Manisha Agarwal1, Mani Sachdeva2, Shalin Shah2, Rajiv Raman3, Padmaja K Rani4, Ramachandran Rajalakshmi5, Sobha Sivaprasad6,7, T P Vignesh8, Kim Ramasamy8, Aishwarya Madharia9, Alok Sen9, Shalini Sugumar10, Umesh Chandra Behera10, Ann Maria Rodrigues11, Giridhar Anantharaman11, Swati Priya3, Atanu Majumdar12. 1. Vitreoretina department, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Lane, Daryaganj, New Delhi, 110002, India. agarwalmannii@yahoo.co.in. 2. Vitreoretina department, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Lane, Daryaganj, New Delhi, 110002, India. 3. Vitreoretina Department, Sankara Nethralaya, 18 college road, Chennai, Tamil Nadu, 600 006, India. 4. Vitreoretina Department, Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, 500045, India. 5. Medical Retina and Ocular Research, Department of Ophthalmology, Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, 6, Conran Smith Road, Gopalapuram, Chennai, Tamil Nadu, 600086, India. 6. NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK. 7. Vision Sciences, UCL Institute of Ophthalmology, London, UK. 8. Vitreoretina Department, Aravind Eye Hospital, 1,Annanagar, Madurai, Tamil Nadu, 625 020, India. 9. Vitreoretina Department, Sadguru Netra Chikitsalya, Chitrakoot, 210204, India. 10. Retina Vitreous Service, Vitreoretina Department, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, 751024, India. 11. Vitreoretina Department, Giridhar Eye Institute, Near Ponneth Temple, Cochin, 682 020, India. 12. Bio-statistical department, Dr. Shroff's Charity Eye Hospital, New Delhi, 110002, India.
Abstract
PURPOSE: To correlate optical coherence tomography (OCT)-based morphological patterns of diabetic macular edema (DME), biomarkers and grade of diabetic retinopathy (DR) in patients with various stages of chronic kidney disease (CKD) secondary to diabetes. DESIGN: Multicentric retrospective cross-sectional study was conducted at seven centers across India. METHODS: Data from medical records of patients with DME and CKD were entered in a common excel sheet across all seven centers. Staging of CKD was based on estimated glomerular filtration rate (eGFR). RESULTS: The most common morphological pattern of DME was cystoid pattern (42%) followed by the mixed pattern (31%). The proportion of different morphological patterns did not significantly vary across various CKD stages (p = 0.836). The presence of external limiting membrane-ellipsoid zone (ELM-EZ) defects (p < 0.001) and foveal sub-field thickness (p = 0.024) showed a direct correlation with the stage of CKD which was statistically significant. The presence of hyperreflective dots (HRD) and disorganization of inner retinal layers (DRIL) showed no significant correlation with the stage of CKD. Sight threatening DR was found to increase from 70% in CKD stage 3 to 82% in stages 4 and 5 of CKD, and this was statistically significant (p = 0.03). CONCLUSION: Cystoid morphological pattern followed by mixed type was the most common pattern of DME on OCT found in patients suffering from stage 3 to 5 of CKD. However, the morphological patterns of DME did not significantly vary across various CKD stages. ELM-EZ defects may be considered as an important OCT biomarker for advanced stage of CKD.
PURPOSE: To correlate optical coherence tomography (OCT)-based morphological patterns of diabetic macular edema (DME), biomarkers and grade of diabetic retinopathy (DR) in patients with various stages of chronic kidney disease (CKD) secondary to diabetes. DESIGN: Multicentric retrospective cross-sectional study was conducted at seven centers across India. METHODS: Data from medical records of patients with DME and CKD were entered in a common excel sheet across all seven centers. Staging of CKD was based on estimated glomerular filtration rate (eGFR). RESULTS: The most common morphological pattern of DME was cystoid pattern (42%) followed by the mixed pattern (31%). The proportion of different morphological patterns did not significantly vary across various CKD stages (p = 0.836). The presence of external limiting membrane-ellipsoid zone (ELM-EZ) defects (p < 0.001) and foveal sub-field thickness (p = 0.024) showed a direct correlation with the stage of CKD which was statistically significant. The presence of hyperreflective dots (HRD) and disorganization of inner retinal layers (DRIL) showed no significant correlation with the stage of CKD. Sight threatening DR was found to increase from 70% in CKD stage 3 to 82% in stages 4 and 5 of CKD, and this was statistically significant (p = 0.03). CONCLUSION: Cystoid morphological pattern followed by mixed type was the most common pattern of DME on OCT found in patients suffering from stage 3 to 5 of CKD. However, the morphological patterns of DME did not significantly vary across various CKD stages. ELM-EZ defects may be considered as an important OCT biomarker for advanced stage of CKD.
Authors: L P Aiello; T W Gardner; G L King; G Blankenship; J D Cavallerano; F L Ferris; R Klein Journal: Diabetes Care Date: 1998-01 Impact factor: 19.112
Authors: Jennifer K Sun; Michael M Lin; Jan Lammer; Sonja Prager; Rutuparna Sarangi; Paolo S Silva; Lloyd Paul Aiello Journal: JAMA Ophthalmol Date: 2014-11 Impact factor: 7.389