Queens University, Belfast, United Kingdom.
Belfast Health and Social Care Trust, Belfast, United Kingdom.
JAMA Ophthalmol. 2018 Feb 1;136(2):202-208. doi: 10.1001/jamaophthalmol.2017.6256.
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.
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.
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.
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).
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.
在糖尿病性黄斑水肿（DME）中，在频域光学相干断层扫描（SD-OCT）上识别基线标志物及其与糖尿病性视网膜病变（DR）严重程度的相关性可能有助于疾病管理和未来试验的设计。
研究 DME 患者中 DR 严重程度、SD-OCT 视网膜形态和视力之间的相关性。
设计、地点和参与者：这是一项在单一三级转诊中心进行的横断面观察性病例系列研究。在 2013 年 12 月 28 日至 2014 年 4 月 30 日期间观察了 80 名 DME（102 只眼）患者的人口统计学资料、视力、SD-OCT 和彩色眼底照片，在 2016 年 5 月 1 日至 7 月 31 日期间进行了分析。
SD-OCT 上捕获的特征和厚度指标。在 SD-OCT 上，我们对 DME 的类型和形状、视网膜内囊样异常内的隔室形状和存在、高反射点和焦点的存在、外限膜和椭圆体带的完整性、内视网膜层（DRIL）的排列紊乱的存在和程度以及玻璃体黄斑界面和视网膜前膜的状态进行了分级。我们测量了黄斑中心凹和最大病变部位的视网膜厚度、黄斑中心凹的脉络膜厚度以及黄斑颞侧和鼻侧 1000μm 的视网膜厚度。彩色照片的分级用于确定 DR 严重程度阶段。
平均（SD）年龄为 63（11）岁，30 名参与者（37.5%）为女性。与外限膜破坏（比值比[OR]，4.4；95%置信区间[CI]，1.6-12.0；P=0.003）、椭圆体带破坏（OR，2.7；95%CI，1.0-7.2；P=0.03）、存在视网膜前膜（OR，2.8；95%CI，1.0-7.4；P=0.03）和黄斑中心凹视网膜厚度增加（OR，1.6；95%CI，1.1-2.2；P<0.001）有关。增殖性 DR 患者发生 DRIL 的可能性更大（OR，7.3；95%CI，1.7-31.4；P=0.007）。平均视力每增加 100μm 的平均全局 DRIL（95%CI，-7.9 至 1.4；P=0.006），视力下降约 4.7 个字母。
发现 DRIL 与外视网膜的破坏和 DR 严重程度的增加有关。似乎需要进一步的纵向研究来确定 DRIL 是否是 DME 眼中具有临床相关性的非侵入性形态学标志物。
