Evidence map›Paper›PMID 42765790›Full record

ArticleInvestigative ophthalmology & visual science2026

The Behavior of the External Limiting Membrane and Ellipsoid Zone in Diabetic Macular Edema: A Population AI-Assisted Optical Coherence Tomography Study.

Edoardo Midena, Marco Lupidi, Luisa Frizziero, Giulia Midena, Elisabetta Pilotto, Lisa Toto, Maria Vittoria Cicinelli, Daniele Veritti, Giuseppe Covello, Rosangela Lattanzio and 44 more

Abstract read
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In one paragraph

Article in Investigative ophthalmology & visual science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

54 authors.

Edoardo MidenaDepartment of Ophthalmology, University of Padova, Padova, Italy.
Marco LupidiDepartment of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
Luisa FrizzieroDepartment of Ophthalmology, University of Padova, Padova, Italy.
Giulia MidenaIRCCS - Fondazione Bietti, Rome, Italy.
Elisabetta PilottoDepartment of Ophthalmology, University of Padova, Padova, Italy.
Lisa TotoOphthalmology Clinic, Department of Medicine and Science of Ageing, "G. d'Annunzio" University Chieti-Pescara, Chieti, Italy.
Maria Vittoria CicinelliSchool of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Daniele VerittiDepartment of Medicine-Ophthalmology, University of Udine, Udine, Italy.
Giuseppe CovelloOphthalmology, Department of Surgical, Medical, Molecular Pathology and Clinical Care Medicine, University of Pisa, Pisa, Italy.
Rosangela LattanzioSchool of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Michele FigusOphthalmology, Department of Surgical, Medical, Molecular Pathology and Clinical Care Medicine, University of Pisa, Pisa, Italy.
Luca DanieliDepartment of Ophthalmology, University of Padova, Padova, Italy.
Enrico BorrelliDepartment of Ophthalmology, City of Health and Science Hospital, University of Turin, Turin, Italy.
Michele ReibaldiDepartment of Ophthalmology, City of Health and Science Hospital, University of Turin, Turin, Italy.
Daniele TognettoEye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy.
Leandro InferreraEye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy.
Simone DonatiOphthalmology Unit, Circolo Hospital, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Settimio RossiMultidisciplinary Department of Medical, Surgical and Dental Sciences, Eye Clinic, University of Campania "Luigi Vanvitelli," Naples, Italy.
Paolo MelilloMultidisciplinary Department of Medical, Surgical and Dental Sciences, Eye Clinic, University of Campania "Luigi Vanvitelli," Naples, Italy.
Paolo LanzettaDepartment of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Valentina SaraoDepartment of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Giulia GregoriDepartment of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
Carlo CaginiDepartment of Medicine and Surgery, University of Perugia, Perugia, Italy.
Chiara Maria EandiDepartment of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland.
Adriano CarnevaliDepartment of Ophthalmology, University Magna Graecia of Catanzaro, Azienda Ospedaliera-Universitaria R. Dulbecco, Catanzaro, Italy.
Vincenzo ScorciaDepartment of Ophthalmology, University Magna Graecia of Catanzaro, Azienda Ospedaliera-Universitaria R. Dulbecco, Catanzaro, Italy.
Emilia MaggioOphthalmology Unit, IRCCS Sacro Cuore Don Calabria Hospital Verona, Verona, Italy.
Grazia PertileOphthalmology Unit, IRCCS Sacro Cuore Don Calabria Hospital Verona, Verona, Italy.
Ciro CostagliolaEye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy.
Gilda CennamoEye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy.
Paolo MoraOphthalmology Unit, University Hospital of Parma, Parma, Italy.
Roberto Dell'OmoDepartment of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy.
Marzia AffatatoDepartment of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy.
Marzia PassamontiOphthalmology Clinic, Department of Medicine and Science of Ageing, "G. d'Annunzio" University Chieti-Pescara, Chieti, Italy.
Mariacristina ParravanoIRCCS - Fondazione Bietti, Rome, Italy.
