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Akihiro Ishibazawa, Taiji Nagaoka, Kengo Takahashi, Atsushi Takahashi, Harumasa Yokota, Akitoshi Yoshida; Association between Diabetic Macular Edema and Chronic Kidney Disease in Patients with Type 2 Diabetes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2400.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the association between diabetic macular edema (DME) and chronic kidney disease (CKD) in type 2 diabetic mellitus patients.
Sixty-one eyes of 61 patients with clinically relevant DME were analyzed using optical coherence tomography (OCT) and fluorescein angiography (FA). The features of DME were classified from OCT and FA findings. The presence of CKD was defined as persistent proteinurea or an estimated glomerular filtration rate below 60 ml/min/1.73 m^2. The central macular thickness (CMT) and logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) also were evaluated. We separately analyzed the presence of cystoid macular changes and serous retinal detachment (SRD) in patients with or without CKD.
Based on OCT and FA findings, DME were classified as focal (microaneurysm leakage), diffuse (dilated capillary plexus leakage), combined, and ischemic (foveal avascular zone enlargement). The patients were divided into those without CKD (CKD(-) group, n=39) and those with CKD (CKD(+) group, n=22). The mean CMTs ± standard deviations (SD) in the CKD(-) and CKD(+) groups were 473.7 ± 157.2 μm and 474.78 ± 131.3 μm, respectively (not significant [NS]). The mean logMAR VAs ± SDs in the CKD(-) and CKD(+) groups were 0.31 ± 0.3 and 0.33 ± 0.3, respectively (NS). Regarding the DME classifications, the incidence rates of focal, diffuse, combined, and ischemic patterns were 58.8%, 10.3%, 23.7%, and 5.2%, respectively, in the CKD(-) group, and 47.8%, 8.7%, 39.1%, and 4.3%, respectively, in the CKD(+) group. There were no significant differences in these DME classification between the CKD(-) and CKD(+) groups. Cystoid changes occurred in 79.5% of the CKD(-) group and 86.4% of the CKD(+) group (NS). However, SRDs developed in 28.2% of the CKD(-) group and 63.6% of the CKD(+) group, a difference that reached significance (p=0.015).
SRDs developed significantly more frequently in patients with CKD with DME, which suggested that impaired renal function might be associated with DME.
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