Association of Disorganization of Retinal Inner Layers With Vision After Resolution of Center-Involved Diabetic Macular Edema
Association of Disorganization of Retinal Inner Layers With Vision After Resolution of Center-Involved Diabetic Macular Edema
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DOI：
10.1001/jamaophthalmol.2015.0972
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发表时间：
2015-07-01
影响因子：
8.1
通讯作者：
Koozekanani, Dara D.
中科院分区：
文献类型：
--
作者：
Radwan, Salma H.;Soliman, Ahmed Z.;Koozekanani, Dara D.
黄斑水肿（ME）的预后和治疗反应根据潜在的异常而变化。视力（VA）改善的生物标志物可能影响不同类型ME的管理决策。目的研究非糖尿病和糖尿病ME患者ME消退后视网膜内层（DRIL）和其他光谱域光学相干断层扫描（SD-OCT）衍生变量的紊乱是否与随后的VA相关。在视网膜疾病的三级转诊眼科中心进行了一项纵向队列研究，其中进行了Snellen VA测试和SD-OCT黄斑成像。对2010年12月1日至2012年12月31日期间所有ME患者的病历进行了审查。末次随访日期为2013年6月1日。参与者包括55例（70只眼）在8个月内消退的中心受累ME患者。根据ME来源（糖尿病vs非糖尿病）对患者进行分组。排除标准包括干扰高质量SD-OCT图像采集的显著介质不透明度。戴面具的分级者分析了中央1500 μ m黄斑区的变化，包括囊肿、DRIL长度和范围以及视网膜外层破坏。等级内和等级间的一致性斯皮尔曼等级相关系数为0.70至0.93的定量测量，和。主要结果和指标：视力和SD-OCT测量的形态学变化。在涉及多变量模型（包括基线VA和DRIL）的糖尿病ME中，通过参数估计值（PE）为0.0003（95% CI，0-0.0006）（P=.03）确定总长度与后续VA相关。校正基线VA后，8个月期间的VA变化与DRIL变化最相关（PE，0.0002 [95% CI，0-0.0003]; P=.04）。DRIL早期和晚期消退的受试者在8个月时的VA缺陷均有所改善（最小二乘均值[SE]分别为41.3 [28.5]和40.9 [37.5]），而非消退者（无论是不一致的还是持续的）的VA恶化。校正基线VA后，与无基线DRIL的患者相比，持续DRIL患者的VA缺陷差异最大（分别为-89.6 [27.2] vs 49.7 [19.6]; P= 0.006）。结论和相关性基线DRIL的存在及其消退模式可能与中心参与的糖尿病ME消退后的后续VA相关。
IMPORTANCE 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.OBJECTIVE 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-mu m 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. values ranged from 0.88 to 1.00 for qualitative grading.MAIN OUTCOMES AND MEASURES Visual acuity and morphologic changes measured on SD-OCT.RESULTS 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).CONCLUSIONS AND RELEVANCE The presence of DRIL at baseline and its resolution pattern may be associated with subsequent VA after resolution of center-involved diabetic ME.