Optical coherence tomographic reflectivity of photoreceptors beneath cystoid spaces in diabetic macular edema.
OBJECTIVE
To investigate the relationship between the cystoid spaces in the outer plexiform layer (OPL) and the characteristics of the photoreceptors beneath the cystoid spaces in patients with diabetic macular edema (DME).


METHODS
In this observational cross-sectional study, 123 eyes of 96 consecutive patients with clinically significant macular edema were retrospectively reviewed. The characteristics of the photoreceptors on optical coherence tomography (OCT) images represented by the external limiting membrane (ELM) and the junction between inner and outer segments (IS/OS), and their association with the overlying cystoid spaces were investigated.


RESULTS
The areas beneath the cystoid spaces in the OPL had a longer transverse length of disrupted or faint IS/OS and disrupted ELM lines than those without cystoid spaces (P < 0.001, P < 0.001, and P = 0.009). The IS/OS lines beneath the cystoid spaces had higher reflectivity than those in areas without cystoid spaces (P < 0.001). Enlarged cystoid spaces extending from the inner nuclear layer to the OPL were associated with disrupted IS/OS or ELM but not faint IS/OS (P < 0.001, P < 0.001, and P = 0.467). The transverse length of disrupted IS/OS at the fovea was correlated with the logarithm of the minimum angle of resolution (logMAR) more than the association between foveal thickness and logMAR (r = 0.49, P < 0.001 vs. r = 0.28, P = 0.002). The ELM descended to the RPE more frequently in eyes with single-lobulated fluorescein pooling in the foveal avascular zone than those with multi-lobulated pooling (P < 0.001).


CONCLUSIONS
OCT showed that the cystoid spaces in the OPL were accompanied by photoreceptor damage beneath the cystoid spaces in DME.
Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan. mutomo@kuhp.kyoto-u.ac.jp
Tomoaki
T
Murakami
Kazuaki
K
Nishijima
Tadamichi
T
Akagi
Akihito
A
Uji
Takahiro
T
Horii
Naoko
N
Ueda-Arakawa
Yuki
Y
Muraoka
Nagahisa
N
Yoshimura
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003930:Diabetic Retinopathy / Q000473:pathology*; D005260:Female; D006801:Humans; D008269:Macular Edema / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D020419:Photoreceptor Cells, Vertebrate / Q000473:pathology*; D012044:Regression Analysis; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*