INTRODUCTION
Diabetic Retinopathy is an important cause of blindnessand is a progressive disease affecting the integrity of the microscopic vessels found in the retina, broadly divided into two clinical stages: non proliferative (NPDR) and proliferative diabetic retinopathy (PDR). Diabetic macular edema(DME) affects 15% of patients 15yrs after diagnosis (1). The prevalence of diabetes mellitus(DM) overall is expected to approximately double globally between 2000 and 2030 (2). The burden of DME is likely to increase as prevalence of DM is expected to rise by 50% globally, from 2000 to 2030 (3). DME affects central vision and can lead to decline in vision ranging from slight visual blurring to blindness, substantially affecting independence and quality of life (4-5). Clinically Significant Macular Edema (CSME) is defined as observation of retinal thickness or hard exudates accompanied with retinal thickening within 500μm of the center of the macula or if a zone of one- disc area size of retinal thickness is seen within one- disc diameter of the center of the macula, as per the Early Treatment of Diabetic Retinopathy Study (ETDRS report number 7, 1991).
ERA’S JOURNAL OF MEDICAL RESEARCH, VOL.5 NO.1
Received on : 16-05-2018
Accpected on : 25-05-2018
Address for correspondence
Dr. Luxmi Singh
Department of Ophthalmology
Era's Lucknow Medical College &
Hospital, Lucknow - 226003
Email: drluxmi@rediggmail.com
Contact no: +91-9369123042

Orignal Article

ERA’S JOURNAL OF MEDICAL RESEARCH

VOL.5 NO.1

DOI:10.24041/ejmr2018.55

DIABETIC MACULAR EDEMA IN ASSOCIATION WITH DIABETIC

RETINOPATHY IN PATIENTS OF TYPE 2 DIABETES MELLITUS

Luxmi Singh, Lubna Ahmed, Swati Yadav, Pragati Garg, B.B Lal

Department of Ophthalmology

Era’s Lucknow Medical College & Hospital, Sarfarazganj Lucknow, U.P., India-226003

ABSTRACT

Diabetic Retinopathy is an important cause of blindness with diabetic

macular edema(DME) affecting 15% of patients 15yrs after diagnosis. The prevalence of diabetes mellitus(DM) is expected to approximately double

globally between 2000 and 2030. The burden of DME is likely to increase as prevalence of DM is expected to rise by 50% globally, from 2000 to 2030. Therefore, is a major cause of concern. To study diabetic macular edema prevalence and pattern in association with severity of diabetic retinopathy in patients of type 2 diabetes mellitus. 300 patients with type 2 diabetes mellitus were included in anobservational cross sectional study. Clinical assessment

was done by recording Visual acuity by Snellen's drum test, slit lamp examination, direct and indirect ophthalmoscope, fundus examination with

+90 D lens, Goldman applanation tonometry, gonioscopy, Cirrus SD-OCT macula and fundus photography. Among 600 eyes, prevalence of DME was 14.0% and 24.3% in NPDR and PDR eyes respectively. Statistically, this difference was not significant (p=0.226).Among the categories of diabetic retinopathy, a significant increase in prevalence of DME was observed with increasing severity of NPDR (p<0.001). Among 87 eyes with DME, the pattern of DME was 59.8% with diffuse retinal thickening, 21.8% with cystoids macular edema and 18.4% with serous retinal detachment. Prevalence of DME was more in NPDR group increasing with severity of NPDR. The prevalence of DME pattern of diffused retinal thickening was most followed by cystoid macular edema and serous retinal detachment among those with diabetic retinopathy.

KEYWORDS: Diabetes mellitus, prevalence, DME, Diabetic retinopathy.

There is not enough literature establishing the prevalence of diabetic macular edema among those with diabetic retinopathy in patients of type 2 diabetes mellitus.

Materials and methods: It was an observational cross sectional study, including 300 prediagnosed type 2 diabetics, attending the ophthalmology OPD at Era University referred from Medicine OPD for fundus evaluation. Clinical examination included assessment of Visual acuity by Snellen's drum test, slit lamp examination, applanation tonometry, direct and indirect ophthalmoscope, fundus examination with +90 D lens, gonioscopy, fundus photography, Cirrus SD- OCT macula. The data was analyzed using Statistical Package for Social Sciences, version 15.0. For, categorical data Chi-square test was used whereas continuous data was analyzed using ANOVA and student "t"-test. Multi variate assessment was done using logistic regression. The confidence level of the study was kept at 95% and hence a "p" value less than 0.05 indicated a statistically significant association.

Result: Among 600 eyes ,a total of 65 (10.8%) had no retinopathy, 37 (6.2%) had PDR – of these 18 (3%) were mild to moderate PDR, 13 (2.2%) were high risk PDR and remaining 6 (1%) were advanced diabetic

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DIABETIC MACULAR EDEMAIN ASSOCIATION WITH DIABETIC RETINOPATHY IN PATIENTS OF TYPE 2 DIABETES MELLITUS

eyes. 493 (82.2%) had NPDR - of these 225 (45.6%) had as minimal NPDR, 152 (25.3%) had mild NPDR (25.3%), 72 (12%) as moderate NPDR, (1.6%) 10 very severe NPDR 34 (5.7%) severe NPDR.Those which could not be assessed were a total of 5 (0.8%) eyes.

