Importance of ellipsoid zone line in the treatment of diabetic macular edema.

Abstract

Introduction: Diabetic macular edema (DME) is a worst manifestation of diabetic retinopathy (DR). Current advanced techniques may reverse DME, usually evaluated by the improvement in visual acuity (VA). In clinical practice VA is not improved even after marked decrease in the macular thickness. Structures abnormalities for example to ellipsoid zone (EZ) may account for post treatment visual outcome.

Objectives: To evaluate the relationship between Ellipsoid Zone line (EZ Line) and best corrected visual acuity (BCVA) after treating diabetic macular edema in type II diabetic patients.

Methodology: For this prospective and observational study patients of type II diabetes mellitus with clinically significant macular edema (CSME) without proliferative diabetic retinopathy were recruited. The BCVA was recorded by Snellen Acuity Chart and discriminant values of macular thickness and EZ line defect were evaluated using Ocular Coherence Tomography at the time of presentation and during follow-up period. SPSS 22 version was used for results analysis

Results: At 6th months follow-up, overall improvement in interruption of EZ line was good but statistically significant (P≤ 0.001) was found in sub class II a. The mean reduction in central sub foveal thickness (CSFT) was found significant (P≤ 0.001) in all class of EZ line but the mean value of BCVA in class I EZ line (70±SD18, P≤ 0.001) was better than class II (45±SD18, P-value = 0.021); and we did not find any correlation between the BCVA and level of interruption of EZ line after progressive decrease in CSFT (r = 0.210, P-value = 0.021).

Conclusion: It has been concluded the by the quantitative measurement of retinal layer with OCT we can say that EZ line continuity is closely linked to visual outcome in eyes with macular edema.

Keywords: Ellipsoid Zone Line, CME, Integrity of IS OS junction, CSFT