Correlating the patterns of Diabetic macular edema, Optical Coherence Tomography Biomarkers and Grade of Diabetic Retinopathy With Stage of Renal Disease

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Abstract PurposeTo correlate Optical coherence tomography (OCT) based morphological patterns of diabetic macular edema (DME), prognostic biomarkers and grade of diabetic retinopathy (DR) in patients with various stages of chronic kidney disease (CKD) secondary to diabetes. DesignMulticentric retrospective cross-sectional study conducted at seven centres across India.MethodsData from medical records of patients with DME and CKD was entered in a common excel sheet across all seven centers. Staging of CKD was based on estimated glomerular filtration rate (eGFR). ResultsThe most common morphological pattern of DME was cystoid pattern (42%) followed by the mixed pattern (31%). The proportion of different morphological patterns did not significantly vary across various CKD stages (p=0.836). Presence of external limiting membrane-ellipsoid zone (ELM-EZ) defects (p<0.001) and foveal sub-field thickness (p=0.024) showed a direct correlation with the stage of CKD which was statistically significant. Presence of hyper reflective dots (HRD) and disorganization of inner retinal layers (DRIL) showed no significant correlation with the stage of CKD. Sight threatening DR was found to increase from 70% in CKD stage-3 to 82% in stage-4 and 5 of CKD and this was statistically significant (p=0.03).ConclusionsCystoid morphological pattern followed by mixed type was the most common pattern of DME on OCT found in patients suffering from stage 3 to 5 of CKD. However, the morphological patterns of DME did not significantly vary across various CKD stages. ELM-EZ defects may be considered as an important OCT biomarker for advanced stage of CKD.

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