Diyabetik Maküler Ödem Olgularında Optik Koherens Tomografideki Hiperreflektif Noktalar

Öz

ÖZ Amaç: Diyabetik maküler ödem (DMÖ) tanısı ile takip edilen olguların optik koherens tomografi (OKT) bulgularını incelemek ve bu bulgular ile olguların kliniği arasındaki ilişkiyi analiz etmektir. Gereç ve Yöntem: Bu çalışmada DMÖ olgularının tıbbi kayıtları incelendi. İç limitan membran ile dış nükleer tabaka arasındaki hiperreflektif noktaları iç, daha dış katmanlardaki hiperreflektif noktalar ise dış katlardaki hiperreflektif noktalar olarak gruplandırıldı. Bir başka gruplama ise OKT’de elipsoid zonun (EZ) ve dış limitan membranın (DLM) düzenli bir görünümünün olup olmadığına göre yapıldı. Bulgular: 125 olgunun 167 gözü incelendi. Hiperreflektif noktalar %94,6 olguda iç retinal katlarda iken %57,5 olguda dış retinal katlarda idi. %15,6 olguda EZ bozukluğu mevcut iken yine %15,6 olguda DLM bozukluğu mevcuttu. En iyi düzeltilmiş görme keskinliği (EİDGK) iç ve dış retinal tabakalarda hiperreflektif nokta bulunan olgularda ve EZ ve DLM bozukluğu bulunan olgularda anlamlı şekilde daha düşüktü (tamamında p<0,001). Dış retinal katmanlardaki hiperreflektif nokta varlığında EZ ve DLM’nin bozuk olma olasılığının yüksek olduğu (p<0,001), fakat iç retinal katmanlardaki hiperreflektif nokta varlığında EZ ve DLM’deki bozulma olasılığının artmadığı görüldü (p>0,05). Sonuç: DMÖ’de hiperreflektif noktalar iç retinal tabakalarda daha sıktır. Hem iç hem de dış retinal tabakalardaki hiperreflektif noktalar düşük görme keskinliği ile ilişkiliyken, sadece dış retinal tabakalardaki hiperreflektif noktaların varlığı EZ ve DLM bozuklukları ile ilişkilidir. Anahtar Kelimeler: Dış limitan membran, Diyabetik maküler ödem, Elipsoid zon, Hiperreflektif nokta, Optik koherens tomografi

Anahtar Kelimeler

• Dış limitan membran
• Diyabetik maküler ödem
• Elipsoid zon
• Hiperreflektif nokta
• Optik koherens tomografi

Hyperreflective Spots in Optical Coherence Tomography in Subjects with Diabetic Macular Edema

Abstract

ABSTRACT Objective:To investigate optic coherence tomography (OCT) findings of patients with diabetic macular edema (DME) and to analyze the relationship between these findings and the clinics. Methods:In this study, medical records of DME cases were investigated.Hyperreflective spots between inner limiting membrane and outer nuclear layer were determined as hyperreflective spots in inner layers, and those beyond outer nuclear layer were determined as hyperreflective points in outer layers.Another grouping was made according to whether ellipsoid zone (EZ) and external limiting membrane (ELM) had a regular appearance in OCT. Results:167-eyes of 125-cases were evaluated.Hyperreflective spots were in the inner retinal layers in 94.6% of the cases, while they were in the outer retinal layers in 57.5%.EZ disruption was present in 15.6% of the cases and ELM disruption was present in 15.6% of the cases.The best corrected visual acuity (BCVA) was significantly lower in the cases had hyperreflective spots in the inner or outer retinal layers, or had EZ or ELM disruptions (p<0.001, for all).In the presence of hyperreflective spots in the outer retinal layers, the probability of disruption in EZ and ELM was high (p<0.001), but probability of disruption in EZ and ELM did not increase in the presence of hyperreflective spots in the inner retinal layers (p>0.05). Conclusion:In DME, hyperreflective spots are more common in the inner retinal layers.Hyperrefective spots in both inner and outer retinal layers are associated with low visual acuity, while only the presence of hyperreflective spots in the outer retinal layers is associated with EZ and ELM disruptions. Key Words: Diabetic macular edema, Ellipsoid zone, External limiting membrane, Hyperreflective spot, Optical coherence tomography

Keywords

• Diabetic macular edema
• Ellipsoid zone
• External limiting membrane
• Hyperreflective spot
• Optical coherence tomography

