Study Explores Associations Between DME and Proliferative Diabetic Retinopathy

John O'Fee

New data shows that epiretinal membrane and vitreomacular interface status may not be significantly associated with diabetic macular edema in patients with proliferative diabetic retinopathy.

However, the presence of epiretinal membranes and vitreomacular interface status can potentially influence the development of center-involving diabetic macular edema, the investigators noted.

These findings were presented at the Association for Research in Vision and Ophthalmology (ARVO) Virtual Meeting.

Led by John O’Fee of the Keck School of Medicine at USC, the investigative team sought to identify and characterize patients with proliferative diabetic retinopathy who go on to develop diabetic macular edema.

“Vascular endothelial growth factor is a major mediator of both diabetic macular edema and proliferative diabetic retinopathy,” O’Fee and colleagues wrote. “In our clinical practice, we have observed a significant number of patients with proliferative diabetic retinopathy without any diabetic macular edema.”

Thus, the team conducted an observational, retrospective case series of patients with proliferative diabetic retinopathy admitted to retina clinics at a single large acute-care teaching hospital. The study was conducted between December 2018 – October 2020.

During their observations, they classified vitreomacular interface status as vitreomacular adhesion without traction, vitreomacular traction, or macular posterior vitreous detachment.

“Eyes were excluded if they had received retinal laser or intravitreal injection of a pharmacotherapeutic agent <1 year from OCT date, had any prior intraocular surgery or comorbid ophthalmic disorders associated with diabetic macular edema,” the investigators noted.

As such, they evaluated a total of 293 eyes from 210 screened patients. The team reported that 66.2% of eyes presented with diabetic macular edema while 33.8% did not.

Further, there were no major differences (P < .05) in average visual acuity, retinal thickness, cube volume, and dialysis status between patients with and without diabetic macular edema. There were also no significant differences in epiretinal membrane (P = .196) and vitreomacular interface status (P = .340).

Among eyes with center-involving diabetic macular edema (n = 90), 44.4% presented with vitreomacular adhesion without traction, 7.8% with vitreomacular traction, and 47.8% with posterior vitreous detachment. As many as 82.2% of eyes had epiretinal membranes, of which 66.2% had center-involving epiretinal membranes.

Conversely, among eyes with non-center-involving diabetic macular edema (n = 104), 67.3% presented with vitreomacular adhesion without traction, 1% with vitreomacular traction, and 31.7% with posterior vitreous detachment. Up to 45.2% had presence of epiretinal membranes, of which 44.9% had center-involving epiretinal membranes.

Overall, the team reported that eyes with center-involving diabetic macular edema were more likely to have posterior vitreous detachment than eyes with non-center-involving diabetic macular edema (P = .001). This was similarly true for presence of epiretinal membranes (P ≤ .001) and center-involving epiretinal membranes (P = .019).

The study, “Factors Associated with Diabetic Macular Edema Development in Patients with Proliferative Diabetic Retinopathy” was presented at ARVO 2021.