title: Association of Disorganization of Retinal Inner Layers With Vision After Resolution of Center-Involved Diabetic Macular Edema.
abstract: OBJECTIVE
  Macular edema (ME) prognosis and treatment response vary according to the underlying abnormalities. Biomarkers of visual acuity (VA) improvement could influence management decisions in different types of ME.
  
  
  OBJECTIVE
  To investigate whether disorganization of retinal inner layers (DRIL) and other spectral-domain optical coherence tomography (SD-OCT)-derived variables are associated with subsequent VA after ME resolution in both nondiabetic and diabetic ME.
  
  
  METHODS
  A retrospective, longitudinal cohort study in which Snellen VA testing and SD-OCT macular imaging were performed, was conducted at a tertiary referral eye center for retinal diseases. The medical records of all patients with ME from December 1, 2010, to December 31, 2012, were reviewed. The date of the last follow-up was June 1, 2013. Participants included 55 patients (70 eyes) with center-involved ME that had resolved during an 8-month period. Patients were grouped based on the source of ME (diabetic vs nondiabetic). Exclusion criteria included significant media opacity interfering with good-quality SD-OCT image acquisition. Masked graders analyzed the central 1500-μm macular region for changes, including cysts, DRIL length and extent, and outer retinal layers disruption. Intragrader and intergrader agreement Spearman rank correlation coefficients ranged from 0.70 to 0.93 for quantitative measurement, and κ values ranged from 0.88 to 1.00 for qualitative grading.
  
  
  METHODS
  Visual acuity and morphologic changes measured on SD-OCT.
  
  
  RESULTS
  In both groups, VA after ME resolution correlated with baseline VA. In diabetic ME involving a multivariable model including baseline VA and DRIL, total length was associated with subsequent VA as determined by a parameter estimate (PE) of 0.0003 (95% CI, 0-0.0006) (P = .03). The VA change during the 8-month period, after adjusting for baseline VA, was best associated with DRIL change (PE, 0.0002 [95% CI, 0-0.0003]; P = .04). Participants whose DRIL resolved, both early and late, showed improvement in their VA deficit at 8 months (least squares mean [SE], 41.3 [28.5] and 40.9 [37.5], respectively) compared with nonresolvers, whether inconsistent or persistent, whose VA worsened. After adjustment for baseline VA, eyes with persistent DRIL showed the largest difference in VA deficit compared with those with no baseline DRIL (-89.6 [27.2] vs 49.7 [19.6], respectively; P = .006).
  
  
  CONCLUSIONS
  The presence of DRIL at baseline and its resolution pattern may be associated with subsequent VA after resolution of center-involved diabetic ME.
authors.affiliation: Vitreoretinal Service, Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis2Department of Ophthalmology, Cairo University, Cairo, Egypt.
authors.forename: Salma H
authors.initials: SH
authors.lastname: Radwan
authors.affiliation: Vitreoretinal Service, Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis2Department of Ophthalmology, Cairo University, Cairo, Egypt.
authors.forename: Ahmed Z
authors.initials: AZ
authors.lastname: Soliman
authors.affiliation: medical student, University of Minnesota Medical School, Minneapolis.
authors.forename: Julian
authors.initials: J
authors.lastname: Tokarev
authors.affiliation: Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Vitreoretinal Service, Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis.
authors.forename: Frederik J
authors.initials: FJ
authors.lastname: van Kuijk
authors.affiliation: Vitreoretinal Service, Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis.
authors.forename: Dara D
authors.initials: DD
authors.lastname: Koozekanani
mesh_terms: D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008137:Longitudinal Studies; D008269:Macular Edema / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D015999:Multivariate Analysis; D012160:Retina / Q000473:pathology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D041623:Tomography, Optical Coherence / Q000379:methods; D014792:Visual Acuity / Q000502:physiology*