Retinal Microstructure Based on Optical Coherence Tomography Predicts Visual Prognosis in Diabetic Macular Edema with Extended Intraretinal Cysts and Subretinal Fluid.

Abstract

Abstract Purpose We investigated the association between the retinal microstructure on optical coherence tomography (OCT) and the visual outcomes of diabetic macular edema (DME) with extended intraretinal cysts (IRCs) (maximum diameter ≥ 200 μm) and serous retinal detachment (SRD) who underwent anti-vascular endothelial growth factor intravitreal injections. Methods We retrospectively reviewed 58 eyes from 43 DME patients with extended IRCs and subretinal fluid who were treated with three consecutive intravitreal injections of ranibizumab with subsequent as-needed administrations. The OCT images were assessed at baseline and at 1, 3, 6, and 12 monthsafter treatment. The association of the baseline retinal microstructure on OCT with photoreceptor disruption at 12 months was investigated. We also evaluated the relationships between visual outcomes and baseline OCT parameters. Results The mean logarithmic minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) decreased from 0.66 ± 0.34 before treatment to 0.46 ± 0.32 after treatment (p < 0.001). ELM (R = 0.535, p < 0.001) and EZ (R = 0.612, p < 0.001) disruption at 12 months, but not CFT at 12 months (R = 0.185, p = 0.164), were associated with the logMAR BCVA at 12 months. The extent of EZ disruption (R = 0.256, p = 0.039) and the area ratio of SRD spaces (R = 0.409, p = 0.002) at baseline were positively correlated with the extent of EZ disruption at 12 months. The extent of ELM disruption (R = 0.641, p < 0.001) and the area ratio of IRCs (R = 0.287, p = 0.008) at baseline were positively correlated with the extent of ELM disruption at 12 months. The area ratio of SRD spaces (R = 0.400, p = 0.006) and the extent of ELM disruption (R = 0.393, p = 0.014) at baseline were predictive of the logMAR BCVA at 12 months. Conclusion The extent of EZ and ELM disruption was significantly associated with baseline OCT imaging characteristics. Both the baseline area ratio of SRD spaces and ELM disruption might be useful OCT biomarkers to predict the visual outcomes of DME patients with extended IRCs and SRD spaces. Trial registration number and date of registration (retrospectively registered):