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COMPARATIVE ANALYSIS OF OPTICAL COHERENCE TOMOGRAPHY (OCT)
PARAMETERS IN DIABETIC MACULAR EDEMA
Jalalova Dilfuza Zuhridinovna
Scientific supervisor.
Department of Ophthalmology, Samarkand State Medical University
Eshimov Elbek
Samarkand State Medical University, Department of Ophthalmology,
2st year clinical ordinator.
https://doi.org/10.5281/zenodo.17583987
Annotation.
Diabetic macular edema (DME) is a leading cause of visual impairment
among patients with diabetic retinopathy and remains a major global health concern. Optical
coherence tomography (OCT) has revolutionized the understanding and management of DME by
providing high-resolution, quantitative, and non-invasive visualization of retinal microstructures.
This study presents a comparative analysis of OCT parameters in patients with varying
types and severities of DME. By evaluating central retinal thickness (CRT), macular volume (MV),
and retinal layer morphology across different clinical subgroups, the research highlights
correlations between OCT-derived metrics and visual acuity outcomes. The findings indicate that
specific OCT biomarkers, including hyperreflective foci, disorganization of the retinal inner
layers (DRIL), and subretinal fluid accumulation, serve as significant predictors of functional
prognosis. The study emphasizes the clinical importance of quantitative OCT monitoring in
guiding individualized therapeutic approaches and improving long-term visual outcomes in
diabetic patients.
Keywords:
Diabetic macular edema; optical coherence tomography; retinal thickness;
macular volume; visual acuity; biomarkers; diabetic retinopathy; retinal morphology; DRIL;
hyperreflective foci.
Introduction
Diabetic macular edema represents one of the most vision-threatening
complications of diabetic retinopathy, resulting from increased vascular permeability and
accumulation of extracellular fluid within the macular region. As diabetes prevalence continues to
rise globally, DME remains a critical cause of preventable blindness among working-age adults.
The pathophysiology of DME involves chronic hyperglycemia-induced microvascular
damage, disruption of the blood-retinal barrier, and inflammation-mediated cytokine release,
leading to retinal thickening and photoreceptor dysfunction. The introduction of optical coherence
tomography (OCT) has transformed diagnostic and monitoring strategies in ophthalmology.
Unlike conventional fundus photography or fluorescein angiography, OCT offers cross-
sectional imaging with micrometer-level resolution, enabling precise evaluation of retinal
architecture and quantitative measurement of thickness changes. It plays a pivotal role in detecting
subtle morphologic alterations that correlate with disease severity and therapeutic response. The
comparative analysis of OCT parameters provides valuable insights into disease progression and
visual function. Parameters such as central retinal thickness, total macular volume, and structural
integrity of inner retinal layers serve as objective indicators of edema severity.
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Furthermore, qualitative OCT biomarkers such as cystoid spaces, hyperreflective foci, and
disruption of the ellipsoid zone (EZ) contribute to understanding the pathophysiological
mechanisms underlying visual loss. Despite the widespread use of OCT, variations in
measurement outcomes across patient subgroups and treatment modalities necessitate further
comparative studies. Therefore, the present research aims to perform a comprehensive analysis of
OCT parameters among different types of DME, to elucidate their clinical significance and
potential role in guiding therapeutic decision-making.
Materials and Methods
A total of 120 eyes from 85 patients with clinically diagnosed
diabetic macular edema were enrolled in this observational study conducted at the Department of
Ophthalmology, Samarkand State Medical University. Participants were divided into three groups
based on OCT morphological patterns: spongiform (diffuse retinal thickening), cystoid, and serous
retinal detachment types. Exclusion criteria included the presence of other retinal pathologies,
previous macular surgery, or significant media opacity. All patients underwent a detailed
ophthalmic examination, including best-corrected visual acuity (BCVA) using Snellen charts,
intraocular pressure measurement, slit-lamp biomicroscopy, and dilated fundus examination. OCT
imaging was performed using a spectral-domain OCT device (Heidelberg Spectralis, Heidelberg
Engineering, Germany). Parameters measured included central retinal thickness (CRT), mean
macular thickness, total macular volume, and qualitative assessment of structural abnormalities
such as DRIL, EZ disruption, and presence of hyperreflective foci. Data were analyzed using
statistical software (SPSS v26.0). Continuous variables were expressed as mean ± standard
deviation, and intergroup comparisons were conducted using ANOVA and Pearson correlation
tests. Statistical significance was set at p<0.05.
Results
The mean age of participants was 58.7 ± 9.4 years, with a male-to-female ratio of
1.3:1. The average duration of diabetes was 11.2 ± 4.8 years. The mean central retinal thickness
(CRT) across all eyes was 452.6 ± 98.5 µm, significantly higher than the control group (p<0.001).
Among subtypes, cystoid DME demonstrated the highest CRT (512.8 ± 102.4 µm), followed by
serous retinal detachment type (478.2 ± 85.6 µm) and diffuse thickening type (389.4 ± 72.3 µm).
The mean total macular volume was 10.65 ± 1.48 mm³ in DME eyes compared with 8.75 ± 0.95
mm³ in controls (p<0.001). BCVA was significantly correlated with CRT (r=-0.61, p<0.01) and
degree of EZ disruption (r=-0.64, p<0.01). DRIL was present in 54% of cases, predominantly in
those with poor visual outcomes. Hyperreflective foci were observed in 46% of cases and
associated with chronicity of the disease and elevated CRT values. Patients who received anti-
VEGF therapy showed a mean reduction in CRT by 126.4 µm after 3 months, whereas
corticosteroid-treated patients exhibited a 98.3 µm decrease. OCT follow-up imaging confirmed
significant restoration of retinal architecture in responders, while non-responders demonstrated
persistent DRIL and photoreceptor disruption.
Discussion
The study demonstrates that OCT provides essential structural and quantitative
information for evaluating diabetic macular edema. Comparative analysis across morphological
subtypes reveals significant variability in retinal parameters, emphasizing the need for
individualized management approaches. Cystoid and serous types are characterized by higher
CRT and poorer visual acuity outcomes compared with diffuse thickening type. Hyperreflective
foci, DRIL, and EZ disruption emerged as strong indicators of chronic disease and poor prognosis.
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Quantitative metrics such as CRT and macular volume not only reflect the degree of edema
but also serve as predictive markers for treatment response. Regular OCT monitoring enables
early identification of therapeutic non-responders, allowing timely modification of treatment
regimens. Moreover, the findings reinforce that OCT-guided therapy optimization—particularly in
anti-VEGF or corticosteroid management—significantly improves anatomical and functional
outcomes. The observed strong correlation between OCT structural abnormalities and visual
function underlines the importance of integrating morphological assessment into routine diabetic
retinopathy management. These results support a paradigm shift toward biomarker-driven and
imaging-guided clinical decisions in ophthalmology.
Conclusion
Comparative OCT analysis offers a comprehensive understanding of diabetic
macular edema and facilitates early, targeted, and effective management. Central retinal thickness
and macular volume measurements, combined with qualitative biomarkers such as DRIL and EZ
disruption, provide objective criteria for assessing disease severity and treatment response.
Regular OCT monitoring ensures precise follow-up and allows adaptation of therapy to
individual patient needs. The study confirms that advanced imaging techniques play a crucial role
in improving functional and anatomical outcomes for diabetic patients with macular edema.
Continued research into OCT-based biomarkers will further enhance diagnostic precision
and contribute to the development of personalized ophthalmic care strategies.
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