Association of Body Fluid Expansion With Optical Coherence Tomography Measurements in Diabetic Retinopathy and Diabetic Macular Edema

Abstract

PURPOSE. To evaluate associations of body fluid status with optical coherence tomography measurements in patients with diabetic retinopathy (DR). METHODS. This prospective, cross-sectional study enrolled a total of 104 eyes from 104 patients with diabetes mellitus for fundus evaluations of DR and optical coherence tomography examinations. DR severity was graded via fundus photography. Systemic body fluid status was recorded via a body composition monitor with output values of total body water, extracellular water (ECW), intracellular water, and overhydration (OH). Relative overhydration (ROH) was defined as OH/ECW. Volume overload was defined as ROH ‡7%. Correlations of central subfield thickness (CST) with body fluid status were analyzed by partial correlation with adjustment for age, sex, and body mass index (BMI). Logistic regression analysis was used to evaluate factors associated with diabetic macular edema (DME). RESULTS. Higher levels of ECW, OH, and ROH were correlated with thick CST in patients with DR (P ¼ 0.006, 0.021, and 0.008, respectively), but not in those without any DR (all P > 0.05), after adjusting for age, sex, and BMI. Patients with DME (n ¼ 31) had higher OH than DR patients without DME (n ¼ 28) or those without any DR (n ¼ 45) (P ¼ 0.002 and P < 0.001, respectively). Multiple regression model showed that volume overload was the independent factor for the presence of DME (odds ratio, 9.532; 95% confidence interval, 2.898-31.348; P < 0.001). CONCLUSIONS. While both ECW and OH reflect CST in patients with DR, overhydration had particularly strong associations with DME. This study provides a novel insight into our current understanding regarding the pathogenesis for DME.

Renal Biomarkers for Treatment Effect of Ranibizumab for Diabetic Macular Edema

“…Albuminuria with marked protein loss may lower the oncotic pressure and thus drove intravascular fluid into the interstitial tissue [20]. On the other hand, it was reported that overhydration in CKD was associated with DME [21]. The resolution of DME with systemic furosemide treatment, which was intended for volume expansion, was also observed in a few cases [22,23].…”

Clinical Relevance of Body Fluid Volume Status in Diabetic Patients With Macular Edema

“…This study provided new evidence to demonstrate the role of fluid overload in DME. As previously described, the relationship between barrier dysfunction and macular edema, impaired renal function and fluid overload have been investigated, respectively ( 10 , 15 ). However, the complicated interaction between barrier dysfunction and fluid overload has not been elucidated yet, which make it intricate to explain whether the fluid overload is the mediator between barrier dysfunction and macular edema, or it can lead to DME without the impact from BRB breakdown, as fluid overload also had other influencing factors ( 27 – 29 ).…”

“…Interestingly, while DKD has been proven associated with the elevation in extracellular fluid volume ( 14 ), a recent study discovered that fluid overload also appeared in DME patients ( 15 ). Imbalance of hydrostatic and oncotic pressure explained by starling equation could account for the phenomenon.…”

Clinical Analysis of Persistent Subretinal Fluid after Pars Plana Vitrectomy in Macula with Diabetic Tractional Retinal Detachment

“…Tsai et al [21] also reported the correlation of kidney function and residual SRF after intravitreal, anti-VEGF injection in diabetic macular edema patients. Recently, they also reported that the systemic overhydrating condition was the independent factor for diabetic macular edema [23]. Although there are no reports of SRF after TRD surgery, it is clear that impaired kidney function accompanying diabetic retinopathy inhibits the absorption of SRF.…”