Influence of Segmental Supply of Cilioretinal Artery on Morphology of Diabetic Macular Edema

Influence of Segmental Supply of Cilioretinal Artery on Morphology of Diabetic Macular Edema | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Influence of Segmental Supply of Cilioretinal Artery on Morphology of Diabetic Macular Edema Rehana Khan, Mahesh Shanmugam, Rajesh Ramanjulu, Jay Chablani, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.2.21876/v2 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Jan, 2021 Read the published version in BMC Ophthalmology → Version 2 posted 4 You are reading this latest preprint version Show more versions Abstract Background : The supply of Cilioretinal artery (CRA) to different layers of retina influences retinal pathologies like diabetic retinopathy. Since the supply of CRA is segmental, Our aim is to analyze the location of CRA) with non center-involving and center-involving diabetic macular edema (DME) and to evaluate the supply of CRA with segments of macular edema based on Early Treatment of Diabetic Retinopathy Study (ETDRS) scale using optical coherence tomography (OCT). Design : Retrospective study Methods : A retrospective study in which forty-three patients at various stages of diabetic retinopathy with the presence of CRA were identified. Presence and location of CRA was recognized using fundus fluorescein angiography. Classification of DME was based on ETDRS subfields on OCT. Results : Evaluation of 26 men and 17 women of various groups of diabetic retinopathy revealed unilateral CRA in 40 subjects and bilateral CRA in 3 subjects. When CRA supplied the central area, maximum retinal thickness was noted at the temporal quadrant (271.67±164.02 mm) and had non center-involving DME (194.87±121.06 mm), when CRA supplied the lower area, maximum retinal thickness was noted at the superior quadrant (293.64±159.36 mm) and had center-involving DME (395±285.75 mm), and when it supplied the upper area, maximum retinal thickness was noted at the nasal quadrant (293.49±176.18mm) with center-involving DME (292±192.79 mm). Conclusion : The presence of CRA seems to alter the morphology and influences the segment involved in DME. However, further studies with larger sample size are warranted to prove this association. Ophthalmology Cilioretinal artery central-involving macular edema non-central involving macular edema segmental supply optical coherence tomography retinal thickness ETDRS Figures Figure 1 Background The outer retina is supplied by choroidal circulation whereas the inner retina by retinal circulation. There are anatomical, hemodynamic, and autoregulatory differences in these circulations. The changes in retinal circulation are well characterized in diabetic retinopathy. However, the choroidal changes are less well understood. A recent study by Kim et al, [1] determined the choroidal vascular changes in diabetic patients by measuring the choroidal vascularity index (CVI). The authors hypothesized that a reduction in the choroidal vascular component was apparently noted in patients with type-2 diabetes mellitus (DM), even when there is no evidence of diabetic retinopathy (DR). Cilio retinal artery originates from ophthalmic artery and fills up during choroidal flow of fundus fluorescein angiography (FFA). The difference in the supply to different layers of retina by choroidal and retinal circulation may influence the phenotype in retinal pathologies such as diabetic retinopathy. Recent studies have hypothesized that the vascular structures or substances from the choroid might influence diabetic maculopathy [2] .Knudsen and Lervang [3] showed that in patients with diabetes, who had bilateral but asymmetric diabetic maculopathy, more severe maculopathy, which included clinically significant macular edema, was detected in the eye with a CRA. A study conducted by Landa et al [2] using a retinal function imager shows that there is an increased occurrence of diabetic macular edema (DME), if there is a presence of CRA in diabetic eyes. However, usually, the supply of CRA is segmental. The effect of this segmental choroidal supply has not been evaluated in diabetic retinopathy. In this study, our focus was on the analysis of location of CRA with non center-involving and center-involving DME and to evaluate the supply of CRA with segments of macular edema based on Early Treatment of Diabetic Retinopathy Study (ETDRS) scale using optical coherence tomography (OCT). Methods Fundus fluorescein angiography database were segregated to identify people with diabetes and CRA at three tertiary care centers in south India. On screening database from 2015 to 2017, a total of 43 (26 men and 17 women) patients were identified at various stages of diabetic retinopathy with presence of CRA. Out of which unilateral CRA was present in 40 patients and bilateral CRA in 3 patients. All the patients in the study group had adult-onset diabetes mellitus with mild-to-severe non proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). Patients with neovascularization of the disc (NVD) and small fine cilioretinal artery at the disc margin on angiogram were excluded. Clinical Assessment The demographic details and medical history including duration of diabetes-associated systemic hypertension were noted. The treatment received, including LASER and intravitreal injections and visual acuity, was noted. Fundus photos were graded for the presence of diabetic retinopathy using ETDRS classification. Classification of DME is based on ETDRS subfields on OCT. FFA-proven CRA side and prominent regions of the macula (upper, central, and lower) being supplied by it were noted. OCT images were taken in Cirrus SD-OCT and the findings were entered carefully as center-involving DME, non center-involving DME, no DME, presence of epiretinal membrane and/or taut posterior hyaloid membrane causing traction on macula and thinning suggestive of atrophy. Possible presence of CRA in the other eye was also noted. The study was approved by the Institutional Review Board (Ethics committee), Vision Research Foundation and written consent was obtained from the subjects as per the Declaration of Helsinki. Grading of DME The grading of DME was done as follows: [4] Center-involving DME: On clinical examination, definite retinal thickening due to DME involving the center of the macula. The spectral-domain optical coherence tomography (SD-OCT) showed loss of foveal contour, cystic space involving center of fovea, and neurosensory detachment involving the center of fovea. Central subfield thickness on OCT > 290 μm for women, >305 μm for men was observed on SD-OCT (Cirrus; Zeiss). Non center-involving DME: Definite retinal thickening due to DME within 3000 μm of the center of the macula but not involving the center of the macula. The SD-OCT showed cystic spaces and or retinal thickening in non central macular subfields. No DME: Normal central subfield thickness on OCT 209±18 μm in men and 194±23 μm in women. Mean Retinal thickness (in microns) according to Early-Treatment Diabetic Retinopathy Study (ETDRS) protocol [5] . Clinically significant macular edema is considered if the retinal thickening or hard exudates are observed within 500 ± 50 μm of the center of the foveal avascular zone or zones of retinal thickening 1 disc area or larger, any part of which was within 1 disc diameter of the center of the macula [6] . Hence the identification of DME is based on both specific OCT features and retinal thickness was taken into consideration. Statistical Analysis Descriptive statistics was used to analyse the baseline characteristics. For statistical analysis of groups and subgroups, an independent sample t-test was used. Relationship of diabetic macular edema were calculated as proportions of each area of supply by cilioretinal artery. Relationship between area of supply of cilioretinal artery and area of retinal thickness were analysed to report mean and standard deviation in each quadrant of the retina and Chi square test was used to find the Distribution of diabetic macular edema with presence and absence of cilioretinal artery. Results Fundus fluorescein angiography evaluation of these 43 subjects with diabetes revealed a unilateral CRA in 40 subjects and bilateral in 3 subjects. Of these 43 eyes of subjects with diabetic, 5 (11.36%) had mild NPDR, 20 (45.45%) had moderate NPDR, 12 (29.54%) had severe NPDR, and 6 (13.63%) were diagnosed to have PDR. These patients were further classified as having center-involving DME (37.20%), non center-involving DME (37.20%), and no presence of DME (25.58%) ( p = 0.83). (Table 1) shows the patients characteristics according to the status of macular edema in the study group. Among men, the distribution values of center-involving DME, non center-involving DME, and no DME are 68.75%, 75%, and 27.27% ( p = 0.05). Likewise, among women the distribution values of center-involving DME, non center-involving DME, and no DME are 31.25%, 25%, and 72.72% ( p = 0.03). No statistical significant difference was observed for age, duration of diabetes, and stages of diabetic retinopathy among the groups. Table 1: Patients characteristics according to the status of macular edema in the