Giacomo Panozzo1, Maria Vittoria Cicinelli2, Albert J Augustin3, Maurizio Battaglia Parodi2, Josè Cunha-Vaz4, Giuseppe Guarnaccia5, Laurent Kodjikian6, Lee Merrill Jampol7, Anselm Jünemann8, Paolo Lanzetta9, Anat Löwenstein10, Edoardo Midena11, Rafael Navarro12, Giuseppe Querques2, Federico Ricci13, Ursula Schmidt-Erfurth14, Rufino Martins da Silva15, Sobha Sivaprasad16, Monica Varano17, Gianni Virgili18, Francesco Bandello2. 1. Istituto Clinico Sant'Anna, Brescia, Italy. 2. Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. 3. Department of Ophthalmology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany. 4. Association for Innovation and Biomedical Research on Light and Image (AIBILI), University of Coimbra, Coimbra, Portugal. 5. European School of Advanced Studies in Ophthalmology, Lugano, Switzerland. 6. Service d'Ophtalmologie, Hôpital de la Croix-Rousse, CHU de LYON, Hospices Civils de Lyon & Université de Lyon 1, Lyon, France. 7. Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 8. Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany. 9. Istituto Europeo di Microchirurgia Oculare (IEMO), University of Udine, Udine, Italy. 10. Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel. 11. Department of Ophthalmology, University of Padova, Padova, Italy. 12. Instituto de Microcirugia Ocular, Barcelona, Spain. 13. UOSD Patologie Retiniche, Policlinico Tor Vergata, University Tor Vergata, Rome, Italy. 14. Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria. 15. Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal. 16. NIHR Biomedical Research Centre, Moorfields Eye Hospital, London, UK. 17. IRCCS Fondazione G.B. Bietti per lo Studio e la Ricerca in Oftalmologia, Rome, Italy. 18. Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Abstract
AIMS: To present an authoritative, universal, easy-to-use morphologic classification of diabetic maculopathy based on spectral domain optical coherence tomography. METHODS: The first draft of the project was developed based on previously published classifications and a literature search regarding the spectral domain optical coherence tomography quantitative and qualitative features of diabetic maculopathy. This draft was sent to an international panel of retina experts for a first revision. The panel met at the European School for Advanced Studies in Ophthalmology headquarters in Lugano, Switzerland, and elaborated the final document. RESULTS: Seven tomographic qualitative and quantitative features are taken into account and scored according to a grading protocol termed TCED-HFV, which includes foveal thickness (T), corresponding to either central subfoveal thickness or macular volume, intraretinal cysts (C), the ellipsoid zone (EZ) and/or external limiting membrane (ELM) status (E), presence of disorganization of the inner retinal layers (D), number of hyperreflective foci (H), subfoveal fluid (F), and vitreoretinal relationship (V). Four different stages of the disease, that is, early diabetic maculopathy, advanced diabetic maculopathy, severe diabetic maculopathy, and atrophic maculopathy, are based on the first four variables, namely the T, C, E, and D. The different stages reflect progressive severity of the disease. CONCLUSION: A novel grading system of diabetic maculopathy is hereby proposed. The classification is aimed at providing a simple, direct, objective tool to classify diabetic maculopathy (irrespective to the treatment status) even for non-retinal experts and can be used for therapeutic and prognostic purposes, as well as for correct evaluation and reproducibility of clinical investigations.
AIMS: To present an authoritative, universal, easy-to-use morphologic classification of diabetic maculopathy based on spectral domain optical coherence tomography. METHODS: The first draft of the project was developed based on previously published classifications and a literature search regarding the spectral domain optical coherence tomography quantitative and qualitative features of diabetic maculopathy. This draft was sent to an international panel of retina experts for a first revision. The panel met at the European School for Advanced Studies in Ophthalmology headquarters in Lugano, Switzerland, and elaborated the final document. RESULTS: Seven tomographic qualitative and quantitative features are taken into account and scored according to a grading protocol termed TCED-HFV, which includes foveal thickness (T), corresponding to either central subfoveal thickness or macular volume, intraretinal cysts (C), the ellipsoid zone (EZ) and/or external limiting membrane (ELM) status (E), presence of disorganization of the inner retinal layers (D), number of hyperreflective foci (H), subfoveal fluid (F), and vitreoretinal relationship (V). Four different stages of the disease, that is, early diabetic maculopathy, advanced diabetic maculopathy, severe diabetic maculopathy, and atrophic maculopathy, are based on the first four variables, namely the T, C, E, and D. The different stages reflect progressive severity of the disease. CONCLUSION: A novel grading system of diabetic maculopathy is hereby proposed. The classification is aimed at providing a simple, direct, objective tool to classify diabetic maculopathy (irrespective to the treatment status) even for non-retinal experts and can be used for therapeutic and prognostic purposes, as well as for correct evaluation and reproducibility of clinical investigations.
Authors: Alessandro Meduri; Giovanni William Oliverio; Luigi Trombetta; Marta Giordano; Leandro Inferrera; Costantino John Trombetta Journal: J Ophthalmol Date: 2021-03-24 Impact factor: 1.909
Authors: Rony Carlos Preti; Claudio Iovino; Maria Fernanda Abalem; Rafael Garcia; Helen Nazareth Veloso Dos Santos; Gustavo Sakuno; Adrian Au; Leonardo Provetti Cunha; Leandro Cabral Zacharias; Mario Luiz Ribeiro Monteiro; Srinivas Reddy Sadda; David Sarraf Journal: Transl Vis Sci Technol Date: 2021-02-05 Impact factor: 3.283