NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom.
NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
Ophthalmol Retina. 2023 Feb;7(2):142-152. doi: 10.1016/j.oret.2022.07.010. Epub 2022 Aug 7.
To investigate the relative effect of disorganization of the retinal inner layers (DRIL) and ellipsoid zone (EZ) loss on visual function in diabetic macular ischemia (DMI).
Prospective cross-sectional observational study.
Patients with stable treated proliferative diabetic retinopathy (PDR) without center-involved diabetic macular edema were recruited at the Moorfields Eye Hospital from December 2019 to November 2021. The main inclusion criteria were best-corrected visual acuity (BCVA) of ≥ 40 ETDRS letters (Snellen equivalent 20/160) with OCT angiography (OCTA) evidence of DMI in ≥ 1 eye.
Each eligible eye of the recruited patients was assessed for BCVA, OCT, and OCTA metrics. The prespecified OCT parameters were DRIL and subfoveal EZ loss. Generalized estimating equations were used.
The frequency of DRIL and EZ loss, their relative contributions to vision loss, and their associations with microvascular alterations were evaluated.
A total of 125 eyes of 86 patients with PDR were enrolled; 104 (83%) eyes had a BCVA of ≥ 70 letters. Disorganization of the retinal inner layers was more prevalent than EZ loss (46% [58 eyes] vs. 19% [24 eyes]). On average, the presence of DRIL had a more pronounced impact on vision, retinal thickness, and microvascular parameters than EZ loss. After multivariable adjustment, the odds of coexisting DRIL increased by 12% with every letter decrease in BCVA; however, there was no statistically significant association of subfoveal EZ loss with BCVA. In eyes with DRIL in the absence of EZ loss, the BCVA declined significantly by 6.67 letters compared with eyes with no DRIL nor EZ loss (95% confidence interval [CI], -9.92 to -3.41; P < 0.001). However, if DRIL and EZ loss coexisted, the resultant BCVA was 13.22 letters less than eyes without these structural abnormalities (95% CI, -18.85 to -7.59; P < 0.001).
In patients with DMI with a Snellen visual acuity of 20/160 or better, eyes with DRIL were associated with more visual function loss and retinal blood circulation alterations than those with subfoveal EZ loss only.
探讨视网膜内层紊乱（DRIL）和椭圆体带（EZ）丢失对视功能的相对影响在糖尿病黄斑缺血（DMI）中。
前瞻性横断面观察性研究。
2019 年 12 月至 2021 年 11 月，在 Moorfields 眼科医院招募患有稳定治疗性增殖性糖尿病视网膜病变（PDR）且无中心受累性糖尿病性黄斑水肿的患者。主要纳入标准是最佳矫正视力（BCVA）≥40 ETDRS 字母（Snellen 等效 20/160），OCT 血管造影（OCTA）证实≥1 只眼存在 DMI。
对招募患者的每只合格眼进行 BCVA、OCT 和 OCTA 指标评估。预设的 OCT 参数是 DRIL 和中心凹下 EZ 丢失。使用广义估计方程。
评估 DRIL 和 EZ 丢失的频率、它们对视功能丧失的相对贡献以及它们与微血管改变的关系。
共纳入 86 例 PDR 患者的 125 只眼；104 只（83%）眼的 BCVA 大于等于 70 个字母。视网膜内层紊乱比 EZ 丢失更为常见（46%[58 只眼] vs. 19%[24 只眼]）。平均而言，DRIL 的存在对视、视网膜厚度和微血管参数的影响比 EZ 丢失更为显著。多变量调整后，BCVA 每降低 1 个字母，DRIL 共存的可能性增加 12%；然而，中心凹下 EZ 丢失与 BCVA 无统计学显著相关性。在没有 EZ 丢失的情况下存在 DRIL 的眼中，BCVA 与没有 DRIL 或 EZ 丢失的眼中相比显著下降了 6.67 个字母（95%置信区间[CI]，-9.92 至-3.41；P<0.001）。然而，如果 DRIL 和 EZ 丢失同时存在，则与这些结构异常的眼中相比，BCVA 减少了 13.22 个字母（95%CI，-18.85 至-7.59；P<0.001）。
在 Snellen 视力为 20/160 或更好的 DMI 患者中，与仅存在中心凹下 EZ 丢失的眼相比，存在 DRIL 的眼与更明显的视力丧失和视网膜血液循环改变相关。
