Purpose: To classify the outer retinal layer (ORL) deterioration patterns in eyes with diabetic serous macular detachment and to determine their impact on visual and anatomical prognosis.
Methods: In this retrospective case series, optical coherence tomography images of patients with diabetic macular edema between January 2015 and June 2024 were reviewed. Eyes exhibiting serous macular detachment were evaluated for ORL integrity, and five different ORL deterioration patterns were identified according to their structural characteristics: DIFFUSE, PATCH, WEDGE, FISTULA, and SMD-DROL. The relationship of these patterns with best-corrected visual acuity, and posttreatment external limiting membrane and ellipsoid zone status was analyzed with regression models.
Results: A total of 1,018 eyes of 592 patients were reviewed, and 168 eyes of 131 patients exhibited at least one ORL deterioration pattern. WEDGE was the most common pattern (31.75%), while DIFFUSE was the least detected (5.29%). WEDGE was associated with better best-corrected visual acuity and with a decreased risk of alterations in the external limiting membrane/ellipsoid zone ( P < 0.001). External limiting membrane/ellipsoid zone alterations were observed in all eyes with the DIFFUSE, and posttreatment external limiting membrane alteration width was associated with poorer visual outcome ( P < 0.05).
Conclusion: Diabetic serous macular detachment may present various ORL deterioration patterns associated with heterogeneous clinical and anatomical outcomes.
Keywords: diabetic macular edema; diffuse; disruption of retinal outer layers; ellipsoid zone; external limiting membrane; fistula; outer retinal layer; patch; serous macular detachment; wedge.