study group DEMOGRAPHIC AND CLINICAL FINDINGS Center involving DME * N=16 Non center involving DME * N=16 No DME * N=11 P Value Age (Mean in years ± SD) 59.93±8.04 54.18±7.44 60.08±7.22 0.34 Duration of diabetes (Mean in years ± SD) 13.75±8.32 11.37±6.11 9.22±1.85 0.1 Gender N (%) Male 11 (68.75%) 12 (75%) 3 (27.27%) 0.05 Female 5 (31.25%) 4 (25%) 8 (72.72%) 0.03 DR stage N (%) Mild NPDR† 2 (12.5%) 1 (6.25%) 2 (18.18%) 0.83 Moderate NPDR† 7 (43.75%) 10 (62.5%) 3 (27.27%) Severe NPDR† 4 (25%) 4 (25%) 4 (36.36%) PDR‡ 3 (18.75%) 1 (6.25%) 2 (18.18%) * DME- Diabetic macular edema, † NPDR – Non proliferative diabetic retinopathy, ‡ PDR – Proliferative diabetic retinopathy (Table 2) shows relationship of DME with area of supply by CRA. The subjects with center-involving DME had more number of central area of supply by CRA and equal number of upper and lower CRA supply. The subjects with non center-involving DME and No DME had more of central supply and less of upper supply by CRA. Table 2: Relationship of diabetic macular edema and area of supply by cilioretinal artery Area of Supply by CRA * Upper Central Lower Center involving DME† 5 (31.25%) 6 (37.5%) 5 (31.25%) Non center involving DME† 2 (12.5%) 8 (50%) 6 (37.5%) No DME† 1 (9.09%) 6 (56.54%) 4 (36.36%) P Value 0.25 0.10 0.36 CRA – Cilioretinal artery, † DME – Diabetic macular edema (Table 3) shows the distribution of DME with the presence and absence of CRA. The distribution of non center-involving DME in the presence of CRA is comparatively more than in the absence of CRA. The distribution of center-involving DME and No DME in the presence of CRA is lower than in the absence of CRA. The overall distribution of centre and non – centre involving DME was observed more in eyes with the presence of CRA (p=0.062), whereas no diabetic macular edema was observed more in eyes without CRA (i.e control group). Table 3: Distribution of diabetic macular edema with presence and absence of cilioretinal artery CRA Status* Centre Involving DME † Non-Centre involving DME No DME CRA Present 37.2% 39.5% 18.6% CRA Absent 44.2% 20.9% 25.5% P Value 0.3504 0.0083 0.2744 * CRA – Cilioretinal artery, † DME – Diabetic macular edema (Table 4) shows the relationship between area of supply of CRA and area of retinal thickness. (Figure 1) shows area of supply of cilioretinal artery and maximum retinal thickness in ETDRS subfields on OCT. When CRA supplies the central area, the maximum retinal thickness was noted at the temporal quadrant (332.68 ± 89.95) and has non center-involving DME (194.87±121.06 mm), When CRA supplies the lower area, the maximum retinal thickness was noted at the superior quadrant (342.42 ± 88.92) and has center-involving DME (395±285.75 mm) and with CRA supply in the upper area, the maximum retinal thickness was noted at the nasal quadrant (328.44 ± 129.82) with center-involving DME (292±192.79 mm). Table 4: Relationship between area of supply of cilioretinal artery and area of retinal thickness Area of supply of CRA Superior Temporal Inferior Nasal Central subfield Centre 324.34 ± 58.83 332.68 ± 89.95 320.84 ± 83.26 328.42 ± 77.57 306.10 ± 120.33 Upper 293.5 ± 132.15 308.69 ± 160.56 325.13 ± 129.40 328.44 ± 129.82 317.38 ± 152.69 Lower 342.42 ± 88.92 332.04 ± 101.38 319.08 ± 112.80 336.62 ± 127.90 318.69 ± 164.81 P value 0.441 0.858 0.991 0.972 0.962 Discussion The incidence of the cilioretinal artery (CRA) varies among many published reports. A study done by K S Mehra et al [7] , reported the incidence of 6.9 % in Indian population, Jain I S et al [8] , reported 22.8 % in Chandigarh population, Lorentzen et al [9] , 26%, Lei Liu et al [10] , 35% and Collier et al, 21.6 %. Hence the incidence varies between 6% and 40 %. In this study, we evaluated the effect of presence of CRA on the morphology of diabetic macular edema. It was found that the patients with CRA had more non center-involving DME compared to center-involving DME, whereas those without CRA had more center-involving DME compared to non center-involving DME. However, this difference was not statistically significant. We also observed that if the CRA supplied the central areas, the maximum retinal thickness was noted in the non central area (temporally). It was also found that the CRA alters the morphology of macular edema. Probably, its presence protects the area supplied by it from developing macular edema. This is in contrast to the findings in the study by Landa et al [2] who reported higher rates of DME in such eyes. However, the authors did not classify the edema as center or non center involving. As the histological structure of a CRA is similar to the branches of the central retinal artery, it is assumed that it undergoes similar levels of hypoxic damage, or even more due to the absence of “auto regulatory” features, which are a hallmark of the retinal circulation. [11] However, the CRA has a high flow velocity, which may compensate for reduction of flow due to the structural changes in choroid due to diabetes. Recently, Ebraheem et al [12] have reported that the presence of a CRA result in decreased levels of sub retinal fluid (SRF) in treatment-naive nAMD patients compared to controls who lacked a CRA. The authors concluded that CRA alters the hemodynamic of blood flow by diverting blood from the choroid to the inner retinal circulation, resulting in more chances of CME and probably a decreased chance of SRF. Probably through a similar mechanism, the distribution of DME is altered in patients with CRA. The strength of the study was that only FFA-proven CRA were included in the study. However, this reduced the sample size in each group, as the individuals with clinical suspicious of CRA with no FFA were excluded. The systemic factors such as glycemic control, serum lipids, and blood pressure were not considered in the analysis as data for these were not available for all patients. In some cases non-central and no DME cases can progress into central involving DME, and requires longitudinal analysis of the patients which is beyond the scope of this study because of its retrospective nature. Future longitudinal studies are required to fully understand the progression. Conclusion In summary, the presence of CRA seems to alter the morphology of DME. The segmental distribution of CRA also influences the segment involved in DME. However, further studies with larger sample size are warranted to prove this association. Abbreviations CRA: Cilio Retinal Artery DME: Diabetic Macular Edema ETDRS: Early Treatment of Diabetic Retinopathy Study OCT: Optical Coherence Tomography CVI: Choroidal Vascularity Index DM: Diabetes Mellitus DR: Diabetic Retinopathy FFA: Fundus Fluorescein Angiography NPDR: Non Proliferative Diabetic Retinopathy PDR: Proliferative Diabetic Retinopathy NVD: Neovascularization of the disc SD-OCT: Spectral-Domain Optical Coherence Tomography SRF: Sub Retinal Fluid AMD: Age Related Macular Degeneration CME: Cystoid Macular Edema Declarations Ethics approval and consent to participate The study was approved by the Institutional Review Board (Ethics committee), Vision Research Foundation and written consent was obtained from the subjects as per the Declaration of Helsinki. Consent for publication Not applicable Availability of data and materials The datasets generated during and/or analysed during the current study are not publicly available, as it is against the organization/hospital policy. But are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding Not Applicable Acknowledgements None Authors Contributions: R.R 1 , R.K, N.S., contributed in conception and design of the study. R.K., wrote the main manuscript text and prepared all the tables. R.K. and R.R 1 . assisted with statistical analyses. R.R 1 , drafted the work and substantively revised it. M.S., R.R., J.C., N.S., helped in acquisition of the data. All authors reviewed the manuscript. References Kim M, Ha MJ, Choi SY, Park YH. Choroidal vascularity index in type-2 diabetes analyzed by swept-source optical coherence tomography. Scientific reports. 2018 Jan 8;8(1):70. Landa G, Amde W, Haileselassie Y, Rosen RB. Cilioretinal arteries in diabetic eyes are associated with increased retinal blood flow velocity and occurrence of diabetic macular edema. Retina. 2011 Feb 1;31(2):304-11. Knudsen LL, Lervang HH. Can a cilio-retinal artery influence diabetic maculopathy?. British journal of ophthalmology. 2002 Nov 1;86(11):1252-5. Raman R, Bhende M. Diabetic Macular Edema. Medical & Vision Research Foundations. 2015 Jun;33(2):50. SABOURI MR, KAZEMNEZHAD E, HAFEZI V. Assessment of macular thickness in healthy eyes using cirrus HD-OCT: a cross-sectional study. Medical hypothesis, discovery and innovation in ophthalmology. 2016;5(3):104. Sánchez-Tocino H, Alvarez-Vidal A, Maldonado MJ, Moreno-Montañés J, García-Layana A. Retinal thickness study with optical coherence tomography in patients with diabetes. Investigative ophthalmology & visual science. 2002 May 1;43(5):1588-94. Mehra KS. Incidence of cilio-retinal artery in Indians. The British journal of ophthalmology. 1965 Jan;49(1):52. Jain IS, Singh K, Nagpal KC. Vessels at the disc margin (cilioretinal and other simulating cilioretinal vessels). Indian journal of ophthalmology. 