): 143-156.
  10. Otani T., et al. “Patterns of diabetic macular edema with optical coherence tomography”. American Journal of Ophthalmology6 (1999): 688-693.
  11. Fujimoto JG., et al. “Optical coherence tomography: an emerging technology for biomedical imaging and optical biopsy”. Neoplasia 1-2 (2000): 9-25.
  12. Lobo C., et al. “Diabetic macular edema”. In: R. Bernardes and J. Cunha-Vaz (eds.), Optical Coherence Tomography, Biological and Medical Physics, Biomedical Engineering. Springer-Verlag Berlin Heidelberg (2021): 1-21.
  13. Xie XW., et al. “Prevalence and associated factors of diabetic retinopathy. The Beijing Eye Study 2006”. Graefe's Archive for Clinical and Experimental Ophthalmology 246 (2008): 1519-1526.
  14. Acan D., et al. “The prevalence and systemic risk factors of diabetic macular edema: a cross- sectional study from Turkey”. BMC Ophthalmology1 (2018): 91.
  15. Luxmi S., et al. “Diabetic macular edema and its association to systemic risk factors in an urban north Indian population”. Journal of Clinical Ophthalmology2 (2018): 86-91.
  16. Ghosh S., et al. “Correlation of morphological pattern of optical coherence tomography in diabetic macular edema with systemic risk factors in middle aged males”. International Ophthalmology 1 (2015): 3-10.
  17. Ahmadpour-Baghdadabad M., et al. “Optical coherence tomography in diabetic macular edema: patterns and related risk factors”. Nepal Journal of Ophthalmology2 (2013): 190-194.
  18. Al-Sharkawy HT. “Correlation between optical coherence tomographic patterns and visual acuity in eyes with diabetic macular edema”. Delta Journal of Ophthalmology 17 (2016): 35-41.
  19. Alkuraya H., et al. “The correlation between optical coherence tomographic features and severity of retinopathy, macular thickness and visual acuity in diabetic macular edema”. International Ophthalmology 3 (2005): 93-99.
  20. Maalej A., et al. “Optical coherence tomography for diabetic macular edema: early diagnosis, classification and quantitative assessment”. Journal of Clinical and Experimental Ophthalmology 2012 (2012): S:2.
  21. Raman R., et al. “Influence of glycosylated hemoglobin on sight-threatening diabetic retinopathy: a population-based study”. Diabetes Research and Clinical Practice 92 (2011): 168-173.
  22. Benarous R., et al. “Differential association of serum lipids with diabetic retinopathy and diabetic macular edema”. Investigative Ophthalmology and Visual Science 52 (2011): 7464-7469.
  23. Yamamoto S., et al. “Morphological and functional analyses of diabetic macular edema by optical coherence tomography and multifocal electroretinograms”. Graefe's Archive for Clinical and Experimental Ophthalmology2 (2001): 96-101.
  24. Kim BY., et al. “Optical coherence tomographic patterns of diabetic macular edema”. American Journal of Ophthalmology3 (2006): 405-412.
  25. Duh EJ., et al. “Diabetic retinopathy: current understanding, mechanisms, and treatment strategies”. JCI Insight 14 (2017): e93751.


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: © 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.


Acceptance rate35%
Acceptance to publication20-30 days
ISI- IF1.042
JCR- IF0.24

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is May 30, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US