Correlation between disorganization of retinal inner layers and visual prognosis after vitrectomy in proliferative diabetic retinopathy patients_Chinese Journal of Ocular Fundus Diseases

Authors：

Xu Yue ,  Fang Yan , Xie Chi

Department of Ophthalmology, The First Affiliated Hospital of Anhui University of Science & Technology, Huainan 232000, China;

Corresponding author：

Fang Yan, Email: hnfy@sohu.com

Keywords：

Diabetic retinopathy; Vitrectomy; Disorganization of retinal inner layers; Visual prognosis

DOI：

10.3760/cma.j.cn511434-20200604-00261

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To analyze the correlation between disorganization of retinal inner layers (DRIL) and visual prognosis after pars plana vitrectomy (PPV) in patients with proliferative diabetic retinopathy (PDR).Methods A retrospective observational systematic cases study. From January 2019 to January 2020, 52 patients (58 eyes) with PDR who were treated with PPV in the department of ophthalmology of The First Affiliated Hospital of Anhui University of Science & Technology were included in the study. There were 24 males (29 eyes) and 28 females (29 eyes), aged from 45 to 80 years old, with the mean age of 62.95 ±9.38 years. All patients were examined BCVA by using international standard visual acuity chart, and the results were converted into logMAR visual acuity in stastistics. The mean preoperative logMAR BCVA was 2.51±0.69. All patients underwent 23G standard PPV by the same physician. Spectral domain-OCT (SD-OCT) was performed to measure DRIL length within 1 mm of macular area diameter, ellipsoid zone (EZ) fracture length and foveal retinal thickness (CMT) one month after operation. According to the length of DRIL, the patients were divided into three groups: non-DRIL group, DRIL≤500 μm group and DRIL＞500 μm group. The differences of BCVA and the SD-OCT parameters were compared among the three groups after PPV. The postoperative BCVA of the three groups were compared by Kruskal-Wallis H test, and the pairwise comparison between the three groups were performed by Bonferroni correction method. Wilcoxon rank sum test was used to compare BCVA in each group at 1 and 6 months after operation. Spearman rank correlation analysis was used to analyze the correlation between BCVA and measurement parameters of SD-OCT at 1, 3 and 6 months after operation. Multivariate stepwise regression analysis was used to analyze the related factors of visual prognosis after operation.Results At 1 month after operation, the differences in DRIL length ( χ²=52.194, P=0.000) and EZ fracture length (F=9.558, P=0.000) among the three groups were statistically significant, but there was no significant difference in CMT (F=0.817, P =0.447). At 1 and 3 months after operation, there were no significant differences in BCVA between the non-DRIL group and the DRIL≤500 μm group (Z=－1.846, －2.224; P=0.195, 0.078), however, the BCVA of patients in non-DRIL group was better than that of patients in DRIL≤500μm group at 6 months after operation, and the difference was statistically significant (Z=－2.508, P=0.036). The BCVA of patients in non-DRIL group at 1, 3 and 6 months after operation was better than that of patients in DRIL＞500 μm group, and there were significant differences (Z=－5.992, －6.275, －6.497; P＜0.0l). The BCVA of the DRIL≤500 μm group was better than the DRIL＞500 μm group, and the differences were statistically significant (Z=－4.260, －4.161, －4.099; P＜0.01). The comparison of intra-group among the three groups showed that the BCVA of the non-DRIL group and the DRIL ≤ 500 μm group at 6 months after operation were higher than that at 1 month after operation, and the differences were statistically significant (Z=－3.525, －3.420; P＜0.01). There was no significant difference in BCVA between 6 months after operation and 1 month after operation in DRIL＞500 μm group (Z=－0.422, P=0.673). The results of Spearman rank correlation analysis showed that a strong correlation was between the length of DRIL and logMAR BCVA at 1, 3 and 6 months after operation (r_s=0.896, 0.918, 0.940; P＜0.01). The rupture length of EZ was moderately correlated with logMAR BCVA at 1, 3 and 6 months after operation (r_s=0.488, 0.502, 0.521; P＜0.05). There was no significant correlation between CMT and logMAR BCVA at 1, 3 and 6 months after operation (r_s=0.243, 0.220, 0.193; P＞0.05). Multivariate stepwise regression analysis showed that DRIL length was the main predictor of postoperative visual acuity recovery (R²=0.703, P=0.000).Conclusion The length of DRIL and the rupture length of EZ are correlated with the visual prognosis of patients with PDR after PPV, and there is a strong correlation between DRIL and postoperative visual acuity.

