title: SAVE: a grading protocol for clinically significant diabetic macular oedema based on optical coherence tomography and fluorescein angiography.
abstract: OBJECTIVE
  To analyse a new grading protocol for clinically significant diabetic macular oedema (CSME) based on spectral domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA).
  
  
  METHODS
  56 eyes of 40 patients with CSME were examined by Cirrus OCT (Carl Zeiss Meditec), Spectralis HRA and OCT (Heidelberg Engineering) on the same day. Three graders analysed images based on a newly developed grading protocol integrating all relevant information from OCT and FA. The protocol defined four categories: (1) subretinal fluid (category 'S'); (2) the planimetrically measured oedematous area (category 'A'); (3) vitreo-retinal interface abnormalities (category 'V'); and (4) CSME aetiology (category 'E') defining the leakage source.
  
  
  RESULTS
  The new grading protocol allowed for a detailed characterisation of each individual type of CSME. It defines four aetiological types of CSME and analyses four further categories important in diagnosis and during follow-up in clinical and study settings. Atrophic, a new type of CSME, was described and characteristic combinations of triggers of CSME were revealed. Inter-grader agreement, analysed using Fleiss' κ values for Cirrus OCT and Spectralis OCT, respectively, was good for 'S' (0.9; 0.82), 'A' (1.0; 1.0) and 'E' (range 0.63-0.8; 0.57-0.77), and lower for 'V' (0.25; 0.42).
  
  
  CONCLUSIONS
  The 'SAVE' grading protocol of CSME integrates information from two imaging techniques, OCT and FA. Its clinical approach allows examiners to define and further categorise clinical characteristics to find tailored therapeutic strategies.
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bolz
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors.forename: Jan
authors.initials: J
authors.lastname: Lammer
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors.forename: Gabor
authors.initials: G
authors.lastname: Deak
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Pollreisz
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Mitsch
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Scholda
authors.affiliation: Institute of Environmental Health, Center for Public Health, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Kundi
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors.forename: Ursula
authors.initials: U
authors.lastname: Schmidt-Erfurth
mesh_terms: D001813:Blood-Retinal Barrier; D002985:Clinical Protocols; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000145:classification* / Q000175:diagnosis / Q000209:etiology; D005451:Fluorescein Angiography / Q000145:classification*; D006801:Humans; D008269:Macular Edema / Q000145:classification* / Q000175:diagnosis / Q000209:etiology; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D058471:Subretinal Fluid; D041623:Tomography, Optical Coherence / Q000145:classification*; D014822:Vitreous Body / Q000473:pathology
keywords: Imaging; Retina