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Objective: To study the association of spectral domain optical coherence tomography (SD-OCT) based alterations in macular thickness and inner segment-ellipsoid band (ISel) with severity of retinopathy in cases of type 2 diabetes mellitus. Method: Two hundred thirty eight consecutive cases and seventy nine healthy controls were included. Eyes of cases were divided into three groups according to ETDRS classification: diabetes without retinopathy (No DR) (n=79), non-proliferative diabetic retinopathy (NPDR) with macular edema (n=79), and proliferative diabetic retinopathy (PDR) with macular edema (n=80). Visual acuity was assessed using logMAR scale. Fasting and post prandial blood glucose and glycosylated hemoglobin were estimated as per standard protocol. All the study subjects were evaluated using SD-OCT using the macular cube 512×128 feature. Central subfield thickness (µm), cube average thickness (µm) and ISel disruption in foveal region were noted. The integrity of ISel was evaluated by two experienced observers masked to the status of diabetic retinopathy. Chi–square test, analysis of variance, unpaired t test and pearson correlation analysis were used to assess association between the study variables. Results: Statistically significant decrease in visual acuity was found between the study groups (p<0.0001 ). Significant negative correlation of visual acuity was found with HbA1c, central sub field thickness and ISel disruption (p<0.001).Significant increase in central subfield thickness and cube average thickness were found between the study groups (p<0.001). ISel disruption increased with increase in severity of diabetic retinopathy [(NPDR, n=55) versus (PDR, n=68)] (p<0.001).Statistically significant difference in the mean central subfield thickness in the cases with intact and disrupted ISel was observed in NPDR and PDR groups respectively. Conclusion: Diabetic macular edema as assessed by central subfield thickness, cube average thickness and ISel disruption, on SD-OCT, is associated with increased severity of diabetic retinopathy. For the first time, it has been demonstrated that with progression of retinopathy from non-proliferative to proliferative stage, increase in central subfield thickness is associated with ISel disruption.

international journal of ophthalmology and clinical research

Spectral Domain Optical Coherence Tomography Based Alterations in Macular Thickness and Inner Segment Ellipsoidare Associated with Severity of Diabetic Retinopathy