Association between disorganization of retinal inner layers and visual acuity after proliferative diabetic retinopathy surgery

Nobuhiko Shiraki,Kentaro Nishida,Kohji Nishida,Tomoyuki Ishibashi,Hirokazu Sakaguchi,Susumu Sakimoto

doi:10.1038/s41598-019-48679-z

Nobuhiko Shiraki, Kentaro Nishida + Show 4 more

Open Access

https://doi.org/10.1038/s41598-019-48679-z

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Journal: Scientific Reports	Publication Date: Aug 22, 2019
Citations: 15	License type: open-access

Affiliation: Osaka University

Abstract

We report to evaluate if disorganization of the retinal inner layers (DRIL) obtained by swept-source optical coherence tomography (SS-OCT) predicts the postoperative best-corrected visual acuity (BCVA) to treat proliferative diabetic retinopathy (PDR). Twenty-one eyes of 21 patients who underwent vitrectomy for PDR were studied retrospectively. BCVA and SS-OCT images were obtained until 6 months postoperatively. The associations between BCVA and SS-OCT parameters measured in a 1-mm central foveal area were evaluated. The DRIL length, external limiting membrane disruption, and ellipsoid zone (EZ) disruption 1 month postoperatively were associated positively with the postoperative logarithm of the minimum angle of resolution (logMAR) BCVA at 1, 3, and 6 months (1 month, p = 0.009, p = 0.013, p = 0.001; 3 months, p = 0.03, p = 0.021, p = 0.002; and 6 months, p = 0.021, p = 0.013, and p = 0.005, respectively). The eyes with a 500-µm or longer DRIL 1 month postoperatively (19%, 4/21 eyes) had significantly worse VA at 1, 3, and 6 months postoperatively (p = 0.007, p = 0.008, and p = 0.020, respectively). Multilinear regression analysis of all visits until 6 months postoperatively showed that the DRIL was correlated more significantly (p = 0.0004) with logMAR BCVA than the disrupted EZ length. The DRIL in the early postoperative period may predict the visual outcomes after treating PDR.

Highlights

Diabetic retinopathy (DR) is the leading cause of blindness among working-age patients, and the prevalence of diabetes mellitus is predicted to increase globally[1,2]
Sun and associates first characterized the disorganization of the retinal inner layers (DRIL) as the inability to distinguish any of the boundaries of the ganglion cell layer-inner plexiform layer (GCL-IPL) complex, inner nuclear layer (INL), and outer plexiform layer (OPL) in the horizontal B-scan of optical coherence tomography (OCT) images[5,6]
The current study evaluated the association between swept-source OCT (SS-OCT) parameters and the postoperative best-corrected visual acuity (BCVA) in proliferative diabetic retinopathy (PDR)

Summary

Introduction

Diabetic retinopathy (DR) is the leading cause of blindness among working-age patients, and the prevalence of diabetes mellitus is predicted to increase globally[1,2]. Proliferative diabetic retinopathy (PDR) is the advanced stage of DR characterized by preretinal neovascularization[3], which causes vitreous hemorrhages and traction retinal detachments. Those complications are possible indications for pars plana vitrectomy (PPV), but the visual prognosis in some cases is poor. The purpose of the current study was to evaluate the correlation between the DRIL and postoperative VA in eyes with PDR that required vitrectomy. Because one of the most frequent complications of PDR is vitreous hemorrhage, which prevents retinal evaluation, we used swept-source OCT (SS-OCT) to analyze patients during the first month postoperatively. SS-OCT uses a longer wavelength (1,050 nm) than SD-OCT and is expected to penetrate through opacities or into the deeper tissues and obtain sharp images in the early postoperative period

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