scholarly journals Detection of diabetic macular oedema: validation of optical coherence tomography using both foveal thickness and intraretinal fluid

PeerJ ◽  
2015 ◽  
Vol 3 ◽  
pp. e1394 ◽  
Author(s):  
Carmen Hernández-Martínez ◽  
Antonio Palazón-Bru ◽  
Cesar Azrak ◽  
Aída Navarro-Navarro ◽  
Manuel Vicente Baeza-Díaz ◽  
...  
Keyword(s):  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Positive Test ◽  
Diabetic Patients ◽  
Optic Coherence Tomography ◽  
Likelihood Ratios ◽  
Binary Logistic Regression Model ◽  
Foveal Thickness ◽  
Cross Sectional ◽  
Intraretinal Fluid

No studies have yet evaluated jointly central foveal thickness (CFT) and the presence of intraretinal fluid (PIF) to diagnose diabetic macular oedema (DMO) using optic coherence tomography (OCT). We performed a cross-sectional observational study to validate OCT for the diagnosis of DMO using both CFT and PIF assessed by OCT (3D OCT-1 Maestro). A sample of 277 eyes from primary care diabetic patients was assessed in a Spanish region in 2014. Outcome: DMO diagnosed by stereoscopic mydriatic fundoscopy. OCT was used to measure CFT and PIF. A binary logistic regression model was constructed to predict the outcome using CFT and PIF. The area under the ROC curve (AUC) of the model was calculated and non-linear equations used to determine which CFT values had a high probability of the outcome (positive test), distinguishing between the presence or absence of PIF. Calculations were made of the sensitivity, specificity, and the positive (PLR) and negative (NLR) likelihood ratios. The model was validated using bootstrapping methodology. A total of 37 eyes had DMO. AUC: 0.88. Positive test: CFT ≥90 µm plus PIF (≥310 µm if no PIF). Clinical parameters: sensitivity, 0.83; specificity, 0.89; PLR, 7.34; NLR, 0.19. The parameters in the validation were similar. In conclusion, combining PIF and CFT provided a tool to very precisely discriminate the presence of DMO. Similar studies are needed to provide greater scientific evidence for the use of PIF in the diagnosis of DMO.

scholarly journals External validation of cut-off points for foveal thickness taking into account the intraretinal fluid using optical coherence tomography to diagnose diabetic macular oedema

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3922
Author(s):  
Carmen Hernández-Martínez ◽  
Antonio Palazón-Bru ◽  
Cesar Azrak ◽  
Aída Navarro-Navarro ◽  
Manuel Vicente Baeza-Díaz ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Likelihood Ratio ◽  
Macular Oedema ◽  
External Validation ◽  
Diabetic Macular Oedema ◽  
Diabetic Patients ◽  
Optical Coherence ◽  
Foveal Thickness ◽  
Intraretinal Fluid ◽  
Validation Parameters

Background In late 2015, cut-off points were published for foveal thickness to diagnose diabetic macular oedema taking into account the presence of intraretinal fluid using optical coherence tomography (OCT) in primary care patients (90 µm in the presence of intraretinal fluid and 310 µm otherwise). Methods This cross-sectional observational study was carried out on 134 eyes of diabetic patients treated in specialised ophthalmology services in a Spanish region in 2012–2013, to externally validate the aforementioned cut-off points. The main variable (Clinical Standard) was the diagnosis of macular oedema through indirect ophthalmoscopy and posterior segment slit-lamp biomicroscopy. As validation variables, both the foveal thickness and the presence of intraretinal fluid obtained by OCT were used. Validation was performed using bootstrapping by calculating the area under the ROC curve (AUC), sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). Results Forty-one eyes presented diabetic macular oedema (30.6%). The bootstrapping validation parameters were: AUC, 0.88; sensitivity, 0.75; specificity, 0.95; PLR, 14.31; NLR, 0.26. These values were very similar to those of the original publication. Conclusion We have externally validated in specialised care patients the cut-off points published for the diagnosis of diabetic macular oedema. We suggest that others carry out validation studies in their communities.