1972 Dec 1;20(4):141. Lorentzen SE. Incidence of cilioretinal arteries. Acta ophthalmologica. 1970 Jun;48(3):518-24. Liu L, Liu LM, Chen L. Incidence of cilioretinal arteries in Chinese Han population. International journal of ophthalmology. 2011;4(3):323. Giuffre G, Montalto FP, Amodei G. Development of an isolated retinal macroaneurysm of the cilioretinal artery. British journal of ophthalmology. 1987 Jun 1;71(6):445-8. Ebraheem A, Uji A, Abdelfattah NS, Nittala MG, Sadda S, Le PV. Relationship between the Presence of a Cilioretinal Artery and Subretinal Fluid in Neovascular Age-Related Macular Degeneration. Ophthalmology Retina. 2018 May 1;2(5):469-74. Cite Share Download PDF Status: Published Journal Publication published 21 Jan, 2021 Read the published version in BMC Ophthalmology → Version 2 posted Editor assigned by journal 28 Apr, 2020 Reviewers invited by journal 28 Apr, 2020 Editor invited by journal 27 Apr, 2020 Submission checks completed at journal 23 Jan, 2020 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-12458","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":530551,"identity":"1631b0c1-4e11-467e-89d0-9dc64e269035","order_by":1,"name":"Rehana Khan","email":"","orcid":"","institution":"Shri Bhagwan Mahavir Vitreoretinal services, Sankara Nethralaya","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rehana","middleName":"","lastName":"Khan","suffix":""},{"id":530552,"identity":"7a1bf93b-fd3d-493a-88b0-dca9e13625ea","order_by":2,"name":"Mahesh Shanmugam","email":"","orcid":"","institution":"Department of vitreoretinal and ocular oncology services, Sankara Eye hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mahesh","middleName":"","lastName":"Shanmugam","suffix":""},{"id":530553,"identity":"d46312ba-a5b0-4f06-bf24-7720f4759764","order_by":3,"name":"Rajesh Ramanjulu","email":"","orcid":"","institution":"Department of ocular oncology and vitreoretinal services","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rajesh","middleName":"","lastName":"Ramanjulu","suffix":""},{"id":530554,"identity":"20bae0e4-16b9-40c9-9401-091b264ac319","order_by":4,"name":"Jay Chablani","email":"","orcid":"","institution":"Srimati Kannuri Santhamma centre for vitreoretinal services. L.V. Prasad Eye Institute","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jay","middleName":"","lastName":"Chablani","suffix":""},{"id":530555,"identity":"d4f7b3c9-d662-46f8-a94d-b671dfc45a7e","order_by":5,"name":"Niharika Singh","email":"","orcid":"","institution":"Shri Bhagwan Mahavir Vitreoretinal services. Sankara Nethralaya","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Niharika","middleName":"","lastName":"Singh","suffix":""},{"id":530556,"identity":"3865a401-e60a-4169-b080-cc6977512023","order_by":6,"name":"Rajiv Raman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYHCChANw5gcgZmMnRQvjDJAWZlLsY+YBkwRUmbcfeHiYd0dtPv+0w88e2/zaJs/HzMD44WMObi0yZxISDvOeOW4543aauXFu323DNmYGZsmZ23BrkWBISDg4s+2YAcPtBDPp3J7bjEAtbMy8+LTwP4Bokb+d/k3asue2PWEtEgkJBz621RgY3M4xk2b4cTuRCC0PgFrOHDAwvJ1TJtnbcDu5jZmxGb9f+HOSPyTuqDOQu52+TeLHn9u289ubD374iEcLAwNPAgNjw2EIm7ENTDbgUw8E7AeAauqgnD8EFI+CUTAKRsGIBACXR1VTMWPjEgAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-2681-6521","institution":"","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Rajiv","middleName":"","lastName":"Raman","suffix":""}],"badges":[],"createdAt":"2020-01-23 14:04:48","currentVersionCode":2,"declarations":"","doi":"10.21203/rs.2.21876/v2","doiUrl":"https://doi.org/10.21203/rs.2.21876/v2","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-021-01812-x","type":"published","date":"2021-01-21T15:01:29+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":1084516,"identity":"fa11ab43-212c-46ed-8042-843a6d4033c5","added_by":"auto","created_at":"2020-05-13 14:00:38","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":44200,"visible":true,"origin":"","legend":"Supply of cilioretinal artery and maximum retinal thickness in ETDRS subfields on OCT\n(a)\tIn central CRA supply, the maximum retinal thickness was noted at the temporal quadrant (332.68 ± 89.95) and has non center-involving DME (194.87±121.06 m)\n(b)\tIn lower CRA supply, the maximum retinal thickness was noted at the superior quadrant (342.42 ± 88.92) and has center-involving DME (395±285.75 m).\n(c)\tIn upper CRA supply, the maximum retinal thickness was noted at the nasal quadrant (328.44 ± 129.82) with center-involving DME (292±192.79 m).","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-12458/v2/Figure1.jpg"},{"id":13503217,"identity":"001e6962-fbbb-4db0-949b-88ab586210bb","added_by":"auto","created_at":"2021-09-16 23:17:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":437345,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-12458/v2/c2dd23f9-a4d4-486b-9942-1e09935d1680.pdf"}],"financialInterests":"","formattedTitle":"Influence of Segmental Supply of Cilioretinal Artery on Morphology of Diabetic Macular Edema","fulltext":[{"header":"Background","content":"\u003cp\u003eThe outer retina is supplied by choroidal circulation whereas the inner retina by retinal circulation. There are anatomical, hemodynamic, and autoregulatory differences in these circulations. The changes in retinal circulation are well characterized in diabetic retinopathy. However, the choroidal changes are less well understood. A recent study by Kim et al,\u003csup\u003e [1]\u003c/sup\u003e determined the choroidal vascular changes in diabetic patients by measuring the choroidal vascularity index (CVI). The authors hypothesized that a reduction in the choroidal vascular component was apparently noted in patients with type-2 diabetes mellitus (DM), even when there is no evidence of diabetic retinopathy (DR).\u003c/p\u003e\n\u003cp\u003eCilio retinal artery originates from ophthalmic artery and fills up during choroidal flow of fundus fluorescein angiography (FFA). The difference in the supply to different layers of retina by choroidal and retinal circulation may influence the phenotype in retinal pathologies such as diabetic retinopathy.\u003c/p\u003e\n\u003cp\u003eRecent studies have hypothesized that the vascular structures or substances from the choroid might influence diabetic maculopathy\u003csup\u003e [2]\u003c/sup\u003e.Knudsen and Lervang\u003csup\u003e[3]\u003c/sup\u003e showed that in patients with diabetes, who had bilateral but asymmetric diabetic maculopathy, more severe maculopathy, which included clinically significant macular edema, was detected in the eye with a CRA. A study conducted by Landa et al\u003csup\u003e [2] \u003c/sup\u003eusing a retinal function imager shows that there is an increased occurrence of diabetic macular edema (DME), if there is a presence of CRA in diabetic eyes.\u003c/p\u003e\n\u003cp\u003eHowever, usually, the supply of CRA is segmental. The effect of this segmental choroidal supply has not been evaluated in diabetic retinopathy. In this study, our focus was on the analysis of location of CRA with non center-involving and center-involving DME and to evaluate the supply of CRA with segments of macular edema based on Early Treatment of Diabetic Retinopathy Study (ETDRS) scale using optical coherence tomography (OCT).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eFundus fluorescein angiography database were segregated to identify people with diabetes and CRA at three tertiary care centers in south India. On screening database from 2015 to 2017, a total of 43 (26 men and 17 women) patients were identified at various stages of diabetic retinopathy with presence of CRA. Out of which unilateral CRA was present in 40 patients and bilateral CRA in 3 patients. All the patients in the study group had adult-onset diabetes mellitus with mild-to-severe non proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). Patients with neovascularization of the disc (NVD) and small fine cilioretinal artery at the disc margin on angiogram were excluded.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eClinical Assessment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe demographic details and medical history including duration of diabetes-associated systemic hypertension were noted. The treatment received, including LASER and intravitreal injections and visual acuity, was noted. Fundus photos were graded for the presence of diabetic retinopathy using ETDRS classification. Classification of DME is based on ETDRS subfields on OCT.\u003c/p\u003e\n\u003cp\u003eFFA-proven CRA side and prominent regions of the macula (upper, central, and lower) being supplied by it were noted. OCT images were taken in Cirrus SD-OCT and the findings were entered carefully as center-involving DME, non center-involving DME, no DME, presence of epiretinal membrane and/or taut posterior hyaloid membrane causing traction on macula and thinning suggestive of atrophy. Possible presence of CRA in the other eye was also noted. The study was approved by the Institutional Review Board (Ethics committee), Vision Research Foundation and written consent was obtained from the subjects as per the Declaration of Helsinki.