Diabetic macular edema with and without subfoveal neuroretinal detachment

Diabetic, macular edema,subfovea neuroretinal detachment

2017 Jul 4. pii: S0002-9394(17)30280-5. doi: 10.1016/j.ajo.2017.06.026. [Epub ahead of print]

Diabetic macular edema with and without subfoveal neuroretinal detachment: two different morphological and functional entities.

Abstract

PURPOSE:

To assess specific morphologic and functional characteristics in eyes with diabetic macular edema (DME) with subfoveal neuroretinal detachment (SND+) vs DME without SND (SND-).

DESIGN:

Cross-sectional, prospective, comparative case series.

METHODS:

Seventy two patients (72 eyes: 22 eyes SND+ and 50 eyes SND-) with treatment-naïve, center-involving DME were evaluated. Data gathering included fundus color photographs, fluorescein angiography, spectral-domain optical coherence tomography (SD-OCT), best corrected visual acuity (BCVA), and microperimetry. The following parameters were evaluated with SD-OCT: central macular thickness (CMT, including SND); central retinal thickness (CRT, excluding SND); choroidal thickness (CT); nasal and temporal retinal thickness (RT) at 500 μm and 1500 μm from the fovea; the number of hyper-reflective retinal spots (HRS) in the central 3000 μm; and the presence of SND and integrity of the external limiting membrane (ELM). Retinal sensitivity (RS) was evaluated within 4° and 12° of the fovea. Correlation among CT, RS, and HRS in patients with and without SND was determined.

RESULTS:

CMT (P=0.032), temporal RT at 1500 μm (P=0.03), mean CT (P=0.009) and mean number of HRS (P=0.0001) were all higher in SND+ vs SND- eyes. CRT, BCVA, HbA1c, and prevalence of systemic arterial hypertension were not different between the two groups. RS within 4° (P=0.002) and 12° (P=0.015) was lower in SND+ vs SND- eyes. SND correlated significantly with disruption of the ELM (54.55% vs 24%, P=0.01) and lower RS. A direct correlation was found between the number of HRS, presence of SND, CT, and RS within 12° in SND- eyes, and an inverse correlation was found between CT and RS within 12° in SND+ eyes.

CONCLUSIONS:

This data may improve characterization of DME in eyes with SND. DME with SND correlates with greater CT, more HRS, disruption of the ELM and significant macular functional impairment (RS decrease) vs SND-.

KEYWORDS:

OCT; choroidal thickness; diabetic macular edema; external limiting membrane; fixation; hyperreflective spots; microperimetry; neuroretinal detachment; retinal sensitivity