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Audrey Giocanti, Franck Fajnkuchen, Manar Addou Regnard, Sophie Bonnin, Benedicte Marie Dupas, Pascale G Massin, Alain Gaudric, Ramin Tadayoni; Architectural changes of retinal inner layers in diabetic macular edema. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5174. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
After treatment of DME, when a complete resorption of fluid is reached, some abnormalities of outer retinal layers may be seen on SD-OCT and mostly of the ellipsoid zone responsible for insufficient visual outcomes. In addition to these abnormalities, architectural changes of retinal inner layers (ACRIL) may be seen, but we do not know yet what are their exact signification. The purpose of this study was to describe these ACRIL and evaluate their prevalence.
We enrolled in a retrospective and bi-centric study (Lariboisière and Avicenne hospitals) 30 consecutive eyes of patients with a complete resorption of retinal fluid after ranibizumab treatment for DME. We defined the complete resorption of retinal fluid on SD-OCT as a retinal thickness <300 microns with a restauration of the foveal pit (Cirrus II, Carl Zeiss Meditec/ OPKO, OTI). On the first SD-OCT with complete resorption of fluid, we analysed on high definition B-scans (central horizontal and vertical) : discontinuous and indistinguishable aspect of any of the inner retinal layers (ACRIL), cyst perstistance, or hyper-reflective dots (HRD). The clinical outcomes assessed were : age, sex, visual acuity (VA) on ETDRS chart, central retinal thickness (CRT) and the presence of serous retinal detachement (SRD) at baseline, the number of intravitreal injections to obtain a complete retinal resorption of fluid, VA and CRT at the first complete resorption of fluid, and the DME duration before treatment.<br />
We enrolled eyes from 6 women and 15 men. At baseline, VA was 50,3 (15-73) letters and CRT was 529μm (308-821). 13 patients on 30 had a SRD at baseline (43.3%). 4.03 injections (2-13) were necessary to obtain a complete resorption of fluid. At the first complete resorption of fluid, VA was 63,5 (25-84) letters and CRT 244 μm (162-298). DME duration was 35,2 months before RBZ treatment.<br /> In our study, the prevalence of any ACRIL was 76,7%.Discontinuous inner retinal layers were noticed in 73,3% of cases and involved mainly the OPL in 96,7% of cases. An indistinguishable aspect of 2 contiguous layers was reported in 60% of cases. Moreover, HRD were present in 93,4% of cases and mostly involving the inner nuclear layer, we also reported 53,3% of remaining cysts.<br /> <br />
ACRIL are frequent after DME. The association of ACRIL and outer retinal layer abnormalities after DME, makes their responsability for visual acuity outcome difficult to assess.
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