Vitreoretinal Service, Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis2Department of Ophthalmology, Cairo University, Cairo, Egypt.
medical student, University of Minnesota Medical School, Minneapolis.
JAMA Ophthalmol. 2015 Jul;133(7):820-5. doi: 10.1001/jamaophthalmol.2015.0972.
Macular edema (ME) prognosis and treatment response vary according to the underlying abnormalities. Biomarkers of visual acuity (VA) improvement could influence management decisions in different types of ME.
To investigate whether disorganization of retinal inner layers (DRIL) and other spectral-domain optical coherence tomography (SD-OCT)-derived variables are associated with subsequent VA after ME resolution in both nondiabetic and diabetic ME.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective, longitudinal cohort study in which Snellen VA testing and SD-OCT macular imaging were performed, was conducted at a tertiary referral eye center for retinal diseases. The medical records of all patients with ME from December 1, 2010, to December 31, 2012, were reviewed. The date of the last follow-up was June 1, 2013. Participants included 55 patients (70 eyes) with center-involved ME that had resolved during an 8-month period. Patients were grouped based on the source of ME (diabetic vs nondiabetic). Exclusion criteria included significant media opacity interfering with good-quality SD-OCT image acquisition. Masked graders analyzed the central 1500-μm macular region for changes, including cysts, DRIL length and extent, and outer retinal layers disruption. Intragrader and intergrader agreement Spearman rank correlation coefficients ranged from 0.70 to 0.93 for quantitative measurement, and κ values ranged from 0.88 to 1.00 for qualitative grading.
Visual acuity and morphologic changes measured on SD-OCT.
In both groups, VA after ME resolution correlated with baseline VA. In diabetic ME involving a multivariable model including baseline VA and DRIL, total length was associated with subsequent VA as determined by a parameter estimate (PE) of 0.0003 (95% CI, 0-0.0006) (P = .03). The VA change during the 8-month period, after adjusting for baseline VA, was best associated with DRIL change (PE, 0.0002 [95% CI, 0-0.0003]; P = .04). Participants whose DRIL resolved, both early and late, showed improvement in their VA deficit at 8 months (least squares mean [SE], 41.3 [28.5] and 40.9 [37.5], respectively) compared with nonresolvers, whether inconsistent or persistent, whose VA worsened. After adjustment for baseline VA, eyes with persistent DRIL showed the largest difference in VA deficit compared with those with no baseline DRIL (-89.6 [27.2] vs 49.7 [19.6], respectively; P = .006).
The presence of DRIL at baseline and its resolution pattern may be associated with subsequent VA after resolution of center-involved diabetic ME.
黄斑水肿（ME）的预后和治疗反应因潜在异常而异。视力（VA）改善的生物标志物可能会影响不同类型 ME 的治疗决策。
研究在非糖尿病性和糖尿病性 ME 中，ME 消退后，视网膜内层紊乱（DRIL）和其他谱域光相干断层扫描（SD-OCT）衍生变量是否与随后的 VA 相关。
设计、地点和参与者：这是一项回顾性、纵向队列研究，在一家专门治疗视网膜疾病的三级转诊眼科中心进行，对 Snellen VA 测试和 SD-OCT 黄斑成像进行了评估。回顾了 2010 年 12 月 1 日至 2012 年 12 月 31 日期间所有 ME 患者的医疗记录。最后一次随访日期为 2013 年 6 月 1 日。参与者包括 55 名（70 只眼）中心受累 ME 患者，这些患者在 8 个月期间得到了缓解。根据 ME 的来源（糖尿病性与非糖尿病性）对患者进行分组。排除标准包括严重的介质混浊，干扰高质量的 SD-OCT 图像采集。有遮蔽的分级员分析中央 1500 μm 黄斑区域的变化，包括囊肿、DRIL 长度和范围以及外视网膜层的破坏。用于定量测量的内部分级员和外部分级员的等级相关系数的范围为 0.70 至 0.93，用于定性分级的 κ 值范围为 0.88 至 1.00。
SD-OCT 上的视力和形态变化。
在两组中，ME 消退后的 VA 与基线 VA 相关。在包括基线 VA 和 DRIL 的多变量模型中，糖尿病性 ME 中，总长度与随后的 VA 相关，参数估计（PE）为 0.0003（95%CI，0-0.0006）（P=0.03）。在调整基线 VA 后，在 8 个月期间，VA 的变化与 DRIL 的变化最相关（PE，0.0002 [95%CI，0-0.0003]；P=0.04）。无论是早期还是晚期 DRIL 均得到解决的参与者，VA 缺陷在 8 个月时（最小二乘均值[SE]，41.3[28.5]和 40.9[37.5]）均有所改善，而 DRIL 未得到解决的参与者，VA 则恶化，无论是不一致还是持续存在。在调整基线 VA 后，与无基线 DRIL 的眼睛相比，持续存在 DRIL 的眼睛的 VA 缺陷差异最大（-89.6 [27.2]与 49.7 [19.6]，分别；P=0.006）。
基线时存在 DRIL 及其消退模式可能与糖尿病性中心受累 ME 消退后随后的 VA 相关。
