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Vitrectomy for diabetic macular edema: optical coherence tomography criteria and pathology of the vitreomacular interface
摘要： Purpose: To correlate spectral-domain optical coherence tomography (SD-OCT) criteria and clinical data with pathology of the vitreomacular interface (VMI) in eyes with diabetic macular edema (DME). Design: Retrospective cross-sectional study and laboratory investigation. Methods: We included specimens of 27 eyes of 26 patients with center-involved DME that underwent vitrectomy with peeling of the internal limiting membrane (ILM). Selection of specimens was consecutive and in retrospect using our register of the Vitreoretinal Pathology Unit. Clinical data and SD-OCT examinations were correlated to immunocytochemistry and transmission electron microscopy. Classification of DME comprised sponge-like diffuse retinal thickening, cystoid macular edema, and serous retinal detachment. VMI was evaluated for presence of epiretinal membrane (ERM) and thickened vitreous cortex (tVC). Results: ERMs and tVC were found in all DME types. Diffuse DME showed more often tVC than cystoid DME. Hyalocytes, contractile myofibroblasts, glial cells, matrix metalloproteinases-2 and -9, and collagen type I, II and III were positive tested irrespective of DME type. There were no significant cell fragments at the retinal side of ILM. Visual acuity improved in the majority of cases and macular thickness decreased significantly during mean follow-up of 17 ± 10 months. Conclusions: All eyes presented pathologic VMI changes irrespective of the OCT classification of DME type or presence of ERM. Composition of fibrocellular membranes at the VMI indicated remodelling of vitreous cortex and transdifferentiation of hyalocytes into myofibroblasts. Our findings might argue for an early surgical intervention in eyes with DME irrespective of the presence of traction formation imaged by SD-OCT.
关键词： optical coherence tomography,diabetic macular edema,vitrectomy,pathology,vitreomacular interface
更新于2025-09-04 15:30:14
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Choroidal structural analysis in eyes with diabetic retinopathy and diabetic macular edema—A novel OCT based imaging biomarker
摘要： To evaluate structural changes in the choroid among patients with diabetic macular edema (DME), with varying grades of diabetic retinopathy (DR), using enhance depth imaging spectral domain optical coherence tomography (EDI SD-OCT) scans. A cross-sectional study was conducted on 82 eyes with DR and DME and 86 healthy control eyes. Eyes with DME were classified according to the severity of DR as per the international DR severity scale. Sub foveal choroidal thickness (SFCT)was obtained using EDI SD-OCT scans. These scans were binarized into luminal and stromal areas, to derive the choroidal vascularity index (CVI). CVI and SFCT were analyzed between the study and control group using paired-T test. Tukey’s test was used to correlate the differences in CVI and SFCT between different grades of DR. Further analysis was done to look for the effect of DR severity and type of DME on CVI as well as SFCT using correlation coefficient and linear regression analysis. SFCT was significantly increased in eyes with DME as compared to the controls (334.47 ±51.81μm vs 284.53±56.45μm, p<0.001), and showed an ascending trend with worsening of DR, though this difference was not statistically significant [mild non-proliferative diabetic retinopathy (NPDR) = 304.33±40.39μm, moderate NPDR = 327.81±47.39μm, severe NPDR = 357.72±62.65μm, proliferative DR (PDR) = 334.59±47.4μm, p-0.09]. CVI was significantly decreased in DME with DR eyes as compared to controls (63.89±1.89 vs 67.51 ±2.86, p<0.001). CVI was also significantly decreased with worsening DR (mild NPDR = 66.38±0.3, moderate NPDR = 65.28±0.37, severe NPDR = 63.50±0.47, PDR = 61.27±0.9, p<0.001). SFCT and CVI are dynamic parameters that are affected by DME. Unlike CVI, SFCT is also affected by ocular and systemic factors like edema and hypertension. CVI may be a more accurate surrogate marker for DME and DR and can potentially be used to monitor the progression of DR.
关键词： choroidal vascularity index,diabetic macular edema,subfoveal choroidal thickness,optical coherence tomography,diabetic retinopathy
更新于2025-09-04 15:30:14
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Hard exudate based severity assessment of diabetic macular edema from retinal fundus images
摘要： Diabetic macular edema (DME) is a consequence of diabetic retinopathy characterised by the abnormal accumulation of fluid and protein deposit in the macula region of the retina. Prior disclosure of even a trivial trace of DME is essential as it could consequently lead to blurred vision. DME can be diagnosed by the presence of exudates (glossy lesions) in the retinal fundus images. In this work, OD and macula are detected using morphological operation and hard exudates are segmented. Exudates are classified using early treatment diabetic retinopathy standard as normal, moderate or severe cases. The proposed work also incorporates the extraction of various features from the retinal fundus image. Various textural and exudate features are extracted and fed to a classifier to detect DME. Experiments are performed on a publically available database. Performance is evaluated with metrics like accuracy, sensitivity, specificity and accuracy. The results obtained are promising.
关键词： DME,random forest,hard exudates,diabetic macular edema,classification,macula,feature extraction,optic disc
更新于2025-09-04 15:30:14