The relationship between photoreceptor IS/OS junction changes and visual acuity in diabetic macular edema

Nehal M Samy El Gendy, Shaimaa Arfeen, K. Rafaat, S. Sheta
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Abstract

Purpose: To evaluate the integrity of the photoreceptor inner segment and outer segment (IS/OS) junction using spectral-domain optical coherence tomography (SD OCT) in patients with diabetic macular edema and to correlate the relationship between the integrity of the IS/OS junction and visual acuity. Design: Observational, prospective study. Materials and Methods: Forty eyes of 22 diabetic patients having diabetic macular edema. The authors performed spectral-domain optical coherence tomography in all eyes before treatment, 1month and 6 months after treatment. Central subfield thickness was defined as the average retinal thickness of the central 1-mm scanned area. The length of disruption of the inner and outer segments of the photoreceptors in the fovea were measured and graded according to their length as follows: Grade 0: Intact IS/OS line (no disruption at all), grade 1: Mild disruption (<400 μm). Grade 2: Moderate disruption (>400 μm but <1400 μm), Grade 3: Severe disruption (>1400 μm )or completely lost. Results: At the baseline, there was no correlation between the visual acuity (VA) and grade of defect (r = 0.214, P-value = 0.190). After 1 month and 6 months of treatment, there was a correlation between the VA and the grade of the defect (r = 0.538, P-value < 0.001) (r =0.603, P-value < 0.001), respectively. There was no significant association between the improvement in the IS/OS and final VA (P-value < 0.385). The mean change in VA from base line to 1 month in those who showed improvement in the defect was better than those in the nonimproved group (P-value = 0.001), and the mean change in the VA values from base line to 6 months in the improved group was better than those in the non improved group (P-value = 0.001). Conclusions: SD OCT showed that the integrity of the inner and outer segments of the photoreceptors was correlated with best-corrected visual acuity only 1 and 6 month after treatment, but not before treatment, so the correlation was not absolute.
糖尿病黄斑水肿患者光感受器IS/OS连接改变与视力的关系
目的:应用光谱域光学相干断层扫描(SD OCT)评价糖尿病黄斑水肿患者光感受器内外段(IS/OS)连接处的完整性,并探讨IS/OS连接处完整性与视力的关系。设计:观察性、前瞻性研究。材料与方法:22例糖尿病黄斑水肿患者40眼。治疗前、治疗后1个月和6个月分别对所有眼行光谱域光学相干断层扫描。中心子场厚度定义为扫描中心1mm区域的平均视网膜厚度。测量中央凹内、外段光感受器的断裂长度,并根据其长度进行分级:0级:完整的IS/OS线(完全没有断裂),1级:轻度断裂(400 μm ~ 1400 μm)或完全丢失。结果:基线时,视力(VA)与缺损程度无相关性(r = 0.214, p值= 0.190)。治疗1个月和6个月后,VA与缺损程度有相关性(r = 0.538, p值< 0.001)(r =0.603, p值< 0.001)。IS/OS改善与最终VA无显著相关性(p值< 0.385)。缺损改善组VA从基线到1个月的平均变化优于未改善组(p值= 0.001),改善组VA值从基线到6个月的平均变化优于未改善组(p值= 0.001)。结论:SD OCT显示,光感受器内外段的完整性与最佳矫正视力仅在治疗后1个月和6个月存在相关性,而在治疗前无相关性,因此相关性不是绝对的。
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