Phacoemulsification and dexamethasone intravitreal implant in diabetic patients: A combined approach

2021 ◽  
pp. 112067212110393
Author(s):  
Lucrezia Montrone ◽  
Giancarlo Macinagrossa
Keyword(s):  
Macular Oedema ◽  
Functional Outcomes ◽  
Diabetic Macular Oedema ◽  
Diabetic Patients ◽  
Foveal Thickness ◽  
Systemic Complications ◽  
Dexamethasone Intravitreal Implant ◽  
Intravitreal Implant ◽  
Lens Surgery

Purpose: To analyse the morpho-functional outcomes of dexamethasone intravitreal implant (Ozurdex) injected after lens surgery in diabetic patients with coexisting cataract and macular oedema. Methods: This is a non-randomized, perspective, single-group study on 17 eyes with a diagnosis of cataract and early and advanced diabetic macular oedema. All eyes underwent combined phacoemulsification and Ozurdex injection at the end of surgery and morpho-functional outcomes were analysed in 3 months follow-up. Results: Foveal thickness decreased significantly from 349.6 ± 19.8 (95% CI) at baseline to 310.7 ± 17.5 (95% CI) 90 days after surgery ( p < 0.01). Mean BCVA (LogMAR) improved significantly from 0.38 ± 0.08 (95% CI) at baseline to 0.15 ± 0.06 (95% CI) after 90 days ( p < 0.01). Any ocular or systemic complications were observed during follow-up. Conclusions: Dexamethasone intravitreal implant combined with phacoemulsification may be safe and effective to improve morpho-functional outcomes in diabetic patients with coexisting cataract and macular oedema.

scholarly journals A predictive screening tool to detect diabetic retinopathy or macular edema in primary health care: construction, validation and implementation on a mobile application

PeerJ ◽  
2015 ◽  
Vol 3 ◽  
pp. e1404 ◽  
Author(s):  
Cesar Azrak ◽  
Antonio Palazón-Bru ◽  
Manuel Vicente Baeza-Díaz ◽  
David Manuel Folgado-De la Rosa ◽  
Carmen Hernández-Martínez ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Care Physician ◽  
Mobile App ◽  
Diabetic Patients ◽  
Binary Logistic Regression Model ◽  
Foveal Thickness ◽  
Cross Sectional

The most described techniques used to detect diabetic retinopathy and diabetic macular edema have to be interpreted correctly, such that a person not specialized in ophthalmology, as is usually the case of a primary care physician, may experience difficulties with their interpretation; therefore we constructed, validated and implemented as a mobile app a new tool to detect diabetic retinopathy or diabetic macular edema (DRDME) using simple objective variables. We undertook a cross-sectional, observational study of a sample of 142 eyes from Spanish diabetic patients suspected of having DRDME in 2012–2013. Our outcome was DRDME and the secondary variables were: type of diabetes, gender, age, glycated hemoglobin (HbA1c), foveal thickness and visual acuity (best corrected). The sample was divided into two parts: 80% to construct the tool and 20% to validate it. A binary logistic regression model was used to predict DRDME. The resulting model was transformed into a scoring system. The area under the ROC curve (AUC) was calculated and risk groups established. The tool was validated by calculating the AUC and comparing expected events with observed events. The construction sample (n= 106) had 35 DRDME (95% CI [24.1–42.0]), and the validation sample (n= 36) had 12 DRDME (95% CI [17.9–48.7]). Factors associated with DRDME were: HbA1c (per 1%) (OR = 1.36, 95% CI [0.93–1.98],p= 0.113), foveal thickness (per 1 µm) (OR = 1.03, 95% CI [1.01–1.04],p< 0.001) and visual acuity (per unit) (OR = 0.14, 95% CI [0.00–0.16],p< 0.001). AUC for the validation: 0.90 (95% CI [0.75–1.00],p< 0.001). No significant differences were found between the expected and the observed outcomes (p= 0.422). In conclusion, we constructed and validated a simple rapid tool to determine whether a diabetic patient suspected of having DRDME really has it. This tool has been implemented on a mobile app. Further validation studies are required in the general diabetic population.

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