Association of Disorganization of Retinal Inner Layers With Visual Acuity In Eyes With Uveitic Cystoid Macular Edema

Abstract

To determine whether disorganization of retinal inner layers (DRIL) assessed by spectral-domain optical coherence tomography (SDOCT) correlates with visual acuity (VA) in eyes with uveitic cystoid macular edema (CME). Secondary analysis of randomized clinical trial data. Fifty-six eyes of 42 patients with uveiticCME were prospectively imaged as part of theVISUAL-1 trial (Clinicaltrials.gov identifier NCT01138657). Central subfield thickness (CFT), horizontal and vertical extent of DRIL, foveal DRIL (>500μm DRIL) hyperreflective foci (HRF), average and largest area of intraretinal (IR) cysts, and extent of disruption of external limiting membrane (ELM) and ellipsoid zone (EZ) were determined within the 1-mm central subfield and correlated with VA at baseline and follow-up visits. Regression analysis adjusted for clustered observations was used to examine the association between OCT morphologic parameters and VA. Across all visits (n= 168), significant associations were found for CFT (0.080 per 100μm, P < .001), foveal DRIL (0.170, P < .001), horizontal DRIL length (0.055 per 100μm, P < .001), vertical DRIL extent (0.001, P= .005), total area of IR cysts (0.204 per mm2, P < .001), area of largest IR cyst (1.407 per mm2, P< .001), presence of HRF (P= .026), and EZ disruption (0.042 per 100μm, P= .02). ELM disruption did not show a significant association with VA (-0.013 per 100μm, P= .61). DRIL is a robust and easily obtained surrogate marker of VA in participants with current or resolved uveitic CME. CFT, DRIL, IR cyst area, EZ disruption, and HRF had a strong association with VA.