Abstract

This study investigates the anatomical changes at the macula in patients with diabetic macular edema (DME) using Spectral Domain-Ocular Coherence Tomography (SD-OCT), highlighting the significance of SD-OCT in diagnosing and managing DME. The research encompasses the pathophysiological aspects of DME, the role of OCT in its evaluation, and the impact of various risk factors on macular changes. Background: Diabetic Macular Edema (DME) is a leading cause of vision impairment among patients with diabetic retinopathy, characterized by the accumulation of fluid in the macula due to the breakdown of the blood-retinal barrier. The study outlines the clinical and pathophysiological features of DME and emphasizes the importance of early detection and management to prevent vision loss. Spectral Domain-Ocular Coherence Tomography (SD-OCT) offers detailed imaging of retinal layers, making it an indispensable tool in the assessment of DME. Materials and Methods: The study was conducted at the Department of Anatomy along with Dept of Ophthalmology, S.M.S Hospital and Medical College, Jaipur, with a sample size of 100 eyes from treatment-naive patients with DME. Inclusion criteria were clearly defined to ensure the study's integrity. SD-OCT (Topcon 3D OCT 2000) was used to measure central macular thickness, the presence of intra-retinal cystoid spaces, and the integrity of the outer retinal layer at the fovea, among other parameters. Results: The study found significant anatomical changes in the macula among patients with DME, including increased central macular thickness and the presence of intra-retinal cystoid spaces. The average central macular thickness was found to be significantly higher in patients with DME, indicating the severity of macular edema. The integrity of the outer retinal layer at the fovea was compromised in a significant number of cases, correlating with decreased visual acuity. Conclusion: The findings underscore the utility of SD-OCT in the comprehensive assessment of DME, providing essential insights into the anatomical alterations at the macula. Early detection and accurate evaluation of macular changes using SDOCT can guide the management and treatment of DME, potentially improving visual outcomes for patients. The study also suggests the need for further research to explore the implications of these anatomical changes on the prognosis of DME

Description

Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia with significant systemic complications. Among the various complications, diabetic retinopathy (DR) emerges as a leading cause of blindness in the working-age population worldwide. Diabetic Macular Edema (DME), a consequence of DR, is the primary cause of vision loss in individuals with diabetes, attributed to the accumulation of fluid in the macula due to the breakdown of the blood-retinal barrier (1-3). The pathophysiology of DME is complex, involving both vascular and inflammatory pathways leading to the disruption of the inner and outer blood-retinal barriers. Chronic hyperglycemia plays a pivotal role in the pathogenesis, leading to the accumulation of advanced glycation end products (AGEs), upregulation of vascular endothelial growth factor (VEGF), and inflammation, thereby compromising the structural and functional integrity of retinal capillaries (4,5). Spectral Domain-Ocular Coherence Tomography (SD-OCT) has revolutionized the diagnosis and management of DME by providing high-resolution, cross-sectional images of the retina. This non-invasive imaging modality allows for the detailed visualization of retinal layer alterations and quantification of retinal thickness, offering invaluable insights into the diagnosis, monitoring, and treatment planning for patients with DME (6,7). Recent advancements in OCT technology, such as the introduction of spectral-domain and swept-source OCT, have further enhanced our understanding of DME. These technologies offer improved axial resolution and faster scanning speeds, facilitating comprehensive macular evaluation and enabling early detection of subtle macular changes, which are critical for timely intervention (8,9). This study aims to evaluate the anatomical changes at the macula in patients with DME using SD-OCT, exploring the relationship between macular alterations and visual acuity. By integrating clinical findings with SD-OCT imaging, we seek to underscore the importance of OCT in the assessment and management of DME, contributing to the optimization of therapeutic strategies and improvement of patient outcomes.