Abstract
BackgroundTo investigate the clinical features of diabetic macular edema (DME) in eyes with pachychoroid phenotypes using multimodal retinal imaging.MethodsWe retrospectively reviewed 210 eyes from 210 DME patients and analyzed the clinical and imaging parameters, including visual acuity, central macular thickness (CMT), subfoveal choroidal thickness (SFCT) and neural retina layer thickness (NRT). The DME eyes were divided into two groups: group 1 (80 eyes with submacular detachment [SMD]) and group 2 (130 eyes without SMD). The clinical and imaging parameters of 285 eyes from 285 diabetic patients without DME were collected as a control group.ResultsDME eyes with pachychoroid phenotypes were more frequent in group 1 than in group 2 (53 eyes [66.25%] and 53 eyes [40.77%], respectively, P < 0.001). Pachychoroid phenotypes were identified in 108 (37.90%) of the control eyes. CMT and NRT were greater in group 1 than in group 2. In group 1, 37 eyes had SMD combined with focal edema, and 43 eyes had SMD combined with diffuse-type edema. No significant difference in pachychoroid phenotypes was found between the focal and diffuse types (26 [70.27%] and 27 [62.79%], respectively, P = 0.481). In group 2, 70 eyes had focal-type edema, and 60 eyes had diffuse-type edema. No significant difference in the frequency of pachychoroid phenotypes was found (32 [45.71%] and 21 [35.00%], respectively, P = 0.215). Interestingly, among the 70 eyes with focal edema in group 2, 13 (40.6%) and 5 (13.2%) eyes with and without pachychoroid phenotypes showed no definite microaneurysms, respectively.ConclusionSMD and focal edema without definite microaneurysms may be clinical manifestations of DME with pachychoroid phenotypes and possibly related to choroidal circulation disturbance in DME.
Highlights
To investigate the clinical features of diabetic macular edema (DME) in eyes with pachychoroid phenotypes using multimodal retinal imaging
Subretinal fluid accumulation may occur in DME with outer blood-retinal barrier (BRB) breakdown, and choroidal circulation leaks into the subretinal space
When we analyzed 52 eyes with microaneurysms or 52 eyes in which we considered that a leak from microaneurysms was the major mechanism of their macular edema, the central macular thickness (CMT) of 19 eyes with pachychoroid features was not different from that of 33 eyes without pachychoroid features (336.58 and 342.79 μm, P = 0.676)
Summary
To investigate the clinical features of diabetic macular edema (DME) in eyes with pachychoroid phenotypes using multimodal retinal imaging. Inner and/or outer BRB compromise are the main causes for the development of macular edema in diabetic eyes; the genesis of SMD in these eyes seems involve a complex process. Excess fluid that reaches the subretinal space from rapidly increased intraretinal fluid in RVO might exceed the RPE active transport mechanism [2, 7]. This mechanism of SMD development from inner BRB disruption hardly explains the occurrence of SMD without substantial retinal fluid accumulation or when DME is focal (fluid in only the outer plexiform/outer nuclear layer [OPL/ONL]) and far from the macula [8], especially the nasal location. Subretinal fluid accumulation may occur in DME with outer BRB breakdown, and choroidal circulation leaks into the subretinal space
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