Optical coherence tomography distribution patterns of diabetic macular edema and its correlations with diabetic retinopathy stages and systemic factors_Chinese Journal of Ocular Fundus Diseases

Authors：

Li Wei , Du Xinhua , Li Shuting , Wang Xiangning , Chen Yongdong ,  Wu Qiang

Department of Ophthalmology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai 200233, China;

Corresponding author：

Wu Qiang, Email: wyansh@163.com

Keywords：

Macular edema/diagnosis; Diabetic retinopathy/diagnosis; Tomography, optical coherence; Risk factors

DOI：

10.3760/cma.j.issn.1005-1015.2017.03.010

Video：

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Objective To investigate the distribution patterns of diabetic macular edema (DME) based on optical coherence tomography (OCT), and explore its correlation with diabetic retinopathy (DR) stages and systemic factors. Methods A total of 135 patients (242 eyes) with type 2 diabetes were included in this retrospective study. There were 75 males (138 eyes) and 60 females (104 eyes), the ages were from 29 to 83 years, with an average age of (58.8±11.1) years. The general information such as height, weight, smoking history and blood glucose [such as glycosylated hemoglobin (HbA1c)], blood pressure, blood lipid, 24 hours urine protein and other examinations were collected. The diagnosis of DR and DME were made, and the staging of DR and typing of DME were performed based on fundus color imaging and OCT. DR were divided into mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR and proliferative DR (PDR). DME were categorized into 4 types including sponge-like retinal swelling (SME), cystoid macular edema (CME), serous retinal detachment (SRD) and posterior hyaloid traction (PHT). The correlation between DME types and DR staging were analyzed byχ² test and Fisher exact test. Multivariate logistic regression analysis was used to analyze the correlation between DME types and systemic factors. Results In 242 DR eyes the proportions of mild, moderate, severe NPDR and PDR were 30.99%, 32.64%, 23.14% and 13.23%, respectively. There were 199 eyes (82.23%) with DME. There were statistically significant differences in the proportion of DME in different stages of DR (χ²=21.077,P＜0.01). In the 199 eyes with DME, There were 165 eyes (68.18%) of SME, 22 eyes (9.09%) of CME, 7 eyes (2.89%) of SRD and 5 eyes (2.07%) of PHT. The distribution of DME patterns in different stages of DR was statistically significant (χ²=156.273,P＜0.01). Logistic regression analysis showed that the duration of diabetes, HbA1c and macroalbuminuria were independent risk factors for DME [odds ratio (OR)=1.090, 1.510, 4.123;P＜0.05], and were also independent for SME (OR=1.092, 1.445, 3.942;P＜0.05); HbA1c was an independent risk factor for SRD (OR=2.337,P＜0.05). Conclusions There are differences in the distribution of different DME types in each stage of DR. The duration of diabetes, HbA1c and macroalbuminuria were independent risk factors for DME and SME, and macroalbuminuria and HbA1c for CME and SRD.

Citation： Li Wei, Du Xinhua, Li Shuting, Wang Xiangning, Chen Yongdong, Wu Qiang. Optical coherence tomography distribution patterns of diabetic macular edema and its correlations with diabetic retinopathy stages and systemic factors. Chinese Journal of Ocular Fundus Diseases, 2017, 33(3): 262-266. doi: 10.3760/cma.j.issn.1005-1015.2017.03.010 Copy

