Relationship between the Morphology of Diabetic Macular Edema and Renal Dysfunction in Diabetes

Abstract

PurposeTo determine the correlation between renal dysfunction and the morphologic changes of macular edema in diabetes.MethodsThe current study included 93 patients with diabetic macular edema based on optical coherence tomography (OCT) who completed systemic condition testing one month before or after the OCT. Based on the OCT findings, patients were divided into the following five groups: group A (diffuse), group B (cystoid), group C (serous), group D (vitreomacular tractional), and group E (a mixed presence of cystoid and serous types). In each group, we performed a retrospective analysis of serum albumin, urine albumin, and serum creatinine. We also analyzed the patients in whom serum albumin was <3.0 mg/dL and serum creatinine was >1.6 mg/dL. Urine albumin was measured in all five groups. In each group, a comparative analysis was performed using Fisher's exact test.ResultsThe number of patients who were assigned to groups A to E was 15, 46, 6, 3, and 23, respectively. According to a comparison of the patients in whom the serum albumin and serum creatinine were abnormal, there was no significant difference among the five groups. The proportion of patients in whom the urine albumin was abnormal was significantly greater in group C (67%) than in groups A (7%), B (20%), or E (22%).ConclusionsSerous-type macular edema occurred more frequently than other types of macular edema in patients with albuminuria.

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

“…Very few studies have been conducted to determine the correlation of non-ocular factors such as CKD secondary to diabetes with various morphological patterns of DME seen on OCT. [12,20,21] Also the previous studies conducted were single centre studies with a relatively small sample size. None of the studies performed have demonstrated the impact of CKD on the recently described visual prognostic biomarkers in DME and correlated them.…”

“…On review of literature several studies have used proteinuria as a marker of nephropathy and found a relation between disease severity and proteinuria. [12,21,22] However an inconsistent relation has been reported between the two and therefore in our study we have used eGFR as a marker of nephropathy which is possibly a better marker for nephropathy as ethnic variations and age of the patient are used for its determination. Also, eGFR is possibly the earliest marker for nephropathy and albuminuria is an inconsistent marker that may regress or progress.…”

“…[10,11] The morphological patterns of DME described are diffuse, cystoid, serous retinal detachment (SRD), mixed type and vitreomacular traction (VMT). [11,12] Various prognostic biomarkers such as disorganization of the inner retinal layers (DRIL), hyper re ective dots (HRD) and defects of the external limiting membrane-ellipsoid zone (ELM-EZ) have been described on OCT in eyes with DME. [13,14] OCT provides high resolution images and gives precise information of the morphological pattern and retinal thickness thereby guiding the treatment protocols.…”

“…To date, very few studies have been conducted to determine the correlation between the morphological pattern of DME in patients with chronic kidney disease (CKD) secondary to diabetes. [12] The present study was conducted to correlate OCT based morphological patterns of DME and prognostic biomarkers in patients with various stages of CKD secondary to diabetes.…”

Baja recurrencia del edema macular diabético focal, 6 meses después de la fotocoagulación

“…Los resultados de este estudio aplican para pacientes con EMCS focal; en el edema difuso, que generalmente tiene un engrosamiento y cierre capilar extenso 21 , los fármacos antiangiogénicos intravítreos han remplazado a la fotocoagulación. Además, el edema macular difuso se asocia con condiciones sistémicas como dislipidemia y nefropatía diabética, lo cual podría aumentar la proporción de ojos con edema recurrente 22 ; estas variables tienen una menor contribución en el edema macular focal, en el que la filtración viene de uno o más sitios de daño localizados en la red capilar 23 .…”