Interdigitation and Ellipsoid Zones Disruption Correlate with Visual Outcomes Among Treatment-Naive Patients with Diabetic Macular Edema

Overview

Journal Ophthalmic Res

Specialty Ophthalmology

Date 2020 Nov 22

PMID 33221809

Citations 4

Authors

Nardine Sharef

Rabea Kassem

Idan Hecht

Asaf Bar

Idit Maharshak

Zvia Burgansky-Eliash

Yehonatan Weinberger

Raimo Tuuminen

Asaf Achiron

Affiliations

Soon will be listed here.

Abstract

Introduction: We have recently shown that defects in interdigitation and ellipsoid zones (IZ and EZ) can predict response to anti-VEGF therapy in a small group of treatment-naive diabetic macular edema (DME) patients. The aim of the current study is to further evaluate this association in a larger study group of patients over a longer follow-up time.

Methods: Thirty eyes of 30 treatment-naive DME patients were analyzed in this retrospective study. The integrity of foveal IZ and EZ was evaluated using optical coherence tomography at the diagnosis of DME and following anti-VEGF injections. The defect size was correlated with best-corrected visual acuity (BCVA) and central macular thickness (CMT).

Results: The mean patients' age at baseline was 63.0 ± 10.0 years. Patients underwent 3.9 ± 2.9 anti-VEGF injections for a mean of 9.1 ± 4.8 months. Following treatment, the mean Snellen visual acuity (VA) improved from 20/52 to 20/44 (p = 0.05), CMT decreased from 432.5 ± 141.4 μm to 375.2 ± 121.4 µm (p = 0.05) and IZ/EZ defect size decreased from 259.83 ± 375.94 µm to 65.34 ± 143.97 µm (p = 0.001). In patients with no IZ/EZ defects at baseline, the mean Snellen VA was better when compared to those with IZ/EZ defects (20/36 vs. 20/70, p = 0.031). The number of eyes with IZ/EZ defects decreased from 17 (57%) at baseline to 6 (20%) at end of follow-up (p < 0.01). BCVA gain correlated with IZ/EZ defect size reduction (r = 0.41, p = 0.02) but not with improvement in CMT (r = 0.28, p = 0.121).

Conclusions: IZ/EZ defect size correlated not only with baseline BCVA but also predicted the change in BCVA after anti-VEGF treatment. Possible future automatic measurement of IZ/EZ defect size might prove helpful for the evaluation of treatment response.

Citing Articles

The effect of diabetes on short-term outcomes following epiretinal membrane surgery.

Hecht I, Karesvuo M, Kanclerz P, Jeon S, Karesvuo P, Tuuminen R Int Ophthalmol. 2024; 44(1):446.

PMID: 39636335 PMC: 11621169. DOI: 10.1007/s10792-024-03373-6.

Ellipsoid Zone Integrity and Visual Function in Dry Age-Related Macular Degeneration.

Yordi S, Cakir Y, Kalra G, Cetin H, Hu M, Abraham J J Pers Med. 2024; 14(5).

PMID: 38793125 PMC: 11122652. DOI: 10.3390/jpm14050543.

Factors associated with the recurrence of choroidal neovascularization in pathologic myopia.

Jing R, Bo Y, Gao L, Wang Z Front Med (Lausanne). 2022; 9:968800.

PMID: 36172539 PMC: 9510607. DOI: 10.3389/fmed.2022.968800.

Ellipsoid Zone Integrity and Visual Acuity Changes during Diabetic Macular Edema Therapy: A Longitudinal Study.

Kessler L, Auffarth G, Bagautdinov D, Khoramnia R J Diabetes Res. 2021; 2021:8117650.

PMID: 34660813 PMC: 8516551. DOI: 10.1155/2021/8117650.

References

Soiberman U, Goldstein M, Pianka P, Loewenstein A, Goldenberg D . Preservation of the photoreceptor layer following subthreshold laser treatment for diabetic macular edema as demonstrated by SD-OCT. Invest Ophthalmol Vis Sci. 2014; 55(5):3054-9. DOI: 10.1167/iovs.13-12607. View

Iglicki M, Busch C, Zur D, Okada M, Mariussi M, Chhablani J . DEXAMETHASONE IMPLANT FOR DIABETIC MACULAR EDEMA IN NAIVE COMPARED WITH REFRACTORY EYES: The International Retina Group Real-Life 24-Month Multicenter Study. The IRGREL-DEX Study. Retina. 2018; 39(1):44-51. DOI: 10.1097/IAE.0000000000002196. View

Yohannan J, Bittencourt M, Sepah Y, Hatef E, Sophie R, Moradi A . Association of retinal sensitivity to integrity of photoreceptor inner/outer segment junction in patients with diabetic macular edema. Ophthalmology. 2013; 120(6):1254-61. DOI: 10.1016/j.ophtha.2012.12.003. View

Otani T, Yamaguchi Y, Kishi S . Correlation between visual acuity and foveal microstructural changes in diabetic macular edema. Retina. 2009; 30(5):774-80. DOI: 10.1097/IAE.0b013e3181c2e0d6. View

