In patients with diabetic retinopathy morphology of serous maculadetachment and parameters affecting the treatment response

Purpose: In this study, it was aimed to investigate the morphology of serous macular detachment in patients with diabetic retinopathy, to detect other accompanying macular findings and to evaluate the response to treatment. Materials and Methods: Diabetic patients diagnosed with serous macular detachment (SMD) by optical cohort tomography (OCT), followed in the retina unit of Karadeniz Technical University Ophthalmology Department between 2012 and 2022, were retrospectively included in the study. The ages of the patients included in the study ranged from 38 to 82. Diabetes mellitus (DM) duration, HbA1c level and diabetic retinopathy stage of the patients were recorded. Best corrected visual acuity (BCVA) with Snellen chart, total macular thickness (TMC) and central retinal thickness (MRC), measured by OCT, height of serous macular detachment and ratio to MRC, base width and height to base width ratio. The presence and type of edema were recorded. Other OCT findings such as hyperreflective spots (HRN), disorgation in the inner retinal layers (DRIL), vitreoretinal interface pathologies, presence of exudate in the macular area, and deterioration in the ellipzoid zone (EZ) accompanying SMD were recorded. The presence of ischemia in the macular region was recorded in fundus fluorescein angiography (FFA) (optos California). OCT images were obtained with OPTOVUE in macular grid mode and horizontal section passing through the fovea were used for evaluation. Measurements were made manually using the software in the OCT device. Intravitreal antiVEGF, for which the loading dose was completed,and intravitreal/subtenon steroid injections and laser photocoagulation treatments, if applied, were recorded. The treatment responses according to SMD dimensions were analysed, the effect of other accompanying pathologies was evaluated by regression analysis. Results While the mean BCVA was 0.32 ±0.24 before the treatment, it was 0.36 ±0.30 after the treatment, but this increase was not statistically significant (p=0.69). Although the results were not significant, SMD parameters and TMT were smaller in the group with increased visual acuity compared to the unchanged or v decreased groups. There was a statistically significant difference between the initial and post-treatment SMD elevation. (p=0.027). There was no statistically significant difference between the presence of ischemia in the macular region and the initial SMD and retina parameters and BCVA of the eyes. A significant positive correlation was found between SMD height and base width (r=0.858, p=0.0000). While there was a significant correlation between SMD height and base width and total macular thickness (r=0.5693, p=0.0001 and r=0.5116, p=0.0004), no significant correlation was found only between central retinal thickness. (r= -0.1912, p=0.2137, and r= - 0.1224, p=0.4098). While there was no significant correlation between the first VA and SMD elevation (r= -0.2923, p=0.0542), a significant correlation was found between the last VA and SMD elevation (r= -0.3385, p=0.0246,). While there was a significant correlation between baseline VA and TMT (r = -0.3351, p = 0.0262), no significant correlation was found with VA at the final examination (r = -0.2805, p=0.0651). When the response in SMD height was compared according to the applied agent, no statistically significant difference was found between the drug groups (p=0.8742). Similarly, the change in BCVA did not differ significantly between drug groups (p=0,1828). Conclusion and Results: According to the results of the analysis of the data related to SMD in our study, it can be predicted that SMD accompanied by diffuse macular edema will respond better to treatment. The positive correlation between the height of SMD and many parameters shows that the initial SMD parameters may have an effect on VA. Studies with more data and case numbers are needed to predict functional and anatomical outcomes in the response of SMD to treatment.Key Words: Diabetic macular edema, OCT, biomarker, serous macular detachment Anahtar kelimeler: Diyabetik maküler ödem, OKT, biyobelirteç, seröz maküla dekolmanı