INTRODUCTION: Diabetic retinopathy (DR) is a microvascular complication of
both type I and type II diabetes mellitus (DM) has become one of the
leading causes of blindness world wide (Wilkinson 1988)1. It is a
preventable blindness. DR is due to microangiopathy affecting the pre
capillary arterioles, capillaries and venules. Macular edema is an important and complex component of Non
proliferative diabetic retinopathy (NPDR) and Proliferative diabetic
retinopathy (PDR) and is the major cause of impaired vision. This study
focusses on the role of Fundus Fluorescein Angiography (FFA) and
Optical Coherence Tomography (OCT) in diabetic macular edema and
its management. AIM OF THE STUDY: To study the prevalence of diabetic maculopathy in relation to age, gender, duration of diabetes mellitus.
To classify diabetic maculopathy using FFA & OCT
To treat diabetic maculopathy according to FFA & OCT
classification.
To monitor the response to treatment with OCT.
MATERIALS AND METHODS:
This study was conducted in Regional Institute of Ophthalmology And
Government Ophthalmic Hospital, Egmore, Chennai from November 2009 to
November 2011 for a period of 24 months.
INCLUSION CRITERIA:
All patients with clinically significant macular edema and with
central subfield macular thickness more than 200 microns.
EXCLUSION CRITERIA:
i. History of severe systemic disease/steroids
ii. Uncontrolled Diabetes mellitus/Hypertension
iii. Any condition affecting follow up.
iv. History of associated glaucoma/ocular hypertension
v. History or evidence of ongoing uveitis
vi. Advanced diabetic eye disease
All the patients were taken a brief history and subjected to detailed systemic
and ophthalmic examination. Anterior segment examination with slit lamp
biomicroscope and posterior segment examination using 90 D, binocular indirect
ophthalmoscope. Fundus photograph was also taken for documentation. Fundus
fluorescein angiography, Optical coherence tomography were done for all patients.
DISCUSSION:
Diabetic macular edema is the major cause of visual morbidity in diabetic
patients. The laser treatment given by ETDRS remains the standard therapy of
DME. Focal and diffuse types of leaks diagnosed on FFA were treated with focal
and grid laser. Cystoid type and recalcitrant type of macular edema not responding
to laser treatment were given injection IVTA.
CONCLUSION: In our hospital 100 eyes of 50 patients were studied during NOVEMBER
2009 to NOVEMBER 2011. The incidence of diabetic maculopathy is found to be
commoner in the middle age group of 40-60 years the majority were males and the
incidence of diabetic maculopathy increased with the increase in duration of
diabetes.
Among the FFA patterns focal leaks were commoner and in OCT spongy
edema were the common types. Patients who had ischemic type of maculopathy
were kept under observation and had the worst prognosis over time. The majority of
focal leaks improved with focal laser, and diffuse leaks with grid laser. And
majority of recalcitrant types of macular edema and cystoid type showed
improvement with IVTA injection. Patients with ischemic maculopathy in FFA and
VMT & TPH in OCT had the worst visual prognosis
The overall improvement in visual acuity and the reduction in the macular
thickness was detected and documented by OCT. FFA helped in detecting the
specific leakage patterns and to decide the type of laser treatment. OCT aids in
detecting subtle macular edema that may be difficult to detect on slit lamp
biomicroscopy and in documenting the treatment response. and monitoring the
response to treatment more accurately and less invasively than FFA. OCT & FFA
play a major and complementary role in the diabetic maculopathy management
and
follow up