1.	Boscia F. Current approaches to the management of diabetic retinopathy and diabetic macular oedema[J]. Drugs, 2010, 70 (16): 2171-2200. DOI: 10.2165/11538130-000000000-00000.
2.	Kang JW. Correlation of optical coherence tomographic hyperreflective foci with visual outcomes in different patterns of diabetic macular edema[J]. Retina, 2016, 36(9): 1630-1639. DOI: 10.1097/IAE.0000000000000995.
3.	中华医学会糖尿病学分会. 中国2型糖尿病防治指南（2013年版）[J]. 中华糖尿病杂志, 2014,6(7):447-498. DOI:10.3760 /cma. j.issn.1674-5809.2014.07.004.Chinese Diabetes Society, Chinese Medical Association. Standards of care for type 2 diabetes in China[J].Chin J Diabetes Mellitus, 2014,6(7):447-498. DOI:10.3760 /cma. j.issn.1674-5809.2014.07.004.
4.	Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10[J]. Ophthalmology, 1991, 98 (5 Suppl ): S786-806.
5.	Early Treatment Diabetic Retinopathy Study research group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1[J]. Ophthalmology, 1985, 103 (12): 1796-1806.
6.	付浴东, 孟旭霞, 王萍, 等. 不同光相干断层扫描分型糖尿病黄斑水肿玻璃体腔注射雷珠单抗的疗效差异及椭圆体带完整性与视力相关性观察[J]. 中华眼底病杂志, 2017, 33(2): 129-133. DOI: 10.3760/cma.j.issn.1005-1015.2017.02.005.Fu YD, Meng XX, Wang P, et al. Efficacy of intravitreal injection of ranibizumab for different patterns of optical coherence tomography of diabetic macular edema and the relationship between integrity of ellipsoidal zone and visual acuity outcomes [J]. Chin J Ocul Fundus Dis, 2017, 33(2): 129-133. DOI: 10.3760/cma.j.issn.1005-1015.2017.02.005.
7.	Kang SW, Park CY, Ham DI. The correlation between fluorescein angiographic and optical coherence tomographic features in clinically significant diabetic macular edema[J]. Am J Ophthalmol, 2004, 137(2): 313-322. DOI: 10.1016/j.ajo.2003.09.016.
8.	Kim BY, Smith SD, Kaiser PK. Optical coherence tomographic patterns of diabetic macular edema[J]. Am J Ophthalmol, 2006, 142 (3): 405-412. DOI: 10.1016/j.ajo.2006.04.023.
9.	Ahmadpour-Baghdadabad M, Manaviat M, Shojaoddiny-Ardekani A. Optical coherence tomography in diabetic macular edema_ patterns and related risk factors[J]. Nepal J Ophthalmol, 2013, 5(10): 190-194.
10.	Bhagat N, Grigorian RA, Tutela A, et al. Diabetic macular edema: pathogenesis and treatment[J]. Surv Ophthalmol, 2009, 54 (1): 1-32. DOI: 10.1016/j.survophthal.2008.10.001.
11.	Klein R, Klein BE, Moss SE, et al. The Wisconsin epidemiologic study of diabetic retinopathy Ⅳ diabetic macular edema[J]. Ophthalmology, 1984, 91(12): 1464-1474.
12.	Hammes HP, Welp R, Kempe HP, et al. Risk factors for retinopathy and DME in type 2 diabetes results from the German/Austrian DPV database [J/OL]. PLoS One, 2015, 10(7): 0132492[2015-07-15]. . DOI: 10.1371/journal.pone.0132492.
13.	Guan K, Hudson C, Wong T, et al. Retinal hemodynamics in early diabetic macular edema[J]. Diabetes, 2006, 55(3): 813-818.
14.	Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy[J]. Diabetes Care, 2012, 35(3): 556-564. DOI: 10.2337/dc11-1909/-/DC1.
15.	Raman R, Rani PK, Kulothungan V, et al. Influence of serum lipids on clinically significant versus nonclinically significant macular edema: SN-DREAMS report number 13 [J]. Ophthalmology, 2010, 117(4): 766-772. DOI: 10.1016/j.ophtha.2009.09.005.
16.	Zapata MA, Badal J, Fonollosa A, et al. Insulin resistance and diabetic macular oedema in type 2 diabetes mellitus[J]. Br J Ophthalmol, 2010, 94(9): 1230-1232. DOI: 10.1136/bjo.2009.171702.
17.	Zhang J, Ma J, Zhou N, et al. Insulin use and risk of diabetic macular edema in diabetes mellitus: a systemic review and meta-analysis of observational studies[J]. Med Sci Monit, 2015, 21: 929-936. DOI: 10.12659/MSM.892056.
18.	Sugimoto M, Cutler A, Shen B, et al. Inhibition of EGF signaling protects the diabetic retina from insulin-induced vascular leakage[J]. Am J Pathol, 2013, 183(3): 987-995. DOI: 10.1016/j.ajpath.2013.05.017.
19.	Klein R, Sharrett AR, Klein BE, et al. The association of atherosclerosis, vascular risk factors, and retinopathy in adults with diabetes: the atherosclerosis risk in communities study[J]. Ophthalmology, 2002, 109(7): 1225-1234.
20.	Das R, Kerr R, Chakravarthy U, et al. Dyslipidemia and diabetic macular edema: a systematic review and meta-analysis[J]. Ophthalmology, 2015, 122 (9): 1820-1827. DOI: 10.1016/j.ophtha.2015.05.011.
21.	Dirani M, Xie J, Fenwick E, et al. Are obesity and anthropometry risk factors for diabetic retinopathy? The diabetes management project[J]. Invest Ophthalmol Vis Sci, 2011, 52(7): 4416-4421. DOI: 10.1167/iovs.11-7208.
22.	Group TS. Retinopathy in youth with type 2 diabetes participating in the TODAY clinical trial[J]. Diabetes Care, 2013, 36 (6): 1772-1774. DOI: 10.2337/dc12-2387.
23.	Man RE, Sabanayagam C, Chiang PP, et al. Differential association of generalized and abdominal obesity with diabetic retinopathy in Asian patients with type 2 diabetes[J]. JAMA Ophthalmol, 2016, 134(3): 251-257. DOI: 10.1001/jamaophthalmol.2015.5103.