Citation： Xu Yue, Fang Yan, Xie Chi. Correlation between disorganization of retinal inner layers and visual prognosis after vitrectomy in proliferative diabetic retinopathy patients. Chinese Journal of Ocular Fundus Diseases, 2020, 36(11): 867-873. doi: 10.3760/cma.j.cn511434-20200604-00261 Copy

1.	Cheung N, Mitchell P, Wong TY. Diabetic retinopathy[J]. Lancet, 2010, 376(9735): 124-136. DOI: 10.1016/S0140-6736(09)62124-3.
2.	Ito S, Miyamoto N, Ishida K, et al. Association between external limiting membrane status and visual acuity in diabetic macular oedema[J]. Br J Ophthalmol, 2013, 97(2): 228-232. DOI: 10.1136/bjophthalmol-2011-301418.
3.	付燕, 陈松, 顾朝辉, 等. 孔源性视网膜脱离患眼手术后黄斑中心凹无血管区面积与视功能的相关性研究[J]. 中华眼底病杂志, 2020, 36(5): 354-357. DOI: 10.3760/cma.j.cn511434-20190917-00293.Fu Y, Chen S, Gu CH, et al. The changes and correlation between foveal avascular zone size and visual acuity in patients with rhegmatogenous retinal detachment[J]. Chin J Ocul Fundus Dis, 2020, 36(5): 354-357. DOI: 10.3760/cma.j.cn511434-20190917-00293.
4.	Tortorella P, D'Ambrosio E, Iannett L, et al. Correlation between visual acuity, inner segment/outer segment junction, and cone outer segment tips line integrity in uveitic macular edema[J/OL]. Biomed Res Int, 2015, 2015: 853728[2015-06-08]. https://pubmed.ncbi.nlm.nih.gov/26167505/. DOI: 10.1155/2015/853728.
5.	Babiuch AS, Han M, Conti FF, et al. Association of disorganization of retinal inner layers with visual acuity response to anti-vascular endothelial growth factor therapy for macular edema secondary to retinal vein occlusion[J]. JAMA Ophthalmol, 2019, 137(1): 38-46. DOI: 10.1001/jamaophthalmol.2018.4484.
6.	Radwan SH, Soliman AZ, Tokarev J, et al. Association of disorganization of retinal inner layers with vision after resolution of center-involved diabetic macular edema[J]. JAMA Ophthalmol, 2015, 133(7): 820-825. DOI: 10.1001/jamaophthalmol.2015.0972.
7.	Grewal DS, O'Sullivan ML, Kron M, et al. Association of disorganization of retinal inner layers with visual acuity in eyes with uveitic cystoid macular edema[J]. Am J Ophthalmol, 2017, 117: 116-125. DOI: 10.1016/j.ajo.2017.02.017.
8.	Zur D, Iglicki M, Feldinger L, et al. Disorganization of retinal inner layers as a biomarker for idiopathic epiretinal membrane after macular surgery-the DREAM study[J]. Am J Ophthalmol, 2018, 196: 129-135. DOI: 10.1016/j.ajo.2018.08.037.
9.	中华医学会眼科学会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2014年)[J]. 中华眼科杂志, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.Fundus Disease Group of Ophthalmology Association of Chinese Medical Association. Guidelines for clinical diagnosis and treatment of diabetic retinopathy in China (2014)[J]. Chin J Ophthalmol, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.
10.	Newman DK. Surgical management of the late complications of proliferative diabetic retinopathy[J]. Eye (Lond), 2010, 24(3): 441-449. DOI: 10.1038/eye.2009.325.
11.	Park DH, Choi KS, Sun HJ, et al. Factors associated with visual outcome after macula-off rhegmatogenous retinal detachment surgery[J]. Retina, 2018, 38(1): 137-147. DOI: 10.1097/IAE.0000000000001512.
