Turk J Ophthalmol. 2026 Oct 23;56(5):308-316. doi: 10.4274/tjo.galenos.2026.24196.
ABSTRACT
OBJECTIVES: To compare structural optical coherence tomography (OCT) biomarkers and visual acuity between eyes with nonproliferative (NPDR) and proliferative diabetic retinopathy (PDR) in real-life clinical settings.
MATERIALS AND METHODS: This retrospective, cross-sectional, multicentre study included 818 eyes of 534 patients with treatment-naive diabetic macular oedema (DMO) from nine tertiary clinics. Evaluated parameters included central macular thickness (CMT), DMO morphology, disorganisation of the retinal inner layers, ellipsoid zone (EZ) integrity, vitreoretinal interface abnormality (VRIA), and posterior hyaloid status. Analyses used eye-level data with patient-clustered robust standard errors and study-centre fixed effects. A joint multivariable logistic model mutually adjusted EZ integrity, posterior hyaloid status and VRIA together with clinical covariates, with Holm correction across six structural-domain tests.
RESULTS: Of the 818 eyes, 646 had NPDR and 172 PDR. Mean best-corrected visual acuity (BCVA) was worse in PDR (0.74±0.54 versus 0.57±0.42 logarithm of the minimum angle of resolution; p<0.001). In univariable clustered comparisons, no biomarker survived false discovery rate correction across ten comparisons (lowest q=0.095, VRIA). In the joint model (636 eyes, 431 clusters), none survived Holm correction: posterior hyaloid detachment was nominally associated with PDR (odds ratio [OR] 2.03, 95% confidence interval [CI] 1.05-3.92; Holm p=0.208), the global EZ term was not significant (p=0.221), and VRIA was not significant after adjustment for posterior hyaloid status (OR 1.36, 95% CI 0.67-2.75; p=0.388). Centre-adjusted CMT did not differ (p=0.890). Secondarily, PDR, disrupted EZ, higher CMT and VRIA were each associated with worse BCVA.
CONCLUSION: In treatment-naive DMO, no structural OCT biomarker was independently associated with proliferative disease after accounting for fellow-eye correlation, centre effects, mutual adjustment, and multiplicity. Posterior hyaloid detachment gave the most consistent nominal signal, and the vitreoretinal interface variables carried overlapping rather than independent information. These findings do not establish prognosis.
PMID:42928578 | DOI:10.4274/tjo.galenos.2026.24196