Vitreomacular Attachment in Eyes of Diabetic Patients With and Without Macular Edema Assessed by Optical Coherence Tomography (OCT)

Abstract

Abstract: : Purpose: To analyze the vitreoretinal junction by OCT in eyes presenting with diabetic macular edema and to compare them with the eyes of diabetic patients without edema. Methods: Seventy-four eyes were included in a case-control study. They comprised 37 eyes of 25 consecutive diabetic patients with macular edema and 37 eyes of 25 diabetic patients without edema paired for age, gender and type of diabetes. On the same day, all patients had the following examinations: ETDRS best-corrected visual acuity, fundus biomicroscopy with a search for posterior vitreous detachment, OCT scans with analysis of vitreoretinal relationships, and thickness mapping. Eyes were classified according to the status of the vitreous detachment. OCT scans were also qualitatively analyzed. Results: The mean age of patients was 61 years in both groups. In eyes with edema, 15 (41.7%) had no vitreous detachment, 19 (51.4%) had a perifoveolar detachment, and 3 (8.1%) had their vitreous completely detached from the macula. The mean central thickness of the macula was 463.1±104.9 microns in this group. In eyes without edema, the corresponding figures were respectively, 21 (56.8%), 13 (35.1%), 3 (8.1%), and 195.8±28.7. The difference between the 2 groups as regards vitreomacular detachment was not statistically significant (p=0.34). Qualitative analysis of OCT scans showed that the foveal/perimacular thickness ratio was greater in eyes with edema and perifoveolar vitreous detachment, than in other eyes. Conclusions: The role of the traction exerted by the vitreous on the macula in the pathogenesis of diabetic macular edema remains controversial. No study of the prevalence of different patterns of vitreomacular attachment in diabetic patients has yet been carried out with OCT. In the present study the prevalences of these patterns were estimated and no difference was found between patients with edema and those without. However, in eyes with edema and perifoveolar vitreous detachment, qualitative analysis of OCT scans showed that the foveal/perimacular thickness ratio was proportionally greater than in other eyes. These results suggest that the vitreous only has an accessory role in diabetic macular edema.

Keywords: diabetic retinopathy • macula/fovea • vitreous