24-Hour variation of optical coherence tomography-measured retinal thickness in diabetic macular edema

ArticleinEuropean journal of ophthalmology 22(5):785-91 · January 2012with6 Reads
DOI: 10.5301/ejo.5000119 · Source: PubMed
Purpose: To investigate 24-hour variation in retinal thickness in patients with diabetic macular edema (DME) using optical coherence tomography (OCT). Methods: Fifty-three eyes of 53 diabetic patients with clinically significant macular edema and central subfield thickness (CST) >225 µm, 36 eyes of 36 healthy individuals (normal controls), and 22 eyes of 22 diabetic patients without macular pathology (diabetic controls) underwent 5 OCT measurements at 7 am, 10 am, 3 pm, 8 pm, and 1 am. Visual acuity, blood pressure, blood glucose, and body temperature were measured as well. Results: The CST (p<0.0005), total macular volume (p<0.0005), and visual acuity (p<0.0005) showed significant variation in patients. The CST (450 µm at 7 am) reached a minimum at 3 pm (absolute change of -49 µm, relative change of -17%) before increasing again. Thickening changes were higher in more thickened retinas (p<0.0005, p=0.024, absolute and relative change, respectively). Visual acuity was worse in the morning (0.38 logMAR) and improved to a maximum at 8 pm (0.30 logMAR) (p<0.0005). Blood pressure, blood glucose, and body temperature did not vary over time. Conclusions: The 24-hour variation of retinal thickness is observed in a large proportion of patients with DME, with a decrease from morning to afternoon. Time of examination should be taken into account when managing such patients.
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose: We estimated coefficients of repeatability for Spectralis optical coherence tomography (OCT)-derived automated retinal thickness and volume measurements in subjects with center-involving diabetic macular edema (DME). Methods: A total of 50 eyes of 50 consecutive patients with center-involving DME underwent four consecutive "fast" volume scans at a single session using one OCT device operated by one of two experienced operators. Bland-Altman coefficients of repeatability (CR) were calculated for automated retinal thickness measurements in the nine Early Treatment of Diabetic Retinopathy Study (ETDRS) subfields, center point thickness, and total macular volume. Scans were evaluated for significant automated retinal boundary detection error and revised estimates for CR calculated with these scans excluded. Results: CR in the central subfield was 8.03 μm (95% confidence interval [CI] 7.70-8.35 μm). In other subfields, CR ranged from 6.54 to 18.25 μm. Scan sets from 13 subjects had significant boundary detection error; reanalysis with these excluded yielded a CR for the central subfield of 7.44 μm with CR for all other subfields <8 μm. Conclusions: Retinal thickness measurements in subjects with DME obtained using Spectralis OCT are considerably less variable than has been reported with other devices. Changes in central subfield thickness >8 μm can be considered more indicative of true clinical change rather than measurement variability. This finding informs clinical practice and clinical trial design.
    Article · Oct 2012
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