1. Boscia F. Current approaches to the management of diabetic retinopathy and diabetic macular oedema[J]. Drugs, 2010, 70 (16): 2171-2200. DOI: 10.2165/11538130-000000000-00000.
2. Kang JW. Correlation of optical coherence tomographic hyperreflective foci with visual outcomes in different patterns of diabetic macular edema[J]. Retina, 2016, 36(9): 1630-1639. DOI: 10.1097/IAE.0000000000000995.
3. 中华医学会糖尿病学分会. 中国2型糖尿病防治指南（2013年版）[J]. 中华糖尿病杂志, 2014,6(7):447-498. DOI:10.3760 /cma. j.issn.1674-5809.2014.07.004.Chinese Diabetes Society, Chinese Medical Association. Standards of care for type 2 diabetes in China[J].Chin J Diabetes Mellitus, 2014,6(7):447-498. DOI:10.3760 /cma. j.issn.1674-5809.2014.07.004.
4. Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10[J]. Ophthalmology, 1991, 98 (5 Suppl ): S786-806.
5. Early Treatment Diabetic Retinopathy Study research group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1[J]. Ophthalmology, 1985, 103 (12): 1796-1806.
6. 付浴东, 孟旭霞, 王萍, 等. 不同光相干断层扫描分型糖尿病黄斑水肿玻璃体腔注射雷珠单抗的疗效差异及椭圆体带完整性与视力相关性观察[J]. 中华眼底病杂志, 2017, 33(2): 129-133. DOI: 10.3760/cma.j.issn.1005-1015.2017.02.005.Fu YD, Meng XX, Wang P, et al. Efficacy of intravitreal injection of ranibizumab for different patterns of optical coherence tomography of diabetic macular edema and the relationship between integrity of ellipsoidal zone and visual acuity outcomes [J]. Chin J Ocul Fundus Dis, 2017, 33(2): 129-133. DOI: 10.3760/cma.j.issn.1005-1015.2017.02.005.
7. Kang SW, Park CY, Ham DI. The correlation between fluorescein angiographic and optical coherence tomographic features in clinically significant diabetic macular edema[J]. Am J Ophthalmol, 2004, 137(2): 313-322. DOI: 10.1016/j.ajo.2003.09.016.
8. Kim BY, Smith SD, Kaiser PK. Optical coherence tomographic patterns of diabetic macular edema[J]. Am J Ophthalmol, 2006, 142 (3): 405-412. DOI: 10.1016/j.ajo.2006.04.023.
9. Ahmadpour-Baghdadabad M, Manaviat M, Shojaoddiny-Ardekani A. Optical coherence tomography in diabetic macular edema_ patterns and related risk factors[J]. Nepal J Ophthalmol, 2013, 5(10): 190-194.
10. Bhagat N, Grigorian RA, Tutela A, et al. Diabetic macular edema: pathogenesis and treatment[J]. Surv Ophthalmol, 2009, 54 (1): 1-32. DOI: 10.1016/j.survophthal.2008.10.001.
11. Klein R, Klein BE, Moss SE, et al. The Wisconsin epidemiologic study of diabetic retinopathy Ⅳ diabetic macular edema[J]. Ophthalmology, 1984, 91(12): 1464-1474.
12. Hammes HP, Welp R, Kempe HP, et al. Risk factors for retinopathy and DME in type 2 diabetes results from the German/Austrian DPV database [J/OL]. PLoS One, 2015, 10(7): 0132492[2015-07-15]. . DOI: 10.1371/journal.pone.0132492.
