Association of DRIL with OCT Outcomes in Uveitic Macular Edema in the POINT study

Abstract

Purpose : To determine the association of disorganization of the retinal inner layers (DRIL) with optical coherence tomography (OCT) imaging parameters among participants with uveitic macular edema from the PeriOcular vs. INTravitreal corticosteroids for uveitic macular edema (POINT) study.

Methods : The POINT Trial compared the effectiveness of 3 regional corticosteroid injections for uveitic macular edema (UME). Among these participants, OCT scans were evaluated at baseline for the presence of DRIL, along with location with respect to central 1 mm circle. Central subfield thickness (CST), photoreceptor thickness, cysts, subretinal fluid, ellipsoid zone (EZ) status, and choroidal thickness were assessed at baseline. CST percent reduction was compared using baseline and week 12 (primary endpoint) values. Subjects with significant vitreomacular traction or severe epiretinal membranes were excluded. Statistical analysis was conducted with a mixed-effects model using a random effect to account for bilateral study eyes.

Results : Of 231 eyes (190 participants), 191 eyes (83%) had DRIL at baseline. DRIL was seen within central 1mm in 182 eyes (79%). Mean CST at baseline was 375 um (SD 96) in eyes without DRIL and 500 um (SD 143) in eyes with DRIL (p < 0.001). Relative decrease in CST between baseline and week 12 in eyes without DRIL was 16% and with DRIL was 34% (p<0.001). Mean photoreceptor thickness was 31.7 um (SD 4.8) in eyes without DRIL and 28.9 um (SD 7.5) in eyes with DRIL (p = 0.015). In eyes without and with DRIL, EZ disruption within the Central subfield was found in 10.2% of eyes and 26.4%, respectively (p = 0.006). Mean choroidal thickness was 263 um (SD 82) in eyes without DRIL and 252 (SD 80) in eyes with DRIL (p = 0.412). Among other OCT features evaluated, DRIL was significantly associated with cystoid spaces (p< 0.001) but not with subretinal fluid (p = 0.534). Inter-grader agreement provided an 84% exact agreement for the presence of DRIL within the Central subfield.

Conclusions : In the POINT study, a notable prevalence of DRIL was observed in patients with uveitic macular edema, underlining its strong association with increased CST, cystoid spaces, photoreceptor thickness, and EZ disruption. Investigating the evolution of DRIL longitudinally, as the edema subsides, will provide insights in understanding its prognostic value and implications for long-term treatment outcomes.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.