title: Detection of fovea-threatening diabetic macular edema by optical coherence tomography to maintain good vision by prophylactic treatment.
abstract: OBJECTIVE
  To establish a screening and treatment method for fovea-threatening diabetic macular edema (DME) using spectral-domain optical coherence tomography (SD-OCT). In order to maintain good visual acuity (VA), focal/grid laser treatment for screened fovea-threatening DME was evaluated based on macular thickness map images produced by SD-OCT.
  
  
  METHODS
  In 66 diabetic eyes with no visual deterioration, the sensitivity and the specificity of SD-OCT without the use of mydriatics for the detection of fovea-threatening DME were determined. A definite diagnosis of DME was made under mydriasis, using slitlamp biomicroscopy with a contact lens. Eyes with fovea-threatening DME then underwent prophylactic focal/grid laser treatment. The main outcome measures were corrected VA and central macular thickness (CMT).
  
  
  RESULTS
  A definitive diagnosis of DME was made in 5 of the 66 eyes, while macular thickening above the 99th percentile was detected in 11 (Cirrus®) or 13 (RS-3000®) eyes by SD-OCT. The focal/grid laser treatment of the 5 eyes with fovea-threatening DME successfully maintained good VA, which was 0.91 ± 0.76 (average: 20/22; 0.04 ± 0.12 logMAR) before treatment and 0.89 ± 0.70 (average: 20/22; 0.05 ± 0.15 logMAR; p = 0.88) 1 year afterwards. The average CMT was stable before and after focal/grid lasering at 302 ± 29 and 329 ± 55 µm, respectively (p = 0.99).
  
  
  CONCLUSIONS
  The detection of fovea-threatening DME is feasible by SD-OCT without using mydriatics. Prophylactic treatment, such as with focal/grid lasers, was effective in maintaining good VA by avoiding an otherwise highly likely foveal involvement. © 2014 S. Karger AG, Basel.
authors: Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Japan.
authors: Takao
authors: T
authors: Hirano
authors: Yasuhiro
authors: Y
authors: Iesato
authors: Yuichi
authors: Y
authors: Toriyama
authors: Akira
authors: A
authors: Imai
authors: Toshinori
authors: T
authors: Murata
mesh_terms: D000328:Adult; D000368:Aged; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000517:prevention & control; D005260:Female; D005451:Fluorescein Angiography; D005584:Fovea Centralis; D006801:Humans; D017075:Laser Coagulation; D008266:Macula Lutea / Q000473:pathology; D008269:Macular Edema / Q000175:diagnosis* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage; D065286:Prophylactic Surgical Procedures; D011446:Prospective Studies; D011680:Pupil / Q000187:drug effects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods*; D014792:Visual Acuity / Q000502:physiology*
chemical_list: D009184:Mydriatics