13. Guan K, Hudson C, Wong T, et al. Retinal hemodynamics in early diabetic macular edema[J]. Diabetes, 2006, 55(3): 813-818.
14. Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy[J]. Diabetes Care, 2012, 35(3): 556-564. DOI: 10.2337/dc11-1909/-/DC1.
15. Raman R, Rani PK, Kulothungan V, et al. Influence of serum lipids on clinically significant versus nonclinically significant macular edema: SN-DREAMS report number 13 [J]. Ophthalmology, 2010, 117(4): 766-772. DOI: 10.1016/j.ophtha.2009.09.005.
16. Zapata MA, Badal J, Fonollosa A, et al. Insulin resistance and diabetic macular oedema in type 2 diabetes mellitus[J]. Br J Ophthalmol, 2010, 94(9): 1230-1232. DOI: 10.1136/bjo.2009.171702.
17. Zhang J, Ma J, Zhou N, et al. Insulin use and risk of diabetic macular edema in diabetes mellitus: a systemic review and meta-analysis of observational studies[J]. Med Sci Monit, 2015, 21: 929-936. DOI: 10.12659/MSM.892056.
18. Sugimoto M, Cutler A, Shen B, et al. Inhibition of EGF signaling protects the diabetic retina from insulin-induced vascular leakage[J]. Am J Pathol, 2013, 183(3): 987-995. DOI: 10.1016/j.ajpath.2013.05.017.
19. Klein R, Sharrett AR, Klein BE, et al. The association of atherosclerosis, vascular risk factors, and retinopathy in adults with diabetes: the atherosclerosis risk in communities study[J]. Ophthalmology, 2002, 109(7): 1225-1234.
20. Das R, Kerr R, Chakravarthy U, et al. Dyslipidemia and diabetic macular edema: a systematic review and meta-analysis[J]. Ophthalmology, 2015, 122 (9): 1820-1827. DOI: 10.1016/j.ophtha.2015.05.011.
21. Dirani M, Xie J, Fenwick E, et al. Are obesity and anthropometry risk factors for diabetic retinopathy? The diabetes management project[J]. Invest Ophthalmol Vis Sci, 2011, 52(7): 4416-4421. DOI: 10.1167/iovs.11-7208.
22. Group TS. Retinopathy in youth with type 2 diabetes participating in the TODAY clinical trial[J]. Diabetes Care, 2013, 36 (6): 1772-1774. DOI: 10.2337/dc12-2387.
23. Man RE, Sabanayagam C, Chiang PP, et al. Differential association of generalized and abdominal obesity with diabetic retinopathy in Asian patients with type 2 diabetes[J]. JAMA Ophthalmol, 2016, 134(3): 251-257. DOI: 10.1001/jamaophthalmol.2015.5103.

Chinese Journal of Ocular Fundus Diseases

Optical coherence tomography distribution patterns of diabetic macular edema and its correlations with diabetic retinopathy stages and systemic factors

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