Quantitative Analysis of Vitreo-Macular Adhesion in Diabetic Patients Without Proliferative Retinopathy

Background: Vitreomacular adhesion (VMA) is a physiological stage of posterior vitreous detachment that plays a significant role in the progression of diabetic retinopathy. This study aims to quantitatively assess the percentage of VMA in diabetic patients without proliferative disease compared to non-diabetic controls. Methods: This is a prospective, double-masked, cross-sectional study conducted at a tertiary eye care center in central India. Consecutive diabetic patients were evaluated. Proliferative diabetic retinopathy (PDR) was excluded. Optical coherence tomography (OCT) of the macula was done using four radial scans (rotational angulation set at 45°, 90°, 135°, and 180°). Patients were classified as either VMA+ or VMA. A quantitative analysis was performed for each case to calculate the percentage length of the retinal surface with attached vitreous cortex (%VMA). Results: Sixty-eight eyes of 40 patients and 50 eyes of 25 age-matched controls were included for analysis. Mean duration of diabetes mellitus (DM) was 7.9 +/-5.4 yrs. 65/68 eyes (96%) of DM group were VMA+, while 42/50 eyes (84%) of the control group were VMA+ (p=0.032), OR=4.12 (CI= 1.03-16.45). Percentage VMA (%VMA) was higher for the DM group at all meridians, but comparison with controls did not reveal statistically significant findings (average %VMA 65% vs. 58%, p=0.251). Though statistically insignificant, the average %VMA was higher for patients with non-proliferative diabetic retinopathy (NPDR; 71%), in comparison to patients without diabetic retinopathy (DR; 63.4%) or with macular edema (61%) (p=0.554). Conclusion: We could not establish a statistically significant quantitative variation of %VMA between diabetic and non-diabetic individuals, or amongst early manifestations of DR. Future studies in advanced stages of DR with upcoming OCT systems are needed to confirm our findings.