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eGrading of DME\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe grading of DME was done as follows:\u003csup\u003e [4]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCenter-involving DME: \u003c/em\u003eOn clinical examination, definite retinal thickening due to DME involving the center of the macula. The spectral-domain optical coherence tomography (SD-OCT) showed loss of foveal contour, cystic space involving center of fovea, and neurosensory detachment involving the center of fovea. Central subfield thickness on OCT \u0026gt; 290 \u0026mu;m for women, \u0026gt;305 \u0026mu;m for men was observed on SD-OCT (Cirrus; Zeiss).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNon center-involving DME: \u003c/em\u003eDefinite retinal thickening due to DME within 3000 \u0026mu;m of the center of the macula but not involving the center of the macula. The SD-OCT showed cystic spaces and or retinal thickening in non central macular subfields.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNo DME: \u003c/em\u003eNormal central subfield thickness on OCT 209\u0026plusmn;18 \u0026mu;m in men and 194\u0026plusmn;23 \u0026mu;m in women.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMean Retinal thickness (in microns) according to \u003c/em\u003e\u003cem\u003eEarly-Treatment Diabetic Retinopathy Study (ETDRS) protocol\u003csup\u003e [5]\u003c/sup\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eClinically significant macular edema is considered if the retinal thickening or hard exudates are observed within 500 \u0026plusmn; 50 \u0026mu;m of the center of the foveal avascular zone or zones of retinal thickening 1 disc area or larger, any part of which was within 1 disc diameter of the center of the macula \u003csup\u003e[6]\u003c/sup\u003e. Hence the identification of DME is based on both specific OCT features and retinal thickness was taken into consideration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics was used to analyse the baseline characteristics. For statistical analysis of groups and subgroups, an independent sample t-test was used. Relationship of diabetic macular edema were calculated as proportions of each area of supply by cilioretinal artery. Relationship between area of supply of cilioretinal artery and area of retinal thickness were analysed to report mean and standard deviation in each quadrant of the retina and Chi square test was used to find the Distribution of diabetic macular edema with presence and absence of cilioretinal artery.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFundus fluorescein angiography evaluation of these 43 subjects with diabetes revealed a unilateral CRA in 40 subjects and bilateral in 3 subjects. Of these 43 eyes of subjects with diabetic, 5 (11.36%) had mild NPDR, 20 (45.45%) had moderate NPDR, 12 (29.54%) had severe NPDR, and 6 (13.63%) were diagnosed to have PDR. These patients were further classified as having center-involving DME (37.20%), non center-involving DME (37.20%), and no presence of DME (25.58%) (\u003cem\u003ep\u003c/em\u003e = 0.83).\u003c/p\u003e\n\u003cp\u003e(Table 1) shows the patients characteristics according to the status of macular edema in the study group. Among men, the distribution values of center-involving DME, non center-involving DME, and no DME are 68.75%, 75%, and 27.27% (\u003cem\u003ep\u003c/em\u003e = 0.05). Likewise, among women the distribution values of center-involving DME, non center-involving DME, and no DME are 31.25%, 25%, and 72.72% (\u003cem\u003ep\u003c/em\u003e = 0.03). No statistical significant difference was observed for age, duration of diabetes, and stages of diabetic retinopathy among the groups.\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12px; line-height: 200%; font-family: Helvetica; color: rgb(0, 0, 0);\"\u003eTable 1: Patients characteristics according to the status of macular edema in the study group\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"float: left;width:487.95pt;border-collapse:collapse;border:none;margin-left:6.75pt;margin-right:6.75pt;margin-bottom:5.75pt;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:205.3pt;border-top:solid windowtext 1.0pt;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:41.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eDEMOGRAPHIC AND CLINICAL FINDINGS\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:72.5pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:41.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eCenter involving DME\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"line-height: 200%;\"\u003e*\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003eN=16\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:88.15pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:41.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eNon center involving DME\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"line-height: 200%;\"\u003e*\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003eN=16\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.65pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:41.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eNo DME\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"line-height: 200%;\"\u003e*\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003eN=11\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:47.35pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:41.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eP Value\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:205.3pt;border:none;border-left:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003eAge (Mean in years \u0026plusmn; SD)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:72.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e59.93\u0026plusmn;8.04\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:88.15pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e54.18\u0026plusmn;7.44\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e60.08\u0026plusmn;7.22\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:47.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e0.34\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:205.3pt;border:none;border-left:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003eDuration of diabetes (Mean in years \u0026plusmn; SD)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:72.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e13.75\u0026plusmn;8.32\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:88.15pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e11.37\u0026plusmn;6.11\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e9.22\u0026plusmn;1.85\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:47.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e0.1\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:205.3pt;border:none;border-left:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:14.65pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eGender N (%)\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:72.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:14.65pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:88.15pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:14.65pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:14.65pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:47.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:14.65pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:205.3pt;border:none;border-left:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003eMale\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:72.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e11 (68.75%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:88.15pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e12 (75%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e3 (27.27%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:47.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e0.05\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:205.3pt;border:none;border-left:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003eFemale\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:72.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e5 (31.25%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:88.15pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e4 (25%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e8 (72.72%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:47.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e0.03\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:205.3pt;border:none;border-left:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eDR stage N (%)\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:72.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:88.15pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:47.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:205.3pt;border:none;border-left:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003eMild NPDR\u0026dagger;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:72.