12.	焦明菲, 刘巨平, 陈曦腾, 等. 特发性黄斑前膜手术治疗后黄斑微结构变化的观察[J]. 中华眼科杂志, 2018, 54(4): 258-262. DOI: 10.3760/cma.j.issn.0412-4081.2018.04.006.Jiao MF, Liu JP, Chen XT, et al. Long term clinical observation on postoperative microstructural change of macula lutea in treatment of idiopathic macular epiretinal membrane[J]. Chin J Ophthalmol, 2018, 54(4): 258-262. DOI: 10.3760/cma.j.issn.0412-4081.2018.04.006.
13.	Schmidt-Erfurth U, Michl M. Disorganization of retinal inner layers and the importance of setting boundaries[J]. JAMA Ophthalmol, 2019, 137(1): 46-47. DOI: 10.1001/jamaophthalmol.2018.4516.
14.	Sun JK, Lin MM, Lammer J, et al. Disorganization of the retinal inner layers as a predictor of visual acuity in eyes with center-involved diabetic macular edema[J]. JAMA Ophthalmol, 2014, 132(11): 1309-1316. DOI: 10.1001/jamaophthalmol.2014.2350.
15.	Sun JK, Radwan SH, Soliman AZ, et al. Neural retinal disorganization as a robust marker of visual acuity in current and resolved diabetic macular edema[J]. Diabetes, 2015, 64(7): 2560-2570. DOI: 10.2337/db14-0782.
16.	Ishibashi T, Sakimoto S, Shiraki N, et al. Association between disorganization of retinal inner layers and visual acuity after proliferative diabetic retinopathy surgery[J/OL]. Sci Rep, 2019, 9(1): 12230[2019-08-22]. https://pubmed.ncbi.nlm.nih.gov/26167505/. DOI: 10.1038/s41598-019-48679-z.
17.	Garnavou-Xirou C, Xirou T, Gkizis I, et al. The role of disorganization of retinal inner layers as predictive factor of postoperative outcome in patients with epiretinal membrane[J]. Ophthalmic Res, 2020, 63(1): 13-17. DOI: 10.1159/000499370.
18.	Cuenca N, Ortuño-Lizarán I, Sánchez-Sáez X, et al. Interpretation of OCT and OCTA images from a histological approach: clinical and experimental implications[J/OL]. Prog Retin Eye Res, 2020, 77: 100828[2020-01-03]. https://pubmed.ncbi.nlm.nih.gov/26167505/. DOI: 10.1016/j.preteyeres.2019.100828.
19.	Tao LW, Wu Z, Guymer RH, et al. Ellipsoid zone on optical coherence tomography: a review[J]. Clin Exp Ophthalmol, 2016, 44(5): 422-430. DOI: 10.1111/ceo.12685.
20.	黄志坚, 陈晓, 洪玲, 等. 25G玻璃体切割联合内界膜剥除术治疗不同分期特发性黄斑前膜的疗效[J]. 眼科新进展, 2019, 39(5): 461-464. DOI: 10.13389/j.cnki.rao.2019.0106.Huang ZJ, Chen X, Hong L, et al. Clinical efficacy of 25G vitrectomy combined with internal limiting membrane peeling on idiopathic macular epiretinal membrane with different stages[J]. Rec Adv Ophthalmol, 2019, 39(5): 461-464. DOI: 10.13389/j.cnki.rao.2019.0106.
21.	Rodrigues EB, Urias G, Penha FM, et al. Diabetes induces changes in neuroretina before retinal vessels: a spectral-domain optical coherence tomography study[J/OL]. Int J Retina Vitreous, 2015, 1: 4[2015-04-15]. https://pubmed.ncbi.nlm.nih.gov/27847597/. DOI: 10.1186/s40942-015-0001-z.
22.	Nadri G, Saxena S, Stefanickova J, et al. Disorganization of retinal inner layers correlates with ellipsoid zone disruption and retinal nerve fiber layer thinning in diabetic retinopathy[J]. J Diabetes Complications, 2019, 33(8): 550-553. DOI: 10.1016/j.jdiacomp.2019.05.006.
23.	Onishi AC, Ashraf M, Soetikno BT, et al. Multilevel ischemia in disorganization of the retinal inner layers on projection-resolved optical coherence tomography angiography[J]. Retina, 2019, 39(8): 1588-1594. DOI: 10.1097/IAE.0000000000002179.