Iglicki M, Lavaque A, Ozimek M, Negri H, Okada M, Chhablani J . Biomarkers and predictors for functional and anatomic outcomes for small gauge pars plana vitrectomy and peeling of the internal limiting membrane in naïve diabetic macular edema: The VITAL Study. PLoS One. 2018; 13(7):e0200365. PMC: 6040739. DOI: 10.1371/journal.pone.0200365. View

Muftuoglu I, Unsal E, Ozturker Z . Restoration of photoreceptors in eyes with diabetic macular edema. Eur J Ophthalmol. 2017; 27(5):585-590. DOI: 10.5301/ejo.5000907. View

Staurenghi G, Sadda S, Chakravarthy U, Spaide R . Proposed lexicon for anatomic landmarks in normal posterior segment spectral-domain optical coherence tomography: the IN•OCT consensus. Ophthalmology. 2014; 121(8):1572-8. DOI: 10.1016/j.ophtha.2014.02.023. View

Iglicki M, Zur D, Fung A, Gabrielle P, Lupidi M, Santos R . TRActional DIabetic reTInal detachment surgery with co-adjuvant intravitreal dexamethasONe implant: the TRADITION STUDY. Acta Diabetol. 2019; 56(10):1141-1147. DOI: 10.1007/s00592-019-01357-y. View

Shin H, Lee S, Chung H, Kim H . Association between photoreceptor integrity and visual outcome in diabetic macular edema. Graefes Arch Clin Exp Ophthalmol. 2011; 250(1):61-70. DOI: 10.1007/s00417-011-1774-x. View

10.

Zur D, Iglicki M, Sala-Puigdollers A, Chhablani J, Lupidi M, Fraser-Bell S . Disorganization of retinal inner layers as a biomarker in patients with diabetic macular oedema treated with dexamethasone implant. Acta Ophthalmol. 2019; 98(2):e217-e223. DOI: 10.1111/aos.14230. View

11.

Shimozono M, Oishi A, Hata M, Matsuki T, Ito S, Ishida K . The significance of cone outer segment tips as a prognostic factor in epiretinal membrane surgery. Am J Ophthalmol. 2012; 153(4):698-704, 704.e1. DOI: 10.1016/j.ajo.2011.09.011. View

12.

Zur D, Iglicki M, Loewenstein A . The Role of Steroids in the Management of Diabetic Macular Edema. Ophthalmic Res. 2019; 62(4):231-236. DOI: 10.1159/000499540. View

13.

Sakamoto A, Nishijima K, Kita M, Oh H, Tsujikawa A, Yoshimura N . Association between foveal photoreceptor status and visual acuity after resolution of diabetic macular edema by pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol. 2009; 247(10):1325-30. DOI: 10.1007/s00417-009-1107-5. View

14.

Boyer D, Hopkins J, Sorof J, Ehrlich J . Anti-vascular endothelial growth factor therapy for diabetic macular edema. Ther Adv Endocrinol Metab. 2013; 4(6):151-69. PMC: 3855829. DOI: 10.1177/2042018813512360. View

15.

Mori Y, Suzuma K, Uji A, Ishihara K, Yoshitake S, Fujimoto M . Restoration of foveal photoreceptors after intravitreal ranibizumab injections for diabetic macular edema. Sci Rep. 2016; 6:39161. PMC: 5155247. DOI: 10.1038/srep39161. View

16.

Iglicki M, Zur D, Negri H, Esteves J, Arias R, Holsman E . Results in comparison between 30 gauge ultrathin wall and 27 gauge needle in sutureless intraocular lens flanged technique in diabetic patients: 24-month follow-up study. Acta Diabetol. 2020; 57(10):1151-1157. DOI: 10.1007/s00592-020-01530-8. View

17.

Das A, McGuire P, Rangasamy S . Diabetic Macular Edema: Pathophysiology and Novel Therapeutic Targets. Ophthalmology. 2015; 122(7):1375-94. DOI: 10.1016/j.ophtha.2015.03.024. View

18.

Moon B, Um T, Lee J, Yoon Y . Correlation between Deep Capillary Plexus Perfusion and Long-Term Photoreceptor Recovery after Diabetic Macular Edema Treatment. Ophthalmol Retina. 2019; 2(3):235-243. DOI: 10.1016/j.oret.2017.07.003. View

19.

Nieves-Moreno M, Martinez-de-la-Casa J, Bambo M, Morales-Fernandez L, Van Keer K, Vandewalle E . New Normative Database of Inner Macular Layer Thickness Measured by Spectralis OCT Used as Reference Standard for Glaucoma Detection. Transl Vis Sci Technol. 2018; 7(1):20. PMC: 5829952. DOI: 10.1167/tvst.7.1.20. View

20.

Klaassen I, van Noorden C, Schlingemann R . Molecular basis of the inner blood-retinal barrier and its breakdown in diabetic macular edema and other pathological conditions. Prog Retin Eye Res. 2013; 34:19-48. DOI: 10.1016/j.preteyeres.2013.02.001. View