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e2 (12.5%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:88.15pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e1 (6.25%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e2 (18.18%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width:47.35pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e0.83\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:205.3pt;border:none;border-left:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003eModerate NPDR\u0026dagger;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:72.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e7 (43.75%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:88.15pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e10 (62.5%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e3 (27.27%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:205.3pt;border:none;border-left:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003eSevere NPDR\u0026dagger;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:72.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e4 (25%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:88.15pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e4 (25%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e4 (36.36%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:205.3pt;border:none;border-left:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003ePDR\u0026Dagger;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:72.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e3 (18.75%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:88.15pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e1 (6.25%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e2 (18.18%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e*\u003c/span\u003e\u003cem\u003e\u003cspan style=\"line-height: 200%;\"\u003eDME- Diabetic macular edema,\u003c/span\u003e\u003c/em\u003e\u003cem\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026dagger;\u003c/span\u003e\u003c/em\u003e\u003cem\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026nbsp;NPDR \u0026ndash; Non proliferative diabetic retinopathy,\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003cem\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026Dagger;\u003c/span\u003e\u003c/em\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003cem\u003e\u003cspan style=\"font-size: 12px; line-height: 200%; font-family: Helvetica; color: rgb(0, 0, 0);\"\u003ePDR \u0026ndash; Proliferative diabetic retinopathy\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\u003cbr\u003e\n\u003cp\u003e(Table 2) shows relationship of DME with area of supply by CRA. The subjects with center-involving DME had more number of central area of supply by CRA and equal number of upper and lower CRA supply. The subjects with non center-involving DME and No DME had more of central supply and less of upper supply by CRA.\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12px; line-height: 200%; font-family: Helvetica; color: rgb(0, 0, 0);\"\u003eTable 2: Relationship of diabetic macular edema and area of supply by cilioretinal artery\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"float: left;width:425.45pt;border-collapse:collapse;border:none;margin-left:6.75pt;margin-right:6.75pt;margin-bottom:5.75pt;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163pt;border-top: 1pt solid windowtext;border-left: 1pt solid windowtext;border-bottom: none;border-right: none;padding: 0in 5.4pt;height: 17.7pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eArea of Supply by CRA\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"line-height: 200%;\"\u003e*\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.3pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:17.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eUpper\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:17.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eCentral\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.15pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:17.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eLower\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.0pt;border:none;border-left:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:17.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003eCenter involving DME\u0026dagger;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.3pt;border: none;padding: 0in 5.4pt;height: 17.7pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e5 (31.25%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78pt;border: none;padding: 0in 5.4pt;height: 17.7pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e6 (37.5%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.15pt;border-top: none;border-bottom: none;border-left: none;border-image: initial;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.7pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e5 (31.25%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.0pt;border:none;border-left:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:17.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003eNon center involving DME\u0026dagger;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.3pt;border: none;padding: 0in 5.4pt;height: 17.7pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e2 (12.5%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78pt;border: none;padding: 0in 5.4pt;height: 17.7pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e8 (50%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.15pt;border-top: none;border-bottom: none;border-left: none;border-image: initial;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.7pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e6 (37.5%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.0pt;border:none;border-left:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:17.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003eNo DME\u0026dagger;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.3pt;border: none;padding: 0in 5.4pt;height: 17.7pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e1 (9.09%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78pt;border: none;padding: 0in 5.4pt;height: 17.7pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e6 (56.54%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.15pt;border-top: none;border-bottom: none;border-left: none;border-image: initial;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.7pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e4 (36.36%)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.0pt;border:none;border-left:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:17.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003eP Value\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.3pt;border: none;padding: 0in 5.4pt;height: 17.7pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e0.25\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78pt;border: none;padding: 0in 5.4pt;height: 17.7pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e0.10\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.15pt;border-top: none;border-bottom: none;border-left: none;border-image: initial;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.7pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e0.36\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\n\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cem\u003e\u003cspan style=\"line-height: 200%;\"\u003eCRA \u0026ndash; Cilioretinal artery,\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003cem\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026dagger;\u003c/span\u003e\u003c/em\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003cem\u003e\u003cspan style=\"font-size: 12px; line-height: 200%; font-family: Helvetica; color: rgb(0, 0, 0);\"\u003eDME \u0026ndash; Diabetic macular edema\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\u003cbr\u003e\n\u003cp\u003e(Table 3) shows the distribution of DME with the presence and absence of CRA. The distribution of non center-involving DME in the presence of CRA is comparatively more than in the absence of CRA. The distribution of center-involving DME and No DME in the presence of CRA is lower than in the absence of CRA. The overall distribution of centre and non \u0026ndash; centre involving DME was observed more in eyes with the presence of CRA (p=0.062), whereas no diabetic macular edema was observed more in eyes without CRA (i.e control group).