Among categories of diabetic retinopathy, a significant increase in prevalence of DME was observed with increasing severity of NPDR (p<0.001). The prevalence rates increased from 10.7% to 70% from minimal to very severe NPDR groups. Prevalence of DME among all diabetics was 24.3% in PDR and14.0% in NPDR types respectively. This difference was statistically (p=0.226) insignificant.

The pattern of DME among DME eyes(n=87) was 59.8% (52) with diffuse retinal thickening, 18.4% (16) with serous retinal detatchment, and 21.8% (19) with cystoids macular edema.

DISCUSSION

Diabetic Retinopathy is an important cause of blindness with diabetic macular edema(DME) affecting 15% of patients 15yrs after diagnosis (1). The prevalence of diabetes mellitus(DM) is expected to approximately double globally between 2000 and 2030 (2). The burden of DME is likely to increase as prevalence of DM by 50% globally (3). Therefore, is a major cause of concern.

The prevalence of diabetic macular edema among diabetic retinopathy patients-Wong et al. (2008)7- 16.3%.Wang FH et al 8(2009) Study from rural China-

12%. Yauet al. (2012) (9) - 7.48%. Ding and Wong(2012) (8)-10% in USA.Leeet al. (2015) 9metaanalysis- range from 1.4% to 33.3% in different studies. We found it to be 13% in diabetic eyes with retinopathy whereas the overall prevalence in diabetic eyes (n=600) 14.5%.

Prevalence of DME was 14.0% and 24.3% in NPDR and PDR types and 10.7% among those without retinopathy. No significant association of DME with different ETDRS categories of DR was seen. However, within NPDR subtype a significant association between severity of NPDR and DME was observed. The findings suggest that the regular course of diabetic retinopathy progression does not correlate with the course of diabetic macular edema progression.

Considering the pattern of DME amongst DR patients - 59.8% had diffuse retinal thickening followed by 21.8% having Cystoid macular edema and 18.4% having serous retinal detachment. Similar to results-Otani T et al(1999) (10), Cater A et al (2005) (11) Serous retinal detatchment prevalence in series by Munk Mr et al (1999) (12) Ozdemir H et al (2005) varied from 15% to 31%.Cystoid macular edema pattern was slightly lower in our study as compared to the finding of Otani et al. (1999) (10) who reported it to be 47%.This differences in pattern findings to that of others could be attributed to the fact that we assigned only one pattern to an eye and included the dominating pattern. Whereas in some other studies 14 more than one patterns were identified and reported from a single eye.

 

SN

DR

 

Total No.

 

With DME

 

Without DME

 

Statistical

 

 

 

 

 

 

 

 

 

(n=87)

 

 

(n=513)

 

 

Significance

 

 

 

 

 

 

 

No.

 

 

%

 

No.

 

%

 

χ2

‘p’

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

 

No retinopathy

65

7

 

 

10.7

56

 

86.15

0.025

 

0.874

 

2.

 

NPDR

493

71

 

 

14.4

424

 

86.0

0.567

 

0.452

 

 

 

 

Minimal NPDR

225

24

 

 

10.7

201

 

89.3

 

 

 

 

 

 

 

 

Mild NPDR

152

18

 

 

11.8

134

 

88.2

 

 

 

Less

 

 

 

Moderate NPDR

72

11

 

 

15.3

61

 

84.7

 

 

 

 

 

 

Severe NPDR

34

9

 

 

26.5

25

 

73.5

 

 

 

than

 

 

 

Very Severe NPDR

10

7

 

 

70.0

3

 

30.0

33.2

 

0.001

 

 

 

 

DR

 

Total No.

 

With DME

 

Without DME

 

Statistical

 

SN

 

 

 

 

 

 

 

 

 

 

 

(n=87)

 

 

(n=513)

 

 

Significance

 

 

 

 

 

 

 

No.

 

%

 

No.

 

%

 

χ2

‘p’

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

 

PDR

 

37

 

9

 

 

24.3

 

28

 

75.7

 

3.07

 

0.08

 

 

 

 

Mild to moderate PDR

 

18

 

3

 

 

16.7

 

15

 

83.3

 

 

 

 

 

 

 

 

High risk PDR

 

13

 

5

 

 

38.5

 

8

 

61.5

 

 

 

 

 

 

 

 

Advanced Diabetic

 

6

 

1

 

 

16.7

 

5

 

83.3

 

2.18

 

0.337

 

4.

