ArticleFrontiers in medicine2026
Clinical and optical coherence tomography predictors of spontaneous resolution of diabetic macular edema: incremental value of the subfoveal large choroidal vessel layer thickness ratio.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Spontaneous anatomical improvement can occur in selected patients with diabetic macular edema (DME) managed initially by observation, but reliable predictors remain insufficiently defined. This study evaluated clinical and optical coherence tomography (OCT) predictors of 6-month spontaneous resolution and the incremental prognostic value of the subfoveal large choroidal vessel layer thickness ratio (SLCVLTR). Methods: This retrospective single-center study included 302 eyes of 302 adults with type 2 diabetes and OCT-confirmed DME who underwent initial observation without immediate DME-directed treatment from March 2021 to March 2025. Spontaneous resolution was defined as both a ≥20% reduction in central subfield thickness (CST) and an absolute CST ≤ 300 μm at 6 months without DME-directed treatment. Multivariable logistic regression identified independent predictors. Discrimination, calibration, and clinical utility were assessed using receiver operating characteristic analysis, the Hosmer-Lemeshow test, and decision curve analysis. Results: Spontaneous resolution occurred in 83 eyes (27.5%). Higher hemoglobin A1c (odds ratio [OR], 0.762; 95% confidence interval [CI], 0.597-0.971), greater CST (OR, 0.989; 95% CI, 0.983-0.995), cystoid versus diffuse edema (OR, 0.438; 95% CI, 0.232-0.826), more hyperreflective foci (OR, 0.921; 95% CI, 0.872-0.973), and higher SLCVLTR (OR, 0.932; 95% CI, 0.895-0.972) were independently associated with lower odds of spontaneous resolution, whereas intact ellipsoid-zone continuity was associated with higher odds (OR, 1.855; 95% CI, 1.028-3.347). Adding SLCVLTR to the clinical-retinal OCT base model increased the area under the curve from 0.812 to 0.847 ( Conclusion: Spontaneous resolution of DME is associated with systemic metabolic control, edema severity, retinal microstructural integrity, and choroidal laminar structure. SLCVLTR provides independent and incremental prognostic information and may improve risk stratification in carefully selected patients considered for initial observation.
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