1. Cheung N, Mitchell P, Wong TY. Diabetic retinopathy[J]. Lancet, 2010, 376(9735): 124-136. DOI: 10.1016/S0140-6736(09)62124-3.
2. Ito S, Miyamoto N, Ishida K, et al. Association between external limiting membrane status and visual acuity in diabetic macular oedema[J]. Br J Ophthalmol, 2013, 97(2): 228-232. DOI: 10.1136/bjophthalmol-2011-301418.
3. 付燕, 陈松, 顾朝辉, 等. 孔源性视网膜脱离患眼手术后黄斑中心凹无血管区面积与视功能的相关性研究[J]. 中华眼底病杂志, 2020, 36(5): 354-357. DOI: 10.3760/cma.j.cn511434-20190917-00293.Fu Y, Chen S, Gu CH, et al. The changes and correlation between foveal avascular zone size and visual acuity in patients with rhegmatogenous retinal detachment[J]. Chin J Ocul Fundus Dis, 2020, 36(5): 354-357. DOI: 10.3760/cma.j.cn511434-20190917-00293.
4. Tortorella P, D'Ambrosio E, Iannett L, et al. Correlation between visual acuity, inner segment/outer segment junction, and cone outer segment tips line integrity in uveitic macular edema[J/OL]. Biomed Res Int, 2015, 2015: 853728[2015-06-08]. https://pubmed.ncbi.nlm.nih.gov/26167505/. DOI: 10.1155/2015/853728.
5. Babiuch AS, Han M, Conti FF, et al. Association of disorganization of retinal inner layers with visual acuity response to anti-vascular endothelial growth factor therapy for macular edema secondary to retinal vein occlusion[J]. JAMA Ophthalmol, 2019, 137(1): 38-46. DOI: 10.1001/jamaophthalmol.2018.4484.
6. Radwan SH, Soliman AZ, Tokarev J, et al. Association of disorganization of retinal inner layers with vision after resolution of center-involved diabetic macular edema[J]. JAMA Ophthalmol, 2015, 133(7): 820-825. DOI: 10.1001/jamaophthalmol.2015.0972.
7. Grewal DS, O'Sullivan ML, Kron M, et al. Association of disorganization of retinal inner layers with visual acuity in eyes with uveitic cystoid macular edema[J]. Am J Ophthalmol, 2017, 117: 116-125. DOI: 10.1016/j.ajo.2017.02.017.
8. Zur D, Iglicki M, Feldinger L, et al. Disorganization of retinal inner layers as a biomarker for idiopathic epiretinal membrane after macular surgery-the DREAM study[J]. Am J Ophthalmol, 2018, 196: 129-135. DOI: 10.1016/j.ajo.2018.08.037.
9. 中华医学会眼科学会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2014年)[J]. 中华眼科杂志, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.Fundus Disease Group of Ophthalmology Association of Chinese Medical Association. Guidelines for clinical diagnosis and treatment of diabetic retinopathy in China (2014)[J]. Chin J Ophthalmol, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.
10. Newman DK. Surgical management of the late complications of proliferative diabetic retinopathy[J]. Eye (Lond), 2010, 24(3): 441-449. DOI: 10.1038/eye.2009.325.
11. Park DH, Choi KS, Sun HJ, et al. Factors associated with visual outcome after macula-off rhegmatogenous retinal detachment surgery[J]. Retina, 2018, 38(1): 137-147. DOI: 10.1097/IAE.0000000000001512.
12. 焦明菲, 刘巨平, 陈曦腾, 等. 特发性黄斑前膜手术治疗后黄斑微结构变化的观察[J]. 中华眼科杂志, 2018, 54(4): 258-262. DOI: 10.3760/cma.j.issn.0412-4081.2018.04.006.Jiao MF, Liu JP, Chen XT, et al. Long term clinical observation on postoperative microstructural change of macula lutea in treatment of idiopathic macular epiretinal membrane[J]. Chin J Ophthalmol, 2018, 54(4): 258-262. DOI: 10.3760/cma.j.issn.0412-4081.2018.04.006.