 

 

 

 

 

 

 

 

 

 

 

 

Cannot be assessed

 

5

 

0

 

 

0

 

5

 

100

 

0.855

 

0.355

 

Table 1. Severity Diabetic Retinopathy (ETDRS) With Diabetic MacularEdema (n=600eyes )

ERA’S JOURNAL OF MEDICAL RESEARCH, VOL.5 NO.1

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Jan - June 2018

ERA’S JOURNAL OF MEDICAL RESEARCH

VOL.5 NO.1

 

70

 

ME

60

 

 

50

 

with

 

 

 

40

 

Percentage

 

 

 

30

 

 

 

 

 

 

20

 

 

 

10

 

 

 

0

 

 

 

retinopathy

No

 

Minimal

NPDR

NPDR

Mild

r

 

te

 

a

 

ode

M

R

 

R

D

 

 

 

 

D

 

P

 

 

 

 

 

P

 

N

 

N

 

 

re

 

 

 

severe

 

e

 

v

 

 

 

e

 

 

 

 

S

 

 

 

 

 

ery

 

to

 

V

 

Mild

 

 

 

 

NPDR

PDR

 

 

PDR

Disease

assessed

moderate High

risk

 

 

 

 

 

 

 

 

 

 

Diabetic

 

be

 

 

Advanced

 

Cannot

 

 

 

 

 

 

 

 

REFERENCES

1.

Shaw Je,Sicree RA,ZimmetPz.Global Estimates

 

of the prevalence of diabetes for 2010 and

 

20130.Dibetes Res Clin Pract 20101;87:4-14.

2.

Wild S.et al,Global Prevalence of diabetes:

 

estimates for the year 2000 and projecyions for

 

2030.Diabetes Care 2004:27:1047-1053.

3.

Chen E et al. Burden of illness of diabetic macular

 

edema:literature review.Curr Med Res

 

Opin2010;28-1587-1597.

4.

Hariprasad SM,Mieler WF,Grassi M,Green

 

JL,Jager RD,et al.Vision- related quality of life in

Fig1: Diabetic macular edema Prevalence

withSeverity of diabetic retinopathy(n=600 eyes )

SN

Characteristic

No. of Eyes

Percentage

1.

Diffuse retinal thickening

52

59.8

2.

Cystoid macular edema

19

21.8

3.

Serous retinal detachment

16

18.4

Table 2: Patterns of DME (EDTR) in Diabetic

Macular Edema Eyes (n=87eyes )

patients with diabetic macular aedema.Br J

Ophthalmol.2008;92:89-92.

5. Lamoureux EL,TaiES,Thumboo J ,et al.Impact of

diabetic retinopathy on vision-specific

function.Ophthalmology.2010;117:75-756.

6. Yang W,Lu J Weng J et al.China National

Diabetes and Meatabolic Disorder Study

Group.Prevalance of Diabetes among men and

women in China.N Eng J Med 20101;362:1090-

1101.

Serous retinal

detachment

18.4%

Cystoid macular

Diffuse retinal

7. Wang FH, Liang YB, Zhang F ,et al.Prevalance of

diabetic retinopathy in rural China:the Handan

Eye Study.Ophthalmology.2009;116:461-67.

edema

thickening

8. Lee R,Wong TY,Subanayagam C.Epidemiology

21.8%

59.8%

Fig2: Patterns of DME in

DME Eyes (n=87eyes )

 

CONCLUSION

 

 

No statistically

significant correlation

was

established when DME was correlated with different EDTRS categories of diabetic retinopathy. However, DME prevalence showed increase with increase in grade of severity of NPDR. Occurance of diabetic macular edema is independent of diabetic retinopathy status of a diabetic eye.

The prevalence of DME pattern of diffused retinal thickening is the most with cystoids macular edema and serous retinal detatchment following next, among eyes with diabetic retinopathy.

of diabetic retinopathy,diabetic macular edema

and related vision loss.Eye and vision 2015;2:17.

9. Otani T,KishiS,Maruyama et al.Patterns of

diabetic macular edema with OCT.Am J

Ophthalmol.1999;127:688-693.

10. C a t i e r A , Ta d a y o n i

R , P a q u e s M , e t

al.Characterisation of

macular edema from

v a r i o u s e t i o l o g i e s b y O C T . A m J Ophthalmol.2005;140:200-206.

11.Munk MR, Sac S,Huf W, et al.Differential diagnosis of macular edema of different pathophysiological origins by spectral domain OCT.Retina.2014;34:2218-2232.

12.OzdemirH,KaracorluM,Karacorlus.Serous macular detatchment in diabetic cystoids macular edema.ActaOphthalmol Scan.2005;83:63-66.

▄ ▄

How to cite this article : Singh L., Ahmad L., Yadav S., Garg P., Lal B.B., Diabetic Macular Edemain Association With Diabetic

Retinopathy In Patients Of Type 2 Diabetes Mellitus. EJMR2018;5(1):6-8.

ERA’S JOURNAL OF MEDICAL RESEARCH, VOL.5 NO.1

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