\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12px; line-height: 200%; font-family: Helvetica; color: rgb(0, 0, 0);\"\u003eTable 3: Distribution of diabetic macular edema with presence and absence of cilioretinal artery\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"float: left;border-collapse:collapse;border:none;margin-left:6.75pt;margin-right:6.75pt;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom: .0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eCRA Status*\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.65pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eCentre Involving DME\u003c/span\u003e\u003c/strong\u003e\u003cem\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026dagger;\u003c/span\u003e\u003c/em\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.7pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eNon-Centre involving DME\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.7pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom: .0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eNo DME\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom: .0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eCRA Present\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e37.2%\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e39.5%\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom: .0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e18.6%\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom: .0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eCRA Absent\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e44.2%\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e20.9%\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom: .0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e25.5%\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom: .0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eP Value\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%; background: white;\"\u003e\u0026nbsp;0.3504\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%; background: white;\"\u003e0.0083\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom: .0001pt;margin-left:.5in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;margin:0in;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%; background: white;\"\u003e0.2744\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cem\u003e\u003cspan style=\"line-height: 200%;\"\u003e*\u003c/span\u003e\u003c/em\u003e\u003cem\u003e\u003cspan style=\"line-height: 200%;\"\u003eCRA \u0026ndash; Cilioretinal artery,\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003cem\u003e\u003cspan style=\"line-height: 200%;\"\u003e\u0026dagger;\u003c/span\u003e\u003c/em\u003e\u003cem\u003e\u003cspan style=\"line-height: 200%;\"\u003eDME \u0026ndash; Diabetic macular edema\u003c/span\u003e\u003c/em\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan style=\"font-size: 12px; line-height: 200%; font-family: Helvetica; color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\u003cbr\u003e\n\u003cp\u003e(Table 4) shows the relationship between area of supply of CRA and area of retinal thickness. (Figure 1) shows area of supply of cilioretinal artery and maximum retinal thickness in ETDRS subfields on OCT. When CRA supplies the central area, the maximum retinal thickness was\u0026nbsp; noted at the temporal quadrant (332.68 \u0026plusmn; 89.95) and has non center-involving DME (194.87\u0026plusmn;121.06 mm), When CRA supplies the lower area, the maximum retinal thickness was noted at the superior quadrant (342.42\u0026nbsp; \u0026plusmn;\u0026nbsp; 88.92) and has center-involving DME (395\u0026plusmn;285.75 mm) and\u0026nbsp; with CRA supply in\u0026nbsp; the upper area, the maximum retinal thickness was noted at the nasal quadrant (328.44 \u0026plusmn; 129.82) with center-involving DME (292\u0026plusmn;192.79 mm).\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12px; line-height: 200%; font-family: Helvetica; color: rgb(0, 0, 0);\"\u003eTable 4: Relationship between area of supply of cilioretinal artery and area of retinal\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003ethickness\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"float: left;border: none;width:498.3pt;border-collapse:collapse;margin-left:6.75pt;margin-right: 6.75pt;margin-bottom:5.75pt;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:62.7pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:15.55pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eArea of supply of CRA\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:83.6pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:15.55pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eSuperior\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:90.6pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:15.55pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eTemporal\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:88.1pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:15.55pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eInferior\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.65pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:15.55pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eNasal\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.65pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:15.55pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eCentral subfield\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:62.7pt;padding:0in 5.4pt 0in 5.4pt;height:14.85pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eCentre\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.6pt;padding: 0in 5.4pt;height: 14.85pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e324.34 \u0026plusmn; 58.83\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90.6pt;padding: 0in 5.4pt;height: 14.85pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003e332.68 \u0026plusmn; 89.95\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.1pt;padding: 0in 5.4pt;height: 14.85pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e320.84 \u0026plusmn; 83.26\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;height: 14.85pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e328.42 \u0026plusmn; 77.57\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;height: 14.85pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e306.10 \u0026plusmn; 120.33\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:62.7pt;padding:0in 5.4pt 0in 5.4pt;height:14.85pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eUpper\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.6pt;padding: 0in 5.4pt;height: 14.85pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e293.5 \u0026plusmn; 132.15\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90.6pt;padding: 0in 5.4pt;height: 14.85pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e308.69 \u0026plusmn; 160.56\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.1pt;padding: 0in 5.4pt;height: 14.85pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e325.13 \u0026plusmn; 129.40\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;height: 14.85pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003e328.44 \u0026plusmn; 129.82\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;height: 14.85pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e317.38 \u0026plusmn; 152.69\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:62.7pt;padding:0in 5.4pt 0in 5.4pt;height:15.55pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eLower\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.6pt;padding: 0in 5.4pt;height: 15.55pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003e342.42 \u0026nbsp;\u0026plusmn; \u0026nbsp; \u0026nbsp; 88.92\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90.6pt;padding: 0in 5.4pt;height: 15.55pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e332.04 \u0026nbsp;\u0026plusmn; 101.38\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.1pt;padding: 0in 5.4pt;height: 15.55pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e319.08 \u0026nbsp;\u0026plusmn; 112.80\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;height: 15.55pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e336.62 \u0026nbsp;\u0026plusmn; 127.90\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;padding: 0in 5.4pt;height: 15.55pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e318.69 \u0026nbsp;\u0026plusmn; 164.81\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:62.7pt;border:none;border-bottom:double windowtext 2.25pt;padding:0in 5.4pt 0in 5.4pt;height:15.55pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cstrong\u003e\u003cspan style=\"line-height: 200%;\"\u003eP value\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 2.25pt double windowtext;padding: 0in 5.4pt;height: 15.55pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e0.441\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 2.25pt double windowtext;padding: 0in 5.4pt;height: 15.55pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e0.858\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88.1pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 2.25pt double windowtext;padding: 0in 5.4pt;height: 15.55pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e0.991\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 2.25pt double windowtext;padding: 0in 5.4pt;height: 15.55pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e0.972\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 2.25pt double windowtext;padding: 0in 5.4pt;height: 15.55pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:0in;line-height: 200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"line-height: 200%;\"\u003e0.962\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size: 12px; line-height: 200%; font-family: Helvetica; color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe incidence of the cilioretinal artery (CRA) varies among many published reports. A study done by K S Mehra et al \u003csup\u003e[7]\u003c/sup\u003e, reported the incidence of 6.9 % in Indian population, Jain I S et