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Observational Study
. 2018 Feb 1;136(2):202-208.
doi: 10.1001/jamaophthalmol.2017.6256.

Disorganization of Inner Retina and Outer Retinal Morphology in Diabetic Macular Edema

Radha Das  1 , Gareth Spence  2 , Ruth E Hogg  1 , Michael Stevenson  1 , Usha Chakravarthy  1
Affiliations
Observational Study

Disorganization of Inner Retina and Outer Retinal Morphology in Diabetic Macular Edema

Radha Das et al. JAMA Ophthalmol. .

Abstract

Importance: In diabetic macular edema (DME), identification of baseline markers on spectral-domain optical coherence tomography (SD-OCT) and their association with severity of diabetic retinopathy (DR) might aid in disease management and the design of future trials.

Objective: To examine associations between DR severity, retinal morphology on SD-OCT, and visual acuity in participants with DME.

Design, setting, and participants: This cross-sectional observational case series was conducted at a single tertiary care referral center. Demographics, visual acuity, SD-OCT, and color fundus photographs of 80 individuals with DME (102 eyes) seen between December 28, 2013, and April 30, 2014, were analyzed between May 1 and July 31, 2016.

Main outcomes and measures: Features captured on SD-OCT and thickness metrics. On SD-OCT we graded type and shape of DME, shape and presence of septae within the intraretinal cystoid abnormalities, presence of hyperreflective dots and foci, integrity of the external limiting membrane and ellipsoid zone, presence and extent of disorganization of the inner retinal layers (DRIL), and the status of the vitreomacular interface and epiretinal membrane. We measured retinal thickness at the fovea and at the site of maximum pathology, choroidal thickness at the fovea, and 1000 μm temporal and nasal to the fovea. Color photographs were graded to derive a DR severity stage.

Results: The mean (SD) age was 63 (11) years, and 30 participants (37.5%) were women. The odds of having DRIL were greater in eyes with disrupted external limiting membrane (odds ratio [OR], 4.4; 95% CI, 1.6-12.0; P = .003), disrupted ellipsoid zone (OR, 2.7; 95% CI, 1.0-7.2; P = .03), presence of epiretinal membrane (OR, 2.8; 95% CI, 1.0-7.4; P = .03), and increase in retinal thickness at the fovea (OR, 1.6; 95% CI, 1.1-2.2; P < .001). Occurrence of DRIL was more likely in eyes with proliferative DR (OR, 7.3; 95% CI, 1.7-31.4; P = .007). Mean visual acuity decreased by approximately 4.7 letters for each 100-μm increase in the average global DRIL (95% CI, -7.9 to 1.4; P = .006).

Conclusions and relevance: An association was found between DRIL and disruption of the outer retina and increasing DR severity. Further longitudinal studies seem warranted to determine whether DRIL is a clinically relevant noninvasive morphological marker in eyes with DME.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Hogg reports grants from Novartis and Optos Plc outside of the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Spectral-Domain Optical Coherence Tomography Images of Disrupted Inner and Outer Retinal Layers
A, Spectral-domain optical coherence tomography image showing disrupted external limiting membrane (ELM) and ellipsoid zone (EZ) in diabetic macular edema (DME). The yellow line denotes disruption of the ELM and EZ. B, Spectral-domain optical coherence tomography image showing the presence of disorganization of the retinal layers (DRIL) and epiretinal membrane (ERM) in DME. Arrow depicts the epiretinal membrane. The area of DRIL is denoted by a line where the retinal boundaries cannot be identified.
See this image and copyright information in PMC

References

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