First Author: J.Sheth INDIA
Co Author(s): A. Giridhar
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Vitreomacular interface has been postulated to play a role in pathogenesis and progression of diabetic retinopathy (DR) and diabetic macular edema (DME). The aim of our study was to report various morphological patterns of vitreomacular interface abnormalities (VMIA) on spectral domain optical coherence tomography (SD-OCT) in diabetics and to assess its relationship with the various stages of Diabetic Retinopathy (DR) and macular thickness. Our objective was to evaluate whether the presence of vitreomacular interface abnormalities (VMIA) substantially influence the emergence as well as progression of diabetic retinopathy (DR) and diabetic macular edema (DME).
Treatment-naïve patients with diabetes presenting to vitreoretinal clinic of Giridhar Eye Institute, India, between July 2015 and September 2015 were included in the study. This study was conducted in accordance to tenets of Helsinki and was approved by Institutional Review Board. Written informed consent was obtained from each patient.
Prospective study of two hundred and sixty-one eyes of 149 treatment naïve diabetic patients undergoing SD-OCT evaluation using the Spectralis OCT. The study participants were divided into three groups for further subgroup analysis: Group 1: Diabetics without diabetic retinopathy (DR), Group 2: Diabetics with non-proliferative diabetic retinopathy (NPDR) and Group 3: Diabetics with proliferative diabetic retinopathy (PDR). SD-OCT features were recorded and patients were noted to have either presence or absence of VMIA. Absence of VMIA was denoted as normal while their presence was scrutinized and characterized as abnormal vitreoretinal adhesions / tractions (foveal/ extrafoveal/ peripapillary traction) and epiretinal membranes (partially or globally adherent). Central macular thickness (CMT) analysis was done too. The results were compared between the groups and analysed using SPSS software.
Of the 261 eyes, (80 Males, 69 Females); Mean age: 60 years (range: 30-82)], 88 belonged to group 1, 92 to group 2 and 81 to group 3 respectively. Overall, VMIA were observed in 91 /261(34%) eyes. Of these, the prevalence of VMIA was 17% (15/88), 33.6% (31/92) and 55.5% (45 /81) in groups 1, 2 and 3 respectively with a statistically increasing frequency with increasing severity of diabetic retinopathy (p<0.001). Globally adherent ERM, the most common VMIA observed in our patients (22.9%), was also noted to significantly influence the CMT (p<0.2). Although extrafoveal and peripapillary traction were seen exclusively in Group 3, partially separated ERM formed the most common VMIA in this group. Presence of VMIA was significantly associated with increased CMT irrespective of the stage of retinopathy. Even in group 1 eyes with VMIA, despite the CMT being within normal range, it was significantly more compared to those without VMIA (p<0.004). Concurrently, DME was seen in 34/92 eyes in group 2 and 13/80 eyes in group 3, which was found to be significantly associated with VMIA(Group 2: p=0.003; Group 3: p=0.01) Gender or duration of DM were not found to have any association with VMIA.
Vitreomacular interface abnormalities (VMIA’s) are significantly associated with increased macular thickness even before the onset of retinopathy. Increased frequency of VMIA, especially epiretinal membranes, are seen with evolving stages of diabetic retinopathy. The presence of extrafoveal and peripapillary traction only in the proliferative retinopathy group and increased frequency of VMIA in this group supports the role of vitreous in progression of DR.