Purpose  To discuss the relationship between macular autofluorescence and the density of macular pigment in the eyes with cystoid macular edema .Furthermore to provide the valuable parameters for patients followup.
Methods In a retrospective case series study, 35 eyes (28 cases) with diabetic macular edema, central vein occlusion and branch vein occlusion were included from July 2009 to May 2011. 35 age and sex-matched normal eyes were as the control eyes. CME was studied by color fundus photography, fluorescent angiography (FFA) and optical coherence tomography (OCT). Autoflorescence was recorded by Heidelberg retinal angiography 2 (HRA2) system Fluorescein angiography (FA) model. Macular pigment was evaluated using HRA2 IF (infrared) and FA model. The density of macular pigment was graded into three categories: those without foveal macular pigment, those with partial macular pigment and those with mormal amount macular pigment. Eyes from the age-matched subjects were used as the control eyes. Monte Carlo exact test to test the correlation of the density of macular pigment and the fundus autofluorecence, liner by liner associate test to interpret the liner trend of the two variables. Morphology and distribution of macular autofluorece, the density and distribution of macular pigment were used as the main outcome measures.

Results All the eyes with CME had petaloid-shaped autofluorecence in the macular area (100%). No autofluorecence was found in the control eyes (0).The density of the macular pigment varied from without macular pigment (33 eyes, 94.3%) to partial macular pigment (2 eyes, 5.7%) accordingly in the eyes with CEM. However, all the normal eyes present normal amount macular pigment (100%). Macular autofluorecence presents minus correlation with the macular pigment in the study. Cystoid macular edema cases had a strong autofluorescence signal, which disappeared one month after the successful treatment of intravitreal injection of anti-VEGF agent, laser or intravitreal tramcinolone acetonide.

Conclusions Autofluorescence is a novel approach to demonstrating cystoid macular edema. autofluorecence can be used to follow up parameter for patients with CME. This technique can also be used to confirm post-treatment outcome of cystoid macular edema. The present of macular autofluorecence minus correlates the density of macular pigment.