References

1. 1. Yoshida S, Murakami T, Nozaki M, Suzuma K, Baba T, Hirano T, Sawada O, Sugimoto M, Takamura Y, Tsuiki E. Review of clinical studies and recommendation for a therapeutic flow chart for diabetic macular edema. Graefes Arch Clin Exp Ophthalmol 2020 Sep 30. doi: 10.1007/s00417-020-04936-w.
2. 2. Chung YR, Kim YH, Ha SJ, Byeon HE, Cho CH, Kim JH, Lee K. Role of Inflammation in Classification of Diabetic Macular Edema by Optical Coherence Tomography. J Diabetes Res 2019; 2019:8164250. doi: 10.1155/2019/8164250.
3. 3. Zhang X, Zeng H, Bao S, Wang N, Gillies MC. Diabetic macular edema: new concepts in patho-physiology and treatment. Cell Biosci 2014; 14: 4:27.
4. 4. İlhan Ç. Diyabetik maküler ödemde görüntüleme. Mersin Univ Saglik Bilim Derg 2018; 11: 376-382.
5. 5. Kostanyan T, Wollstein G, Schuman JS. New developments in optical coherence tomography. Curr Opin Ophthalmol 2015; 26:110-115.
6. 6. Kwan CC, Fawzi AA. Imaging and Biomarkers in Diabetic Macular Edema and Diabetic Retinopathy. Curr Diab Rep 2019; 19:95.
7. 7. Chung H, Park B, Shin HJ, Kim HC. Correlation of fundus autofluorescence with spectral-domain optical coherence tomography and vision in diabetic macular edema. Ophthalmology 2012; 119: 1056–1065.
8. 8. Danis RP, Hubbard LD. Imaging of diabetic retinopathy and diabetic macular edema. Curr Diab Rep 2011; 11: 236-243.

9. 9. Çıtırık M, İlhan Ç, Teke MY. Optik koherens tomografi. Güncel Retina 2017; 1: 58-68.
10. 10. Uji A, Murakami T, Nishijima K, Akagi T, Horii T, Arakawa N, Muraoka Y, Ellabban AA, Yoshimura N. Association Between Hyperreflective Foci in the Outer Retina, Status of Photoreceptor Layer, and Visual Acuity in Diabetic Macular Edema. Am J Ophthalmol 2012; 153: 710-717.
11. 11. Sabaner MC, Akdogan M, Doğan M, Oral AY, Duman R, Koca T, Bozkurt E. Inflammatory cytokines, oxidative and antioxidative stress levels in patients with diabetic macular edema and hyperreflective spots. Eur J Ophthalmol 2020 Oct 2; 1120672120962054. doi: 10.1177/1120672120962054.
12. 12. Bolz M, Schmidt-Erfurth U, Deak G, Mylonas G, Kriechbaum K, Scholda C. Diabetic Retinopathy Research Group Vienna. Optical coherence tomographic hyperreflective foci: a morphologic sign of lipid extravasation in diabetic macular edema. Ophthalmology 2009; 116: 914–920.
13. 13. Ogino K, Murakami T, Tsujikawa A, Miyamoto K, Sakamoto A, Ota M, Yoshimura N. Characteristics of optical coherence tomographic hyperreflective foci in retinal vein occlusion. Retina 2012; 32: 77–85.
14. 14. Turgut B, Yildirim H. The causes of hyperreflective dots in optical coherence tomography excluding diabetic macular edema and retinal venous occlusion. Open Ophthalmol J 2015; 9: 36–40.
15. 15. Vujosevic S, Bini S, Midena G, Berton M, Pilotto E, Midena E. Hyperreflective intraretinal spots in diabetics without and with nonproliferative diabetic retinopathy: an in vivo study using spectral domain OCT. J Diabetes Res 2013; 2013: 491835.
16. 16. Ibrahim AS, El-Remessy AB, Matragoon S, Zhang W, Patel Y, Khan S, Al-Gayyar MM, El-Shishtawy MM, Liou GI. Retinal microglial activation and inflammation induced by amadoriglycated albumin in a rat model of diabetes. Diabetes 2011; 60: 1122–1133.
17. 17. Mimouni M, Nahum Y, Levant A, Levant B, Weinberger D. Cystoid macular edema: a correlation between macular volumetric parameters and visual acuity. Can J Ophthalmol 2014; 49: 183–187.
18. 18. Browning DJ, Glassman AR, Aiello LP, Beck RW, Brown DM, Fong DS, Bressler NM, Danis RP, Kinyoun JL, Nguyen QD, Bhavsar AR, Gottlieb J, Pieramici DJ, Rauser ME, Apte RS, Lim JI, Miskala PH. Relationship between optical coherence tomography-measured central retinal thickness and visual acuity in diabetic macular edema. Ophthalmology 2007; 114: 525–536.
19. 19. Murakami T, Nishijima K, Akagi T, Uji A, Horii T, Ueda-Arakawa N, Muraoka Y, Yoshimura N. Segmentational analysis of retinal thickness after vitrectomy in diabetic macular edema. Invest Ophthalmol Vis Sci 2012; 53: 6668–6674.