Analysis Of Prevalence And Risk Factors For Different Types Of Diabetic Macular Edema

PURPOSE: To elucidate the prevalence for different types of diabetic macular edema(DME)and relationship between different typing methods,then analyze the correlation between retinal thickness and visual acuity and the risk factors for DME,in order to delay thedevelopment of DME and save patients' visual acuity.METHODS: The clinical and follow-up data of 135 patients(242 eyes)who were diagnosed diabetic retinopathy(DR)during January 2015 to November 2015 were reviewed.DR and DME were diagnosed based on the optical coherence tomography(OCT),fundus fluorescein angiography(FFA)andphotography,and they were divided into diffirent DME types and diffirent DR stages.DME were divided into three types according to FFA tests: focal leakage,diffuse leakage and diffuse cystoid leakage.And based on OCT tests they were divided into four types:sponge-like swelling macular edema(SME),cystoid macular edema(CME),serous retinal detachment(SRD)and posterior hyaloidal traction(PHT).Analyze the correlation betweenmacular thickness and visual acuity and the relationship between different types of DME and DR stages.Thenelucidate risk factors for diffirent types of DMEfrom the aspect of sex,age,body mass index(BMI),diabetes duration,fasting blood glucose,glycated hemoglobin(HA1c),duration of hypertension,blood pressure(systolic blood pressure,diastolic blood pressure,pulse pressure),hyperlipidemia(four types),microalbuminuria,proteinuria,anemia(Hb),smoking history andinsulin use.Results:1.Of all the 135 DR patients(242 eyes),75 eyes(30.99%)with mild NPDR,79 eyes(32.64%)with moderate NPDR,56 eyes(23.14%)with severe NPDR and 32 eyes(13.23%)with PDR;The proportion of OCT types: 43 eyes(17.77%)with no macular edema(NME),and 199eyes(82.23%)with macular edema,including165 eyes(68.18%)with SME,22 eyes(9.09%)with CME,7 eyes(2.89%)with SRD and 5(2.07%)with PHT;The proportion of FFA types:135 eyes(55.79%)with focal leakage,69 eyes(28.51%)with diffuse leakage,14 eyes(5.78 %)with diffuse cystoid leakage and24 eyes(9.92%)with no leakage.The proportion of each types were in different degrees(p <0.0001).2.DME can occur in every DR stage,anditsproportion ineach stage was in a increasing trend,there was a statistically significant difference(p <0.0001).3.The proportion of each type of DME patientsin different stages of DR was in a statistically significant difference(p <0.0001).4.We found that in the comparative study of FFA and OCT types,focal and diffuse leakage in FFA results are most performance for the sponge-like edema in OCT tests,and diffuse cystoid leakage most forcystoid edema,the difference was statistically significant(p <0.0001).5.Theaverage best-corrected visual acuity(BCVA)of 135 cases(242eyes)was Log MAR(0.29 ± 0.27),average macular thickness was(331.65 ± 53.16)?m,and the mean macular volume was(1.023 ± 0.16)?m3,with Pearson correlation analysis,we got a significant correlation between visual acuity and retinal thickness and macular volume(p<0.0001).6.The average BCVA of each OCT type were : SME = Log MAR(0.29 ± 0.23),CME =Log MAR(0.57 ± 0.30),SRD = Log MAR(0.61 ± 0.35),PHT = Log MAR(0.54 ± 0.43),NME =Log MAR(0.24 ± 0.26)?m;average macular thickness were: SME =(323.21 ± 24.85)?m,CME=(418.85 ± 95.25)?m,SRD =(422.25 ± 109.83)?m,PHT =(369.44 ± 42.16)?m,NME =(296.57 ± 21.42)?m;and average macular volume were: SME =(0.999 ± 0.09)?m3,CME =(1.256 ± 0.28)?m3,SRD =(1.249 ± 0.28)?m3,PHT =(1.196 ± 0.15)?m3,NME =(0.927 ± 0.07)?m3.There were significantly different in mean BCVA,macular thickness and volume of diffirent OCT types(P <0.0001).7.Inunivariate analysis,the risk factors associated with DME were sex,diabetes duration,insulin use,Hb A1 c,smoking,HDL-C,proteinuria and anemia;and SME-related risk factors include sex,diabetes duration,insulin use,Hb A1 c,smoking,HDL-C and proteinuria;CME-related risk factors were diabetes duration,insulin use,TC and proteinuria;SRD associated risk factors include diabetes duration,Hb A1 c,pulse pressure and HDL-C;and diabetes duration,proteinuria and anemia for PHT.Each of the above risk factors were statistically different from NME group(p <0.05).8.Logistic regression analysis showed that independent risk factors for DME werediabetes duration(OR=1.090;95%CI1.006,1.181),Hb A1c(OR=1.510;95%CI1.087,2.099)andproteinuria(OR=4.123;95%CI1.189,14.302)?The independent risk factorfor SME include diabetes duration(OR=1.092;95% CI 1.004,1.188),Hb A1c(OR=1.445;95% CI 1.024,2.039),and proteinuria(OR=3.942;95% CI 1.098,14.152);and proteinuria(OR=5.146;95% CI 1.094,24.211)and Hb A1c(OR=2.337;95% CI 1.063,5.139)for CME and SRD,respectively.CONCLUSION:1.DME can occur in every DR stages,and the prevalence increased with the aggravation of disease.SME of OCT type andfocal leakage of FFA type was in a highest rate,and theymostly occurredin mild and moderate NPDR,other types were relatively small,and they mostly occurs in severe NPDR and PDR stages.2.The coincidence diagnosis rate of these two tests was reach up to 92.15%.Two kinds of typing methods have a certain relationship.3.Visual acuity was negatively correlated withmacualr thickness and volume.The average macular thickness of SRD patients was thickest,SME was the thinnest,but all were thicker than NME.The average macular volume of CME was the largest,SME wasthe smallest,but allwere larger than NME.And the BCVA of SRD wasthe worst,SME was the best,but all wereworse than NME.4.Diabetes duration isthe common risk factors for DME and diffirent OCT types;sex,insulin use,Hb A1 c,smoking,HDL-C and proteinuria are the common risk factors for DME and SME;and anemia is also a risk factorfor DME,in addition,insulin use,TC andproteinuriaarethe risk factors for CME;Hb A1 c,pulse pressure and HDL-C for SRD;proteinuria and anemia for PHT.5.Diabetes duration,Hb A1 c and proteinuriaare the independent risk factors for DME and SME;proteinuriaand Hb A1 c for CME and SRD,respectively.