Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India.
Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburgh, PA, 15213, USA.
Graefes Arch Clin Exp Ophthalmol. 2021 Sep;259(9):2533-2544. doi: 10.1007/s00417-021-05083-6. Epub 2021 Mar 12.
To report evolution and predictive value of intracystic hyperreflective material (ICHRM) on optical coherence tomography (OCT) in centre-involving diabetic macular oedema (CI-DME).
Demographic and OCT features of patients with treatment-naïve CI-DME were analysed retrospectively. OCT parameters noted were macular oedema type, ICHRM presence, presence of hyperreflective spots, disorganised inner retinal layers and outer retinal layers integrity. Eyes were grouped into group 1 CI-DME without ICHRM and group 2 CI-DME with ICHRM. Univariate and multivariate linear regression analyses were done to study the correlation between various OCT features and final vision.
In this study, 62 eyes of 50 patients were included in group 1 and 61 eyes of 51 patients in group 2. Mean presenting logMAR vision in groups 1 and 2 was 0.374 ± 0.346 and 0.523 ± 0.369 respectively. Poor final visual acuity was noted in CI-DME with ICHRM group (p = 0.015). On linear regression analysis, 3 OCT features, namely, ICHRM presence (p = 0.034), inner segment-outer segment layer disruption (p = 0.001) and ellipsoid zone defects (p = 0.003), were associated with poor final vision. More intravitreal anti-VEGF (2.98 vs 0.629) and steroid (1.51 vs 0.242) injections were required for macular oedema resolution in ICHRM group.
This study is the first to assess the ICHRM on OCT as predictor for treatment outcome in DME eyes. We described its evolution during the DME management and its plausible influence on intravitreal therapy. We believe that this finding has the potential to become a novel biomarker for predicting the visual outcome in DME.
报告中心性糖尿病黄斑水肿（CI-DME）中囊内高反射物质（ICHRM）在光学相干断层扫描（OCT）中的演变及其预测价值。
回顾性分析未经治疗的 CI-DME 患者的人口统计学和 OCT 特征。记录的 OCT 参数包括黄斑水肿类型、ICHRM 存在、高反射点存在、内视网膜层紊乱和外视网膜层完整性。将眼分为无 ICHRM 的 CI-DME 组 1 和有 ICHRM 的 CI-DME 组 2。进行单变量和多变量线性回归分析，以研究各种 OCT 特征与最终视力之间的相关性。
本研究中，50 例患者的 62 只眼纳入组 1，51 例患者的 61 只眼纳入组 2。组 1 和组 2 的初诊 logMAR 视力分别为 0.374±0.346 和 0.523±0.369。ICHRM 组的 CI-DME 最终视力较差（p=0.015）。在线性回归分析中，3 个 OCT 特征，即 ICHRM 存在（p=0.034）、内节-外节层中断（p=0.001）和椭圆体带缺损（p=0.003），与最终视力较差相关。ICHRM 组需要更多的玻璃体腔内抗 VEGF（2.98 与 0.629）和类固醇（1.51 与 0.242）注射以消退黄斑水肿。
本研究首次评估了 OCT 上的 ICHRM 作为 DME 眼治疗结果的预测因子。我们描述了它在 DME 管理过程中的演变及其对玻璃体腔内治疗的可能影响。我们相信，这一发现有可能成为预测 DME 视力结果的新生物标志物。
