Association of Disorganization of Retinal Inner Layers With Visual Acuity In Eyes With Uveitic Cystoid Macular Edema

Am J Ophthalmol. 2017 May;177:116-125. doi: 10.1016/j.ajo.2017.02.017. Epub 2017 Feb 22.


Purpose: To determine whether disorganization of retinal inner layers (DRIL) assessed by spectral-domain optical coherence tomography (SDOCT) correlates with visual acuity (VA) in eyes with uveitic cystoid macular edema (CME).

Design: Secondary analysis of randomized clinical trial data.

Methods: Fifty-six eyes of 42 patients with uveitic CME were prospectively imaged as part of the VISUAL-1 trial ( identifier NCT01138657). Central subfield thickness (CFT), horizontal and vertical extent of DRIL, foveal DRIL (>500 μm DRIL) hyperreflective foci (HRF), average and largest area of intraretinal (IR) cysts, and extent of disruption of external limiting membrane (ELM) and ellipsoid zone (EZ) were determined within the 1-mm central subfield and correlated with VA at baseline and follow-up visits.

Results: Regression analysis adjusted for clustered observations was used to examine the association between OCT morphologic parameters and VA. Across all visits (n = 168), significant associations were found for CFT (0.080 per 100 μm, P < .001), foveal DRIL (0.170, P < .001), horizontal DRIL length (0.055 per 100 μm, P < .001), vertical DRIL extent (0.001, P = .005), total area of IR cysts (0.204 per mm2, P < .001), area of largest IR cyst (1.407 per mm2, P < .001), presence of HRF (P = .026), and EZ disruption (0.042 per 100 μm, P = .02). ELM disruption did not show a significant association with VA (-0.013 per 100 μm, P = .61).

Conclusion: DRIL is a robust and easily obtained surrogate marker of VA in participants with current or resolved uveitic CME. CFT, DRIL, IR cyst area, EZ disruption, and HRF had a strong association with VA.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adalimumab / administration & dosage
  • Adult
  • Aged
  • Anti-Inflammatory Agents / administration & dosage
  • Double-Blind Method
  • Female
  • Fluorescein Angiography
  • Fundus Oculi
  • Humans
  • Macular Edema / diagnosis*
  • Macular Edema / etiology
  • Macular Edema / physiopathology
  • Male
  • Middle Aged
  • Retina / pathology*
  • Tomography, Optical Coherence / methods*
  • Uveitis / complications
  • Uveitis / diagnosis*
  • Uveitis / drug therapy
  • Visual Acuity*
  • Young Adult


  • Anti-Inflammatory Agents
  • Adalimumab

Associated data