Affiliation:
1. Saint-Petersburg Branch of S. Fyodorov Eye Microsurgery Federal State Institution;
North-Western State Medical University named after I.I. Mechnikov;
S.M. Kirov Military Medical Academy
2. Saint-Petersburg Branch of S. Fyodorov Eye Microsurgery Federal State Institution
Abstract
Background. Diabetic macular edema (DME) is one of the main causes of decreased central vision. Determining the reasons for the refractoriness of DME to treatment is an urgent problem.Aims. Based on the analysis of optical coherence tomography, to study the features of pathological changes in the retina and vitreoretinal interface (VRI) in the macular zone in patients with DME.Materials and methods. We studied 587 patients (587 eyes) with diffuse DME in the setting of nonproliferative diabetic retinopathy. In addition to the standard ophthalmological examination, everyone underwent optical coherence tomography of the macular zone with an assessment of structural changes in the retina, morphometric parameters, and the state of the VRI.Results. In 351 patients (59.80 %) with DME, pathological variants of the VRI were revealed, in which the best corrected visual acuity was significantly lower, and the morphometric parameters (retinal thickness and macular volume) were signifi cantly higher. Analysis of morphostructural changes in the macular zone revealed that in pathological VRI, neuroepithelial detachment and high edema are more common, and cystic edema is larger in area compared to the group with a normal VRI. With detachment of neuroepithelium against the background of a pathological VRI, the worst morphometric data are determined, with solid exudates in the macula, the worst indices of visual loss are determined.Conclusions. The pathological VRI in patients with diabetic macular edema occurs in more than half of the cases and is characterized by a high incidence of neuroepithelial detachment, high edema, higher morphometric parameters with worse visual acuity. At the same time, the presence of neuroepithelial detachment corresponds to the worst morphometric indicators of the macular zone, and the presence of solid exudates corresponds to a lower maximum corrected visual acuity. Further research is needed to assess the effect of the listed morphostructural and morphometric changes in combination with various pathological variants of VRI on the effectiveness of DME treatment.
Subject
General Immunology and Microbiology,General Biochemistry, Genetics and Molecular Biology
Reference16 articles.
1. Brown DM, Schmidt-Erfurth U, Do DV, Holz FG, Boyer DS, Midena E, et al. Intravitreal aflibercept for diabetic macular edema: 100-week results from the VISTA and VIVID studies. Ophthalmology. 2015; 122(10): 2044-2052. doi: 10.1016/j.ophtha.2015.06.017
2. Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001; 414(6865): 782-787. doi: 10.1038/414782a
3. Hirst M. Foreword. In: Guariguata L, Nolan T, Beagley J, Linnenkamp U, Jacqmain O (eds). Diabetes atlas; 6th ed. Brussels: International Diabetes Federation (IDF) publishers; 2003: 7-11. URL: www.idf.org/diabetesatlas [date of access: 01.11.2015].
4. Mitchell P, Bandello F, Schmidt-Erfurth U, Lang GE, Massin P, Schlingemann RO, et al. The RESTORE study: Ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology. 2011; 118(4): 615-625. doi: 10.1016/j.ophtha.2011.01.031
5. Kozak I, Barteselli G, Sepah YJ, Sadiq MA, High R, Do DV, et al. Correlation of vitreomacular traction with foveal thickness, subfoveal choroidal thickness, and vitreomacular/foveal angle. Curr Eye Res. 2017; 42(2): 297-301. doi: 10.1080/02713683.2016.1175020