al\u003csup\u003e [8]\u003c/sup\u003e, reported 22.8 % in Chandigarh population, Lorentzen et al\u003csup\u003e [9]\u003c/sup\u003e, 26%, Lei Liu et al\u003csup\u003e [10]\u003c/sup\u003e, 35% and Collier et al, 21.6 %. Hence the incidence varies between 6% and 40 %. In this study, we evaluated the effect of presence of CRA on the morphology of diabetic macular edema. It was found that the patients with CRA had more non center-involving DME compared to center-involving DME, whereas those without CRA had more center-involving DME compared to non center-involving DME. However, this difference was not statistically significant. We also observed that if the CRA supplied the central areas, the maximum retinal thickness was noted in the non central area (temporally). It was also found that the CRA alters the morphology of macular edema. Probably, its presence protects the area supplied by it from developing macular edema. This is in contrast to the findings in the study by Landa et al\u003csup\u003e[2]\u003c/sup\u003e who reported higher rates of DME in such eyes. However, the authors did not classify the edema as center or non center involving. As the histological structure of a CRA is similar to the branches of the central retinal artery, it is assumed that it undergoes similar levels of hypoxic damage, or even more due to the absence of \u0026ldquo;auto regulatory\u0026rdquo; features, which are a hallmark of the retinal circulation.\u003csup\u003e [11]\u003c/sup\u003e However, the CRA has a high flow velocity, which may compensate for reduction of flow due to the structural changes in choroid due to diabetes.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Recently, Ebraheem et al\u003csup\u003e [12]\u003c/sup\u003e have reported that the presence of a CRA result in decreased levels of sub retinal fluid (SRF) in treatment-naive nAMD patients compared to controls who lacked a CRA. The authors concluded that CRA alters the hemodynamic of blood flow by diverting blood from the choroid to the inner retinal circulation, resulting in more chances of CME and probably a decreased chance of SRF. Probably through a similar mechanism, the distribution of DME is altered in patients with CRA.\u003c/p\u003e\n\u003cp\u003eThe strength of the study was that only FFA-proven CRA were included in the study. However, this reduced the sample size in each group, as the individuals with clinical suspicious of CRA with no FFA were excluded. The systemic factors such as glycemic control, serum lipids, and blood pressure were not considered in the analysis as data for these were not available for all patients. In some cases non-central and no DME cases can progress into central involving DME, and requires longitudinal analysis of the patients which is beyond the scope of this study because of its retrospective nature. Future longitudinal studies are required to fully understand the progression.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, the presence of CRA seems to alter the morphology of DME. The segmental distribution of CRA also influences the segment involved in DME. However, further studies with larger sample size are warranted to prove this association.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCRA: Cilio Retinal Artery\u003c/p\u003e\n\u003cp\u003eDME: \u0026nbsp;Diabetic Macular Edema\u003c/p\u003e\n\u003cp\u003eETDRS: Early Treatment of Diabetic Retinopathy Study\u003c/p\u003e\n\u003cp\u003eOCT: Optical Coherence Tomography\u003c/p\u003e\n\u003cp\u003eCVI: Choroidal Vascularity Index\u003c/p\u003e\n\u003cp\u003eDM: Diabetes Mellitus\u003c/p\u003e\n\u003cp\u003eDR: Diabetic Retinopathy\u003c/p\u003e\n\u003cp\u003eFFA: Fundus Fluorescein Angiography\u003c/p\u003e\n\u003cp\u003eNPDR: Non Proliferative Diabetic Retinopathy\u003c/p\u003e\n\u003cp\u003ePDR: Proliferative Diabetic Retinopathy\u003c/p\u003e\n\u003cp\u003eNVD: Neovascularization of the disc\u003c/p\u003e\n\u003cp\u003eSD-OCT: Spectral-Domain Optical Coherence Tomography\u003c/p\u003e\n\u003cp\u003eSRF: Sub Retinal Fluid\u003c/p\u003e\n\u003cp\u003eAMD: Age Related Macular Degeneration\u003c/p\u003e\n\u003cp\u003eCME: Cystoid Macular Edema\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Board (Ethics committee), Vision Research Foundation and written consent was obtained from the subjects as per the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are not publicly available, as it is against the organization/hospital policy. But are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eR.R\u003csup\u003e1\u003c/sup\u003e, R.K, N.S., contributed in conception\u0026nbsp;and design of the study. R.K., wrote the main manuscript text and prepared all the tables. R.K. and R.R\u003csup\u003e1\u003c/sup\u003e. assisted with statistical analyses. R.R\u003csup\u003e1\u003c/sup\u003e, drafted the work and substantively revised it. M.S., R.R., J.C., N.S., helped in acquisition of the data. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKim M, Ha MJ, Choi SY, Park YH. Choroidal vascularity index in type-2 diabetes analyzed by swept-source optical coherence tomography. Scientific reports. 2018 Jan 8;8(1):70.\u003c/li\u003e\n\u003cli\u003eLanda G, Amde W, Haileselassie Y, Rosen RB. Cilioretinal arteries in diabetic eyes are associated with increased retinal blood flow velocity and occurrence of diabetic macular edema. Retina. 2011 Feb 1;31(2):304-11.\u003c/li\u003e\n\u003cli\u003eKnudsen LL, Lervang HH. Can a cilio-retinal artery influence diabetic maculopathy?. British journal of ophthalmology. 2002 Nov 1;86(11):1252-5.\u003c/li\u003e\n\u003cli\u003eRaman R, Bhende M. Diabetic Macular Edema. Medical \u0026amp; Vision Research Foundations. 2015 Jun;33(2):50.\u003c/li\u003e\n\u003cli\u003eSABOURI MR, KAZEMNEZHAD E, HAFEZI V. Assessment of macular thickness in healthy eyes using cirrus HD-OCT: a cross-sectional study. Medical hypothesis, discovery and innovation in ophthalmology. 2016;5(3):104.\u003c/li\u003e\n\u003cli\u003eS\u0026aacute;nchez-Tocino H, Alvarez-Vidal A, Maldonado MJ, Moreno-Monta\u0026ntilde;\u0026eacute;s J, García-Layana A. Retinal thickness study with optical coherence tomography in patients with diabetes. Investigative ophthalmology \u0026amp; visual science. 2002 May 1;43(5):1588-94.\u003c/li\u003e\n\u003cli\u003eMehra KS. Incidence of cilio-retinal artery in Indians. The British journal of ophthalmology. 1965 Jan;49(1):52.\u003c/li\u003e\n\u003cli\u003eJain IS, Singh K, Nagpal KC. Vessels at the disc margin (cilioretinal and other simulating cilioretinal vessels). Indian journal of ophthalmology. 1972 Dec 1;20(4):141.\u003c/li\u003e\n\u003cli\u003eLorentzen SE. Incidence of cilioretinal arteries. Acta ophthalmologica. 1970 Jun;48(3):518-24.\u003c/li\u003e\n\u003cli\u003eLiu L, Liu LM, Chen L. Incidence of cilioretinal arteries in Chinese Han population. International journal of ophthalmology. 2011;4(3):323.\u003c/li\u003e\n\u003cli\u003eGiuffre G, Montalto FP, Amodei G. Development of an isolated retinal macroaneurysm of the cilioretinal artery. British journal of ophthalmology. 1987 Jun 1;71(6):445-8.\u003c/li\u003e\n\u003cli\u003eEbraheem A, Uji A, Abdelfattah NS, Nittala MG, Sadda S, Le PV. Relationship between the Presence of a Cilioretinal Artery and Subretinal Fluid in Neovascular Age-Related Macular Degeneration. Ophthalmology Retina. 2018 May 1;2(5):469-74.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cilioretinal artery, central-involving macular edema, non-central involving macular edema, segmental supply, optical coherence tomography, retinal thickness, ETDRS","lastPublishedDoi":"10.21203/rs.2.21876/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.2.21876/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The supply of Cilioretinal artery (CRA) to different layers of retina influences retinal pathologies like diabetic retinopathy. Since the supply of CRA is segmental, Our aim is to analyze the location of CRA) with non center-involving and center-involving diabetic macular edema (DME) and to evaluate the supply of CRA with segments of macular edema based on Early Treatment of Diabetic Retinopathy Study (ETDRS) scale using optical coherence tomography (OCT).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e: Retrospective study\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e:\u0026nbsp;A retrospective study in which forty-three patients at various stages of diabetic retinopathy with the presence of CRA were identified. Presence and location of CRA was recognized using fundus fluorescein angiography. Classification of DME was based on ETDRS subfields on OCT.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Evaluation of 26 men and 17 women of various groups of diabetic retinopathy revealed unilateral CRA in 40 subjects and bilateral CRA in 3 subjects. When CRA supplied the central area, maximum retinal thickness was noted at the temporal quadrant (271.67±164.02 mm) and had non center-involving DME (194.87±121.06 mm), when CRA supplied the lower area, maximum retinal thickness was noted at the superior quadrant (293.64±159.36 mm) and had center-involving DME (395±285.75 mm), and when it supplied the upper area, maximum retinal thickness was noted at the nasal quadrant (293.49±176.18mm) with center-involving DME (292±192.79 mm).