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John O'Fee, Joseph Juliano, Andrew A Moshfeghi; Factors Associated with Diabetic Macular Edema Development in Patients with Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1038.
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© ARVO (1962-2015); The Authors (2016-present)
Vascular endothelial growth factor is a major mediator of both diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). In our clinical practice, we have observed a significant number of patients with PDR without any DME. The purpose of our study was to identify demographic, medical, ophthalmologic and OCT image characteristics that significantly affect development of DME and types of DME in patients with PDR.
Observational, retrospective case series of PDR patients seen in the retina clinics at a single large acute-care teaching hospital in an urban setting between December 2018 to October 2020. IRB approval was obtained. Vitreomacular interface (VMI) status was classified as: vitreomacular adhesion without traction (VMA), vitreomacular traction (VMT), or macular posterior vitreous detachment (PVD). Eyes were excluded if they had received retinal laser or intravitreal injection of a pharmacotherapeutic agent <1 year from OCT date, had any prior intraocular surgery or comorbid ophthalmic disorders associated with DME.
A total of 293 eyes of 210 screened patients with PDR met our inclusion criteria. Of the eyes, 66.2% had DME and 33.8% had no DME. In PDR patients, when comparing those with DME to those without DME, there were significant differences (p<0.05) in average visual acuity, retinal thickness, cube volume and dialysis status. There were no significant differences in ERM (p=.196) and VMI status (p=0.340). In eyes with center-involving (CI)-DME, VMI status was observed as follows: 44.4% with VMA, 7.8% with VMT, and 47.8% with PVD. In eyes with non-center-involving (NCI)-DME, VMI status was observed as follows: 67.3% with VMA, 1% with VMT, and 31.7% with PVD. CI-DME eyes were significantly more likely to have a PVD than NCI-DME eyes (p=0.001). There were 90 CI-DME eyes, 82.2% of which had ERMs, and of those with ERM, 66.2% had CI-ERM. There were 104 NCI-DME eyes, 45.2% of which had ERMs, and of those with ERM 44.9% had CI-ERM. CI-DME eyes were significantly more likely to have an ERM (p=<0.001) and CI-ERM (p=0.019) than NCI-DME eyes.
In this exploratory study evaluating only patients with PDR, we determined that ERM and VMI status did not have a significant association with DME writ large. However, VMI status and the presence of ERM may influence the development of CI-DME more specifically.
This is a 2021 ARVO Annual Meeting abstract.
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