Title: A double hit to the macula: Staging hypertension's impact on diabetic macular edema via Optical Coherence Tomography
Abstract:
Introduction: Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia resulting from impaired insulin secretion, insulin action, or both. Among ocular complications, Diabetic Retinopathy is a leading cause of preventable blindness worldwide. One of its most visually significant manifestations is Diabetic Macular Edema, which occurs due to leakage of fluid from damaged retinal capillaries into the macular region.
The coexistence of diabetes and hypertension is frequently encountered in clinical practice, and both conditions share common pathogenic pathways involving microvascular dysfunction and chronic inflammation.
Objectives: To evaluate diabetic macular edema with the different stages of Hypertension in type 2 diabetes patients.
Methodology: A cross-sectional study was conducted on 216 diabetic patients. Patients aged 40 years and above, Diagnosed with Type2 diabetes mellitus with diabetic macular edema were included in the study. Patients with other retinal disorders affecting the macula, History of ocular trauma or retinal surgery, Presence of significant media opacity preventing fundus visualization, Macular edema due to causes other than diabetes, Secondary hypertension like Obstructive sleep apnea, Chronic Kidney disease, Renal artery stenosis, Aortic stenosis, Aortic dissection, Drug induced hypertension, Endocrine disorders except Type 2 Diabetes mellitus, White coat hypertension , Malignant Hypertension, Hypertensive Emergency, Hypertensive Urgency were excluded from the study.
After a thorough ophthalmic examination SD OCT was performed to diagnose diabetic macular edema. Blood pressure was measured and graded according to 2025 AHA Hypertension Staging (Office BP) classification. The following OCT features were considered indicative of DME.
· Increase in Central Macular Thickness (CMT) withCentral retinal thickness >250–300 µm
· Intraretinal Cystoid Spaces
· Subretinal Fluid
· Diffuse Retinal Thickening
· Hyperreflective Foci
· Disorganization of Retinal Inner Layers (DRIL).
Results: The main outcome was Central Macular Thickness(CMT). 24% had duration 5-10 years, 38% in between 11-15 years, 28% in between 16-20 years and 10%>20 years. The mean Systolic blood pressure 141±12.73 and the mean Diastolic Blood Pressure was 92.52±7.13. Both mean SBP and mean DBP were significantly high. There was statistically significant correlation between systemic blood pressure values and Central Macular Thickness (CMT) measured via Optical Coherence Tomography (OCT). It showed higher prevalence of complex morphological patterns—such as subretinal fluid detachment, pronounced intraretinal cystoid spaces, and diffuse retinal thickening—in hypertensive diabetic patients.
Conclusion: Diabetic maculopathy was significantly associated with systemic risk factors like high blood pressure, thus early detection of this risk factor and there by prevent the significant visual loss in diabetic patient. and its control prevent the development and progression of maculopathy.
