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New insights into the pathoanatomy of diabetic macular edema: angiographic patterns and optical coherence tomography

 Byeon, Suk Ho  ;  Chu, Young Kwang  ;  Hong, Young Taek  ;  Kim, Min  ;  Kang, Hae Min  ;  Kwon, Oh Woong 
 Retina- the Journal of Retinal and Vitreous Diseases, Vol.32(6) : 1087-1099, 2012 
Journal Title
 Retina- the Journal of Retinal and Vitreous Diseases 
Issue Date
Adult ; Aged ; Aged, 80 and over ; Blood-Retinal Barrier/physiology ; Diabetic Retinopathy/diagnosis* ; Diabetic Retinopathy/physiopathology ; Female ; Fluorescein Angiography* ; Humans ; Macular Edema/pathology* ; Macular Edema/physiopathology ; Male ; Middle Aged ; Retinal Vessels/physiopathology ; Retrospective Studies ; Tomography, Optical Coherence*
autofluorescence ; cystoid macular edema ; diabetic macular edema ; fluid conductivity ; fluorescein angiography ; Henle layer ; microaneurysm ; optical coherence tomography ; plexiform layer
PURPOSE: To describe the pathoanatomy of diabetic macular edema in optical coherence tomography and its correlation with fluorescein angiography patterns. METHODS: Sixty eyes of 56 patients were analyzed. Diabetic macular edema was classified into typical focal leakage (from microaneurysm), typical diffuse leakage (the capillary plexus), or combined/questionable leakage using fluorescein angiography and retinal thickness profiles. The leakage and pooling patterns in fluorescein angiography were matched to the corresponding optical coherence tomography images and analyzed. RESULTS: Focal leakage shows swelling predominantly in the outer plexiform layer (OPL). Deeply located microaneurysms directly leak into the loose fiber portion of OPL (Henle layer) through the "fluid conductivity barrier" (synaptic portion of OPL). Diffuse leakage caused swelling predominantly in the inner nuclear layer and secondarily in the OPL. The deep capillary plexus is located between the two "fluid barriers" (inner plexiform layer and OPL); thus, diffuse leakage is primarily related with swelling in the inner nuclear layer. In the combined/questionable leakage, partial sections consisting of inner nuclear layer swelling and much larger areas of OPL/outer nuclear layer swelling are noticed. CONCLUSION: Based on the concept of the fluid conductivity barrier, we revealed a correlation between the intraretinal location of the leakage source and where the fluid accumulated within the retinal layers.
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1. College of Medicine (의과대학) > Dept. of Ophthalmology (안과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Hae Min(강혜민)
Kwon, Oh Woong(권오웅)
Kim, Min(김민) ORCID logo https://orcid.org/0000-0003-1873-6959
Byeon, Suk Ho(변석호) ORCID logo https://orcid.org/0000-0001-8101-0830
Hong, Young Taek(홍영택)
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