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See Latest ArticlesAssessment of serous macular detachment in eyes with diabetic macular edema by use of spectral-domain optical coherence tomography
Graefe's Archive for Clinical and Experimental Ophthalmology, 06/25/09
Koleva-Georgieva D et al. - Spectral-domain OCT provided valuable information on retinal morphology and was particularly useful in diagnosing sub-clinical SMD in eyes with DME. It disclosed the presence and strength of macular traction either by partially detached posterior hyaloid or by epiretinal membranes. C-scans and C-scan OCT/SLO fundus image overlays added complementary information for the extent and location of the pathological features. Larger studies which follow subjects longitudinally are needed to explain the pathogenesis and determine the prognosis of SMD.
Desislava Koleva-Georgieva, 06/29/09
| The clinical diagnosis of serous macular detachment (SMD) became possible with the introduction of OCT. SMD drove our attention because its'pathogenesis and functional consequences are still not known. As for pathogenesis -two major factors are discussed in literature: ischemia and traction. Six of the 9 eyes with SMD in the present study had macular ischemia (the remaining 3 did not have early phase FA to judge the capillary dropout), and 5 eyes had severe ischemia in retinal periphery. We also found relationship between the presence of macular ischemia and macular edema types. This might be in support to the thesis, that eyes with ischemia are more likely to develop SMD. Traction on macula can be induced from incomplete posterior vitreous detachment (PVD) or a contracting epiretinal membrane. This study assessed both factors, and also attempted to describe the force of the traction by evaluating the presence of a distortion in the retinal contour. There was equal distribution of the 3 macular traction types among eyes with SMD, and there was also equal distribution among eyes with macular edema without SMD. It might be that traction was not a driving force. Still, the number of examined eyes was small, so further studies are needed. However, OCT could be benefitial in the evaluation of the presence and strength of macular traction in the preoperative work-up and postoperative follow-up of patients with macular traction. Some authors have observed in their studies that SMD was only a transitional step in the phase of edema absorption and that it does not have a bad outcome. In this study eyes with SMD were found to have lower visual acuity. Also, eyes with SMD were predominantly associated with severe cystoid edema. It might be that the worse visual acuity in our cohort is due to the accompaning severe cystoid edema and the presence of ischemia. But on the other hand - why SMD is more often associated with severe cystoid pattern and ischemia? Can SMD be a poor prognostic factor? More studies - large, prespective studies, that follow-up patients longitudinally are needed to answer this question. |
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