Publication: Evaluation of associated factors of optical coherence tomography features and their association with visual acuity among diabetic patients with clinically significant macular oedema
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Date
2022
Authors
Noor, Nik Nurfarhana Nik Mohd
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Abstract
Introduction: Clinically significant macular oedema (CSMO) is a specific category of diabetic retinopathy (DR) which is a microvascular complication of diabetes mellitus (DM) that lead to structural changes at the macular. Optical coherence tomography (OCT) offers a structural and quantitative analysis of CSMO. DM status and severity of DR can affect the OCT morphological features and OCT quantitative parameters of CSMO. Visual acuity is directly affected by the changes of these OCT features. By identifying its associated factors, we can address to CSMO patients regarding the choice of treatment, visual prognosis and also the treatment outcome. Objectives: Our objective was to identify the associated factors (demographic, systemic and ocular factors) affecting OCT features (OCT morphology and OCT quantitative parameters) among CSMO patients and also to determine association of these OCT features with visual acuity. Methods: A cross-sectional study was conducted in the Ophthalmology Clinic, Hospital Universiti Sains Malaysia (USM), from January 2020 till November 2021 among Type 2 DM patients with CSMO. OCT was performed to identify the OCT morphological features [sponge-like diffuse retina thickness (SLDRT), cystoid macular oedema (CMO), and subretinal fluid (SRF)] and to measure OCT quantitative features [central macula thickness (CMT) and retina volume]. Results: A total of 140 Type 2 DM patients with CSMO were recruited and analysed in this study. The mean duration of Type 2 DM was 12.0±6.0 years and the mean HbA1c were 10±2.5%. Majority of the patients had mild form of visual impairment (better than 6/18; 45%), followed by moderate visual impairment (6/18 – 6/60; 32.9%) and severe visual impairment (6/60 – 3/60; 9.3%). There was 12.9% of patients presented with blindness (worse than 3/60). The most common OCT morphological features were SLDRT (39.3%), followed by mixed type (30.0%), CMO (25.0%) and SRF (5.7%). Small number of patients had epiretinal membrane (ERM; 19.3%) and vitreomacular traction (VMT; 1.4%). The associated factors affecting OCT morphological features among diabetic patients with CSMO were DM duration (for SLDRT and Mixed type), PDR status (for SLDRT), CMT (for SLDRT and CMO) and retina volume (for CMO, SRF and mixed type). For OCT quantitative features, the associated factors were CMO type (for CMT); age, SRF type, SLDRT type, and CMT (for retina volume) and mixed type (for CMT and retina volume). Among the OCT morphological features, SRF type had significant association with visual acuity. Among the OCT quantitative features, CMT and retina volume had significant association with visual acuity. Conclusion: The most common OCT morphological type among CSMO was SLDRT and the best mean visual acuity was observed in SLDRT group. Duration of DM, PDR status, CMT and retinal volume are the factors affecting OCT morphological features. Whereas age and OCT morphological features are the factors affecting the OCT quantitative parameters. SRF, CMT and retina volume had significant association with the visual acuity. By stabilizing the severity of DR status, it will reduce the structural damage of macular and provide good outcome of visual acuity.
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