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