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The presence of CRA seems to alter the morphology and influences the segment involved in DME. However, further studies with larger sample size are warranted to prove this association.\u003c/p\u003e","manuscriptTitle":"Influence of Segmental Supply of Cilioretinal Artery on Morphology of Diabetic Macular Edema","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2020-05-13 14:00:37","doi":"10.21203/rs.2.21876/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2020-04-28T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-04-28T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-04-27T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-01-23T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-01-27 16:45:44","doi":"10.21203/rs.2.21876/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-03-30T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-03-24T12:00:00+00:00","index":2,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nInteresting manuscript in a current subject that highlights the role of the choroid and choroidal vessels on diabetic retinopathy and especially DME.\nSome sentences of the manuscript need an English revision as the underlying ideas are not completely understandable and deserve to be clarified.\n\nAbstract:\n\n1. In the methods section, the authors say that Diabetic Retinopathy (DR) was graded based on ETDRS classification using OCT. This is not completely correct and I believe they are confusing with DME classification. DR stages classification are based on color fundus photographs. DME classification can be done based on OCT or fundus photographs. Please clarify.\n\nManuscript:\n\nMethods\n1. Grading of DME in Methods section needs a major revision. Authors give the center-involving DME criteria definition based on OCT characteristics like loss of foveal contour and presence of cystoid spaces, which I consider it is correct. However, they also presented reference values of Cirrus SD-OCT. It is not clear if all patients have a Cirrus OCT or not, or if these values were only taken in account in case of Cirrus existence.\nPlease clarify if DME was identified only based on the presence of specific OCT features in all patients or if thickness values were also considered. In this last case, please describe what was the conversion factor used for other OCT machines.\n\n2. Please clarify the criteria used for No DME. These values are based in which OCT machine and how was the conversion performed to others.\n\n3. The definition used in line 118 of page 5 is based on color fundus photographs. I don't think it is adequate for this study that is completely based on OCT. I don't understand why it was described in the methods. It was used in which patients?\n\nStatistical Analysis\n\nChi-square tests and logistics regression analysis are described but not presented in the results section. Please re-write statistical analysis to reflect the results presented.\n\nResults\n\n1. Please re-write the first paragraph of the results. Confusion between diabetes and diabetic.\n2. Line 162 also needs reformulation. It is not clear what authors want to say. I believe that authors want to say that DME patients have CRA more frequently visible than patients without DME and that this is significant. This result should be emphasized as it is connected with the discussion (lines 198-203) and it is an important strength of this work.\n\n3. Table 3 could have p-values to show if these differences were significant or not.\n\n4. Do the authors have some OCT images of DME with thickening of the areas explained in table 4? It could be more appealing.\n\nDiscussion\n\nOverall discussion is well written and address the most important findings of this work. Correlation between presence of CRA and non-center involving DME is newsworthy as it means that choroid probably has some protective role at the macular area and helps to drain extravascular fluids accumulation in DR.\n\nFirst sentence is confused and not very well formulated. Please re-write it.\n* Are the methods appropriate and well described?: **No**\n* Does the work include the necessary controls?: **Unable to assess**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I recommend additional statistical review**\n* Quality of written English: **Needs some language corrections before being published**\n* Declaration of competing interests: **Nothing to declare**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: ** I agree to the open peer review policy of the journal**\n"},{"type":"editorInvitedReview","content":"","date":"2020-03-06T12:00:00+00:00","index":1,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nKhan et al report on the morphologic influence of chorioretinal arteries on diabetic macular edema.\n\nThere are a number of major flaws of the study\n\n- Most importantly in the methods the authors describe the patients cohort as: 43 patients with FFA prove cilioretinal artery (CRA) and diabetic retinopathy. However in the results Table 4. and the first few lines of discussion compare DME between eyes with and without CRA. If you had a control group of patients with DR +/- DME without CRA than describe this in the methods section. How many patients were in this control. If you didn't have a control group than you can't present such data. The most important information in this paper would be to compare the presence of DME, and then the morphologic difference between CRA and non-CRA eyes.\n- P8L162-164 The authors state that: \"The presence of a CRA was observed as an important factor when the overall rates of macular edema in these eyes were compared to those of macular edema in eyes without the presence of CRA (p = 0.062)\". Supposing that you had a control group this would be the most important result, but the statement here is not clear. Is this the difference between DME vs no DME between CRA and non-CRA or center involving DME vs non center involving between CRA and non CRA. The p value is quite low, but not significant maybe your power calculations were not accurate, and you need more cases to prove your point.\n- Table 4 explores the influence of CRA location on the distribution of retinal thickening between the ETDRS subfields. It would be much more informative to compare the differences between in each subfield between the CRA supply areas instead of the p-values presented here (difference between segments for each CRA supply). Furthermore you could include the control group as well and see if CRA alters the morphology of DME.\n- In the same Table 4 center subfield is missing. It would be of interest to include it.\nSome minor points are:\n- The authors mention ETDRS scale /classification on OCT in the abstract and in the methods. This is confusing as the ETDRS scale is a DR severity scale performed on color fundus photography. It would be better to use the term ETDRS subfields on OCT\n- The second part of the first paragraph in the introduction section should rather be in the discussion\n- P3l67 there is a typeset error.\n- The authors should discuss in more detail why they found less DME in CRA patients compared to the results in the literature\n- P5l114-117: Is this a list of OCT subfield normative data? I'm not sure if this is necessary, and certainly not in this form, furthermore there are no units displayed.\n- In the results many of the numerical results from the tables are repeated in the text. They should either be in the table only or in the text only.\n* Are the methods appropriate and well described?: **No**\n* Does the work include the necessary controls?: **No**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Needs some language corrections before being published**\n* Declaration of competing interests: **none**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: ** I agree to the open peer review policy of the journal**\n"},{"type":"reviewerAgreed","content":"","date":"2020-02-24T12:00:00+00:00","index":2,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-02-23T12:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-02-18T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-01-23T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-01-23T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-01-20T12:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-01-16T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"78041420-2e13-43e8-b88c-9cf82986ed48","owner":[],"postedDate":"May 13th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":53211,"name":"Ophthalmology"}],"tags":[],"updatedAt":"2021-01-26T15:04:05+00:00","versionOfRecord":{"articleIdentity":"rs-12458","link":"https://doi.org/10.1186/s12886-021-01812-x","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2021-01-21 15:01:29","publishedOnDateReadable":"January 21st, 2021"},"versionCreatedAt":"2020-05-13 14:00:37","video":"","vorDoi":"10.1186/s12886-021-01812-x","vorDoiUrl":"https://doi.org/10.1186/s12886-021-01812-x","workflowStages":[]},"version":"v2","identity":"rs-12458","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"identity":"rs-12458","version":["v2"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}