Nicola Vito LassandroIRCCS - Fondazione Bietti, Rome, Italy.
Marco NassisiFondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Francesco ViolaFondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Niccolò CastellinoDepartment of Ophthalmology, University of Catania, Catania, Italy.
Francesco CappellaniDepartment of Medicine and surgery, University of Enna "Kore," Enna, Italy.
Giuseppe GiannaccareEye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
Francesco BosciaDepartment of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro," Bari, Italy.
Maria Oliva GrassiDepartment of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro," Bari, Italy.
Donatella MusettiClinica Oculistica DiNOGMI, Università di Genova, Ospedale Policlinico San Martino IRCCS, Genova, Italy.
Valentina FoleganiEye Clinic, Department of Biomedical and Clinical Sciences, Ospedale Luigi Sacco, University of Milan, Milan, Italy.
Alessandro InvernizziEye Clinic, Department of Biomedical and Clinical Sciences, Ospedale Luigi Sacco, University of Milan, Milan, Italy.
Luca RossettiEye Clinic, ASST Santi Paolo e Carlo-San Paolo Hospital, University of Milan, Milan, Italy.
Tommaso BacciOphthalmology Unit, Department of Medicine, Surgery and Neuroscience, Siena University Hospital, Siena, Italy.
Federico RicciRetinal Diseases Unit-PPTV, Department of Experimental Medicine, University of Rome Tor Vergata, Roma, Italy.
Marco LombardoRetinal Diseases Unit-PPTV, Department of Experimental Medicine, University of Rome Tor Vergata, Roma, Italy.
Mary RomanoDepartment of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Nicola ValsecchiOphthalmology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy.
Michele CoppolaIRCCS-San Gerardo, Monza, Italy.
Fabiano CavarzeranDepartment of Ophthalmology, University of Padova, Padova, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Purpose: To investigate the behavior of the external limiting membrane (ELM) and ellipsoid zone (EZ) in diabetic macular edema (DME) using artificial intelligence (AI)-based optical coherence tomography (OCT) quantification. Methods: This was a cross-sectional study. OCT scans of eyes affected by DME were analyzed using a validated AI platform to quantify intraretinal fluid (IRF), subretinal fluid (SRF), inflammatory hyper-reflective retinal foci (I-HRF), and the percentage of interruption of the ELM and EZ. Eyes were classified according to ELM/EZ interruption and grouped into four patterns of integrity: no interruption, EZ interruption >ELM, ELM > EZ, and ELM = EZ. The distribution of the ELM/EZ disruption and associations with other biomarkers, and clinical data, including visual acuity, were analyzed. Results: We analyzed 2355 eyes from 1688 patients affected by DME. ELM interruption was observed in 21.9% of eyes and EZ interruption in 37.6%. A greater prevalence of EZ disruption was also identified in both previously treated and untreated eyes. Eyes with an interrupted ELM/EZ showed significantly greater IRF and SRF volumes and a more centrally located IRF distribution. I-HRF counts were significantly higher in eyes with predominant EZ damage. ELM disruption showed the strongest correlation with visual acuity and SRF burden. Conclusions: Quantitative AI-based OCT analysis demonstrated that the ELM and EZ have distinct yet complementary relationships with fluid biomarkers and visual acuity. EZ alterations are more prevalent and associated with I-HRF increases, whereas ELM disruption appears to reflect deeper structural damage and stronger functional impairment. Integrating outer retinal layer integrity with other features of DME may provide a more comprehensive characterization of DME and support a more personalized prognostic assessment and therapeutic strategies.

Indexed as

Artificial IntelligenceBasement MembraneDiabetic RetinopathyMacular EdemaTomography, Optical CoherenceAgedCross-Sectional StudiesFemaleHumansMaleMiddle AgedSubretinal FluidVisual Acuity

Identifiers

PMID42765790
PMCPMC13614141

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.