September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Association of Macular Nonperfusion (NP) and Leakage with Disorganization of Retinal Inner Layers (DRIL)
Author Affiliations & Notes
  • Rasha Barham
    Beetham Eye Institute, Joslin Diabetes Center, Brighton , Massachusetts, United States
  • Amanda Delacruz
    Teleophthalmology and Image Reading Center, Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
  • Migil Ledesma
    Teleophthalmology and Image Reading Center, Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
  • Aditi Gupta
    Beetham Eye Institute, Joslin Diabetes Center, Brighton , Massachusetts, United States
  • Hala El-Rami
    Beetham Eye Institute, Joslin Diabetes Center, Brighton , Massachusetts, United States
  • Jennifer K Sun
    Beetham Eye Institute, Joslin Diabetes Center, Brighton , Massachusetts, United States
    Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Paolo Sandico Silva
    Beetham Eye Institute, Joslin Diabetes Center, Brighton , Massachusetts, United States
    Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Lloyd P Aiello
    Beetham Eye Institute, Joslin Diabetes Center, Brighton , Massachusetts, United States
    Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Rasha Barham, None; Amanda Delacruz, None; Migil Ledesma, None; Aditi Gupta, None; Hala El-Rami, None; Jennifer Sun, Boston Micromachines (F), Genentech (F), Optovue (F); Paolo Silva, None; Lloyd Aiello, Optos plc (R)
  • Footnotes
    Support  Optos plc; NEI R01 EY024702; JDRF 3-SRA-2014-264-M-R; Beatson Childcare Ambassador Program Foundation; Massachusetts Lions Eye Research Fund
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 6351. doi:
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    • Get Citation

      Rasha Barham, Amanda Delacruz, Migil Ledesma, Aditi Gupta, Hala El-Rami, Jennifer K Sun, Paolo Sandico Silva, Lloyd P Aiello; Association of Macular Nonperfusion (NP) and Leakage with Disorganization of Retinal Inner Layers (DRIL). Invest. Ophthalmol. Vis. Sci. 2016;57(12):6351.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To determine the association of macular NP and leakage with clinically significant diabetic macular edema (CSME) and DRIL in eyes with diabetic retinopathy (DR).

Methods : Mydriatic ultrawide field (UWF) images, fluorescein angiograms (UWF-FA) and spectral-domain optical coherence tomography (SDOCT) were obtained at the same visit in 39 eyes with nonproliferative (NPDR) or proliferative DR (PDR). Stereographically projected UWF images were used to determine DR and DME severity. UWF-FA images were evaluated for extent of macular NP and leakage. On SDOCT scans, a 1-mm wide area centered on the fovea was evaluated for horizontal extent of DRIL. All images were evaluated at a centralized reading center.

Results : DR distribution: mild NPDR 7 (18.0%), moderate 15 (38.5%), severe 8 (20.5%), PDR 7 (18.0), and high risk PDR 2 (5.1%). CSME was present in 8 (20%) eyes. There were no statistically significant differences between eyes without and with CSME in age (mean 60.9 vs 64.2 yrs, p=0.41); diabetes duration (26.8 yrs vs 24.9, p=0.40); or peripheral NP (301.4mm2 vs 236.0mm2, p=0.17). Visual acuity was worse in eyes with CSME (20/40 vs 20/20, p=0.007). The extent of macular NP, leakage and DRIL was larger in eyes with CSME but this was only significant for DRIL (macular NP: 0.48 mm2 vs 0.29 mm2, p=0.45, Leakage: 0.30mm2 vs 0.13mm2, p = 0.06, DRIL: 145.6 microns vs 16.3 microns, p=0.009). In eyes with CSME, worse visual acuity was correlated with more extensive DRIL (r=0.71, p=0.047) but not correlated with macular nonperfusion (p=0.56) or leakage (p=0.49). In eyes where DRIL extent exceeded the mean (42.8 microns, range 0 – 497.2), macular NP and leakage were increased by 3.5-fold (0.73mm2 vs 0.21mm2) and by 2-fold (0.27mm2 vs 0.13mm2), respectively.

Conclusions : The presence of CSME and vision loss in eyes with CSME are more closely correlated with extent of DRIL than with macular nonperfusion or fluorescein leakage. These data suggest a potential mechanism underlying DRIL development wherein macular capillary nonperfusion and leakage may contribute to ischemic compromise of the inner retinal layers, and subsequent visual loss.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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