Abstract
Purpose To investigate the potential association between peripheral blood biomarkers and morphological characteristics of retinal imaging in patients with diabetic macular edema (DME). Methods Participants in this cross-sectional study were 36 consecutive patients (36 eyes) with treatment-naïve DME, who underwent spectral domain-optical coherence tomography (SD-OCT), fundus photography, and fundus fluorescein angiography (FFA). In addition, peripheral blood samples were taken to evaluate full blood count and biochemical parameters. Correlation between imaging characteristics and laboratory parameters was examined. Results Eyes with central subfield thickness greater than 405 μm presented significantly higher neutrophils/lymphocytes (p = 0.043) and higher lipoprotein (a) compared to eyes with CST < 405 μm (p = 0.003). Presence of hyperreflective foci on SD-OCT was associated with significantly higher white blood cell count (p = 0.028). Ellipsoid zone disruption was associated with significantly lower hematocrit (p = 0.012), hemoglobin (p = 0.009), and red blood cell count (p = 0.026), as well as with higher lipoprotein (a) (p = 0.015). Macular ischemia on FFA was associated with significantly higher monocytes (p = 0.027) and monocytes/HDL (p = 0.019). No significant associations were found between laboratory parameters and subretinal fluid, intraretinal fluid, exudates, cysts, disorganization of inner retinal layers, epiretinal membrane, and external limiting membrane condition. Conclusion Specific imaging morphological characteristics were found to be associated with laboratory parameters in patients with DME. These findings may shed light on the pathophysiology of DME and its correlation with the development of specific clinical signs.
Highlights
Diabetic macular edema (DME) is the most common cause of visual impairment in patients with diabetes mellitus (DM), characterized by exudation and accumulation of extracellular fluid in the macula [1, 2]
Several studies have shown that elevated serum lipids, including cholesterol and low-density lipoprotein (LDL), demonstrated a significant association with retinal hard exudates and formation of DME [9,10,11,12], while elevated IL-6 has been correlated with diffuse retinal thickness or severity of DME [13, 14]
Regarding the potential association between imaging characteristics and laboratory variables, no significant correlations were found for intraretinal fluid (IRF), subretinal fluid (SRF), exudates, cysts, disorganization of the inner retinal layers (DRIL), epiretinal membrane (ERM), and external limiting membrane (ELM) condition
Summary
Diabetic macular edema (DME) is the most common cause of visual impairment in patients with diabetes mellitus (DM), characterized by exudation and accumulation of extracellular fluid in the macula [1, 2]. In the pathogenesis of DME, chronic hyperglycemia promotes a cascade of biochemical pathways and consequent structural alterations in the retinal blood vessels’ wall, including the loss of pericytes and the breakdown of the blood-retinal-barrier, leading to retinal vascular permeability [6, 7]. This breakdown is mainly driven by the production of inflammatory cytokines, with vascular endothelial growth factor (VEGF) to be the most prominent [6, 7]. Several studies have shown that elevated serum lipids, including cholesterol and low-density lipoprotein (LDL), demonstrated a significant association with retinal hard exudates and formation of DME [9,10,11,12], while elevated IL-6 has been correlated with diffuse retinal thickness or severity of DME [13, 14]
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