Diabetic macular edema with pachychoroid features
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RESEARCH ARTICLE
Open Access
Diabetic macular edema with pachychoroid features Kyungeun Kang†, Hyungwoo Lee†, Minsu Jang, Hyung Chan Kim and Hyewon Chung*
Abstract Background: To investigate the clinical features of diabetic macular edema (DME) in eyes with pachychoroid phenotypes using multimodal retinal imaging. Methods: We retrospectively reviewed 210 eyes from 210 DME patients and analyzed the clinical and imaging parameters, including visual acuity, central macular thickness (CMT), subfoveal choroidal thickness (SFCT) and neural retina layer thickness (NRT). The DME eyes were divided into two groups: group 1 (80 eyes with submacular detachment [SMD]) and group 2 (130 eyes without SMD). The clinical and imaging parameters of 285 eyes from 285 diabetic patients without DME were collected as a control group. Results: DME eyes with pachychoroid phenotypes were more frequent in group 1 than in group 2 (53 eyes [66.25%] and 53 eyes [40.77%], respectively, P < 0.001). Pachychoroid phenotypes were identified in 108 (37.90%) of the control eyes. CMT and NRT were greater in group 1 than in group 2. In group 1, 37 eyes had SMD combined with focal edema, and 43 eyes had SMD combined with diffuse-type edema. No significant difference in pachychoroid phenotypes was found between the focal and diffuse types (26 [70.27%] and 27 [62.79%], respectively, P = 0.481). In group 2, 70 eyes had focal-type edema, and 60 eyes had diffuse-type edema. No significant difference in the frequency of pachychoroid phenotypes was found (32 [45.71%] and 21 [35.00%], respectively, P = 0.215). Interestingly, among the 70 eyes with focal edema in group 2, 13 (40.6%) and 5 (13.2%) eyes with and without pachychoroid phenotypes showed no definite microaneurysms, respectively. Conclusion: SMD and focal edema without definite microaneurysms may be clinical manifestations of DME with pachychoroid phenotypes and possibly related to choroidal circulation disturbance in DME. Keywords: Diabetic retinopathy, Diabetic macular edema, Pachychoroid, Central macula thickness, Subfoveal choroidal thickness
Background Diabetic macular edema (DME) is the most common cause of vision loss in diabetic retinopathy (DR), and its prevalence increases up to 28–29% in patients with a diabetes duration greater than 20 years [1]. Since Otani et al. [2] reported three patterns of DME, namely, diffuse swelling, cystoid macular edema (CME) and serous macular detachment (SMD), using optical coherence * Correspondence: [email protected] † Kyungeun Kang and Hyungwoo Lee contributed equally to this work. Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
tomography (OCT), the clinical manifestations of each type of DME, including detailed morphologic classifications, have been described [3]. OCT can discriminate DME types, including those with SMD, which is difficult to diagnose by biomicroscopy or fluorescein angiography (FA) [4]. More recently, diffuse and focal ed
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