Vitreoretina department, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Lane, Daryaganj, New Delhi, 110002, India.
Vitreoretina Department, Sankara Nethralaya, 18 college road, Chennai, Tamil Nadu, 600 006, India.
Int Ophthalmol. 2022 Nov;42(11):3333-3343. doi: 10.1007/s10792-022-02332-3. Epub 2022 May 28.
To correlate optical coherence tomography (OCT)-based morphological patterns of diabetic macular edema (DME), biomarkers and grade of diabetic retinopathy (DR) in patients with various stages of chronic kidney disease (CKD) secondary to diabetes.
Multicentric retrospective cross-sectional study was conducted at seven centers across India.
Data from medical records of patients with DME and CKD were entered in a common excel sheet across all seven centers. Staging of CKD was based on estimated glomerular filtration rate (eGFR).
The most common morphological pattern of DME was cystoid pattern (42%) followed by the mixed pattern (31%). The proportion of different morphological patterns did not significantly vary across various CKD stages (p = 0.836). The presence of external limiting membrane-ellipsoid zone (ELM-EZ) defects (p < 0.001) and foveal sub-field thickness (p = 0.024) showed a direct correlation with the stage of CKD which was statistically significant. The presence of hyperreflective dots (HRD) and disorganization of inner retinal layers (DRIL) showed no significant correlation with the stage of CKD. Sight threatening DR was found to increase from 70% in CKD stage 3 to 82% in stages 4 and 5 of CKD, and this was statistically significant (p = 0.03).
Cystoid morphological pattern followed by mixed type was the most common pattern of DME on OCT found in patients suffering from stage 3 to 5 of CKD. However, the morphological patterns of DME did not significantly vary across various CKD stages. ELM-EZ defects may be considered as an important OCT biomarker for advanced stage of CKD.
探讨糖尿病性黄斑水肿（DME）患者不同慢性肾脏病（CKD）分期的光学相干断层扫描（OCT）形态特征、生物标志物与糖尿病性视网膜病变（DR）程度的相关性。
这是一项在印度 7 家中心进行的多中心回顾性横断面研究。
将 DME 合并 CKD 患者的病历资料数据输入到 7 家中心共有的电子表格中。CKD 分期基于估算肾小球滤过率（eGFR）。
DME 最常见的形态学类型是囊样型（42%），其次是混合型（31%）。不同 CKD 分期之间的形态学类型比例无显著差异（p=0.836）。外丛状层-椭圆体带（ELM-EZ）缺损（p<0.001）和中心凹视网膜神经纤维层厚度（p=0.024）与 CKD 分期呈正相关，且具有统计学意义。视网膜内层高反射点（HRD）和内视网膜层紊乱（DRIL）的出现与 CKD 分期无显著相关性。威胁视力的 DR 发生率从 CKD 3 期的 70%增加到 CKD 4 期和 5 期的 82%，且具有统计学意义（p=0.03）。
在患有 3 期至 5 期 CKD 的患者中，OCT 上最常见的 DME 形态学类型是囊样型，其次是混合型。然而，DME 的形态学类型在不同的 CKD 分期之间没有显著差异。ELM-EZ 缺损可能被视为 CKD 晚期的一个重要 OCT 生物标志物。
