Optical coherence tomography (OCT) for detection of macular oedema in patients with diabetic retinopathy

• Published in: Cochrane database of systematic reviews 2015-01, Vol.1, p.CD008081-CD008081
• Main Authors: Virgili, Gianni, Menchini, Francesca, Casazza, Giovanni, Hogg, Ruth, Das, Radha R, Wang, Xue, Michelessi, Manuele
• Format: Article
• Language: English
• Subjects: Diabetic Retinopathy - complications; Diagnostic Errors; Humans; Macular Edema - diagnosis; Macular Edema - etiology; Macular Edema - pathology; Randomized Controlled Trials as Topic; Retina - pathology; Selection Bias; Sensitivity and Specificity; Tomography, Optical Coherence - methods
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD008081.pub3

Diabetic macular oedema (DMO) is a thickening of the central retina, or the macula, and is associated with long-term visual loss in people with diabetic retinopathy (DR). Clinically significant macular oedema (CSMO) is the most severe form of DMO. Almost 30 years ago, the Early Treatment Diabetic Retinopathy Study (ETDRS) found that CSMO, diagnosed by means of stereoscopic fundus photography, leads to moderate visual loss in one of four people within three years. It also showed that grid or focal laser photocoagulation to the macula halves this risk. Recently, intravitreal injection of antiangiogenic drugs has also been used to try to improve vision in people with macular oedema due to DR.Optical coherence tomography (OCT) is based on optical reflectivity and is able to image retinal thickness and structure producing cross-sectional and three-dimensional images of the central retina. It is widely used because it provides objective and quantitative assessment of macular oedema, unlike the subjectivity of fundus biomicroscopic assessment which is routinely used by ophthalmologists instead of photography. Optical coherence tomography is also used for quantitative follow-up of the effects of treatment of CSMO. To determine the diagnostic accuracy of OCT for detecting DMO and CSMO, defined according to ETDRS in 1985, in patients referred to ophthalmologists after DR is detected. In the update of this review we also aimed to assess whether OCT might be considered the new reference standard for detecting DMO. We searched the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment Database (HTA) and the NHS Economic Evaluation Database (NHSEED) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2013), EMBASE (January 1950 to June 2013), Web of Science Conference Proceedings Citation Index - Science (CPCI-S) (January 1990 to June 2013), BIOSIS Previews (January 1969 to June 2013), MEDION and the Aggressive Research Intelligence Facility database (ARIF). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 25 June 2013. We checked bibliographies of relevant studies for additional references. We selected studies that assessed the diagnostic accuracy of any OCT model for detecting DMO or CSMO in