13. Schmidt-Erfurth U, Michl M. Disorganization of retinal inner layers and the importance of setting boundaries[J]. JAMA Ophthalmol, 2019, 137(1): 46-47. DOI: 10.1001/jamaophthalmol.2018.4516.
14. Sun JK, Lin MM, Lammer J, et al. Disorganization of the retinal inner layers as a predictor of visual acuity in eyes with center-involved diabetic macular edema[J]. JAMA Ophthalmol, 2014, 132(11): 1309-1316. DOI: 10.1001/jamaophthalmol.2014.2350.
15. Sun JK, Radwan SH, Soliman AZ, et al. Neural retinal disorganization as a robust marker of visual acuity in current and resolved diabetic macular edema[J]. Diabetes, 2015, 64(7): 2560-2570. DOI: 10.2337/db14-0782.
16. Ishibashi T, Sakimoto S, Shiraki N, et al. Association between disorganization of retinal inner layers and visual acuity after proliferative diabetic retinopathy surgery[J/OL]. Sci Rep, 2019, 9(1): 12230[2019-08-22]. https://pubmed.ncbi.nlm.nih.gov/26167505/. DOI: 10.1038/s41598-019-48679-z.
17. Garnavou-Xirou C, Xirou T, Gkizis I, et al. The role of disorganization of retinal inner layers as predictive factor of postoperative outcome in patients with epiretinal membrane[J]. Ophthalmic Res, 2020, 63(1): 13-17. DOI: 10.1159/000499370.
18. Cuenca N, Ortuño-Lizarán I, Sánchez-Sáez X, et al. Interpretation of OCT and OCTA images from a histological approach: clinical and experimental implications[J/OL]. Prog Retin Eye Res, 2020, 77: 100828[2020-01-03]. https://pubmed.ncbi.nlm.nih.gov/26167505/. DOI: 10.1016/j.preteyeres.2019.100828.
19. Tao LW, Wu Z, Guymer RH, et al. Ellipsoid zone on optical coherence tomography: a review[J]. Clin Exp Ophthalmol, 2016, 44(5): 422-430. DOI: 10.1111/ceo.12685.
20. 黄志坚, 陈晓, 洪玲, 等. 25G玻璃体切割联合内界膜剥除术治疗不同分期特发性黄斑前膜的疗效[J]. 眼科新进展, 2019, 39(5): 461-464. DOI: 10.13389/j.cnki.rao.2019.0106.Huang ZJ, Chen X, Hong L, et al. Clinical efficacy of 25G vitrectomy combined with internal limiting membrane peeling on idiopathic macular epiretinal membrane with different stages[J]. Rec Adv Ophthalmol, 2019, 39(5): 461-464. DOI: 10.13389/j.cnki.rao.2019.0106.
21. Rodrigues EB, Urias G, Penha FM, et al. Diabetes induces changes in neuroretina before retinal vessels: a spectral-domain optical coherence tomography study[J/OL]. Int J Retina Vitreous, 2015, 1: 4[2015-04-15]. https://pubmed.ncbi.nlm.nih.gov/27847597/. DOI: 10.1186/s40942-015-0001-z.
22. Nadri G, Saxena S, Stefanickova J, et al. Disorganization of retinal inner layers correlates with ellipsoid zone disruption and retinal nerve fiber layer thinning in diabetic retinopathy[J]. J Diabetes Complications, 2019, 33(8): 550-553. DOI: 10.1016/j.jdiacomp.2019.05.006.
23. Onishi AC, Ashraf M, Soetikno BT, et al. Multilevel ischemia in disorganization of the retinal inner layers on projection-resolved optical coherence tomography angiography[J]. Retina, 2019, 39(8): 1588-1594. DOI: 10.1097/IAE.0000000000002179.

Chinese Journal of Ocular Fundus Diseases

Correlation between disorganization of retinal inner layers and visual prognosis after vitrectomy in proliferative diabetic retinopathy patients

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content