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Stela Vujosevic, Tommaso Torresin, Silvia Bini, Marianna Berton, Enrica Convento, Edoardo Midena; Diabetic macular edema with and without subfoveal neuroretinal detachment: different morphologic and functional entities. Invest. Ophthalmol. Vis. Sci. 2017;58(8):933.
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© ARVO (1962-2015); The Authors (2016-present)
To assess specific morphologic and functional characteristics in diabetic macular edema (DME) with subfoveal neuroretinal detachment (SND+) vs DME without SND (SND-).
This is a cross-sectional, comparative case series. Seventy two patients (72 eyes) with naive center-involving DME consisted in: 22 eyes SND+ and 50 eyes SND-. All patients had good quality fundus color photo, spectral-domain(SD)-OCT (obtained also in the enhanced depth image mode-EDI), best corrected visual acuity (BCVA) and microperimetry recorded on the same day. Following parameters were evaluated on SD-OCT: central retinal thickness (CRT); choroidal thickness (CT); and on linear B-scan at 0°: nasal and temporal retinal and choroidal thickness at 500µm and 1500µm from the fovea; total number of hyperreflective retinal spots (HRS) counted in the area of 3000 µm centered on the fovea and presence of SND. Retinal sensitivity (RS) was evaluated within 4° and 12°. All measurements were performed by 2 masked graders, independently.
There was no significant difference in HbA1c and systemic hypertension in eyes with SND+ vs SND-. CRT was significantly higher in SND+ (576.0+/-174.4µm), vs (499.5+/-116.7µm) in SND-, (p=0.032). CT was significantly higher in SND+ (229.3+/-48.0 µm) vs SND- group, (196.3+/-48.9µm), p=0.009. Temporal retinal thickness at 1500 µm was significantly higher in SND+ (500.9+/-130.7 µm) vs SND- (430.3+/-117.5 µm), p=0.03. Mean number of HRS was significantly higher in SND+ (100.6+/-12.2) vs SND- group (79.7+/-22.8), p=0.0001. BCVA was not different between the two groups. Retinal sensitivity within 4° was 4.5+/-4.4dB in SND+, vs 10+/-4.4dB in SND- group, p=0.002. RS within 12° was 5+/-0.6dB in SND+ vs 12.8+/-3.9dB in SND- group, p=0.015. A direct correlation was found between: the number of HRS and the presence of SND; CT and RS in SND-; and an inverse correlation between CT and RS in SND+ patients.
Diabetic macular edema with SND is a specific entity of DME with different hypothesis about its pathophysiology. Glycemic control and hypertension do not seem relevant systemic factors. DME with SND shows greater retinal and CT, HRS number and functional impairment (RS decrease) vs SND-. Choroidal thickness differently correlates to RS in SND+ vs SND- eyes. This data may help in better morphologic and functional charaterization of DME with SND.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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