Abstract

Objective: Diabetic macular edema (DME) is the major cause of vision loss in patients with diabetic retinopathy (DR). The purpose of this study was to assess the prevalence of DME in pre diagnosed Type II diabetes mellitus cases, to analyze DME pattern based on Optical Coherence Tomography (OCT) images and to correlate it with glycemic control.

Methods: In cross sectional study, 200 eyes of 100 pre diagnosed type II diabetes mellitus cases were examined for DR, DME and OCT was performed to look for central macular thickness.

Result: 200 eyes were examined, 95 of them were diagnosed to have DR and 19 eyes were diagnosed to have DME. Three characteristics were found in the images of OCT in cases with DME: Diffuse retinal thickening in 9 eyes(42.4%), cystoid macular edema in7 eyes(36.8%) and serous retinal detachment in 3(15.8%). Statistical analysis showed that there was positive correlation of prevalence of DME with poor glycemic control (p<0.046), duration of diabetes (p<0.013), and severity of DR (p<0.000) but not with pattern of DME. There was statistic significance between central macular thickness and increasing grade of DME (p<0.000).

Conclusion: The prevalence of DME is 9.5% in type II diabetes mellitus cases in this study. Prevalence is correlated with DR severity, duration of diabetes, and poor glycemic control. Three patterns of DME are demonstrated with OCT images. The macular thickness is correlated to severity of DME.

Keywords: Diabetes Mellitus, Diabetic Maculopathy, Macular Edema, Pattern, Optical Coherence Tomography. 

1.      Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin Epidemi-ologic Study of Diabetic Retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 1984; 102: 520–526.

2.      Aiello LP, Gardner TW, King GL, Blankenship G, Cavallerano JD, Ferris III FL et al. Diabetic retinopathy. Diabetes Care 1998; 21: 143–156. 

3.      Gupta AK, Mazumdar S, Choudhary S (Eds). Diabetic Retinopathy, In: Practical Approach  toOphthalmoscopic Retinal Diagnosis. P. 302, Delhi, Jaypee Brothers, 2010.

4.      Engerman RL. Pathogenesis of diabetic retinopathy. Diabetes 1989;38:1203-1206. 

5.      Hariprasad SM, Mieler WF, Grassi M, Green JL, Jager RD, Miller L. Vision-related quality of life in patients with diabetic macular oedema. Br J Ophthalmol. 2008;92(1):89–92.

6.      Lamoureux EL, Tai ES, Thumboo J, et al. Impact of diabetic retinopathy on vision-specific function Ophthalm-ology. 2010;117(4):757–765. 

7.      Yau JW, Rogers SL, Kawasaki R, et al.Global prevalence and major risk factors of diabetic retinopathy.Diabetes care 2012 Mar;35(3):556-64.

8.      Agarwal RP, Ranka M, Beniawl R et al.Prevalence of diabetic retinopathy in type II diabetes in relation to risk factors: Hospital Based Study. Int. J Diab Dev Countries. 2003;23:16-19.

9.      Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiolo-gical    study of Diabetic Retinopathy IV. Diabetic Macular Edema. Ophthalmology 1984; 91:1464-1474.

10.  Chung M-S, Lee J-J, Lee C-T et al. Prevalence and risk factors of Taiwanese microalbuminuric type 2 diabetes mellitus with and without diabetic retinopathy. Actanephrologica 2011; 25(2):43-49.

11.  Lam CS, Benzie IF, Choi SW, Chan LY, Yeung VT, Woo GC. Relationship of Diabetic Retinopathy, Antioxidants and Glycaemic control. Optom Vis Sci. 2011 Feb; 88(2):251- 6.

12.  el Haddad OA, Saad MK.   Prevalence and risk factors for diabetic retinopathy among Omani diabetics. Br. J  Ophthalmol.1998 Aug;82(8):901-6.

13.  Wong TY¹, Mwamburi M, Klein R, Larsen M, Flynn H, Hernandez-Medina M et al. Rates of  progression in diabetic retinopathy during different time periods: a systematic review and meta-analysis. Diabetes care. Dec 2009; 32(12): 2307-2313.

14.  Ellis JD, Zvandasara T, Leese G, et al. Clues to duration of undiagnosed disease from retinopathy and maculopathy at diagnosis in type 2 diabetes: a cross sectional study. Br. J Ophthalmol. 2011 Sep;95(9): 1229-33.

15.  Patients with type 2 Diabetes Mellitus. International Journal of Endocrinology Volume 2012(2012), Article ID 157940, 8 Pages.

16.  Mohan Rema, sunndaramPremkumar, BalajiAnitha et al.Prevalence of Diabetic Retinopathy in Urban India: The Chennai urban Rural Epidemiology Study (CURES) Eye Study, I. IOVS, July 2005, Vol. 46, No.7.

17.  Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiological study of Diabetic Retinopathy. II. Prevalence and risk of diabetic retinopathy when age of diagnosis is less than 30 years. Arch ophthalmol 1984; 102:527-532.

18.  Malone JI, Morrison D, Pavan PR. Cuthberston DD. Diabetes Control and Complications Trial: prevalence and significance of Retinopathy in subjects with type I diabetes of less than 5 years duration screened for diabetes control and complication trial. Diabetes Care.2000; 124:500-506.

19.  Sanchez-Tocino H, Alvarez-Vidal A, Maldonado MJ et al. Retinal Thickness Study with optical coherence tomography in patients with diabetes. Invest Ophthalmol Vis Sci 2002;43:1588-94.

20.  Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemic-ological study of Diabetic Retinopathy. A comparison of retinopathy in younger and older onset Diabetic persons. AdvExp Med Biol1984;91:1464-1474.