To the editor

摘要

To the Editor:I enjoyed reading the article "New insights into the pathoanatomy of diabetic macular edema: angiographic patterns and optical coherence tomography" by Byeon et al. The authors are to be commended for their detailed discussion of the regional blood supply and the neural architecture of the macula along with their optical coherence tomography correlations.The authors point out that both layers of the deep retinal capillary plexus are confined to the retina's inner nuclear layer. Because fluid leaking from a retinal capillary would initially accumulate around that leaky capillary, one would expect that diabetic macular edema would predominantly affect the retina's inner nuclear layer. Another reason to expect that macular edema would be confined to the inner nuclear layer is because, as the authors point out, "The synaptic junctions within the outer plexiform layer and the inner plexiform layer have been known to act as a highly resistant fluid barrier."2 Therefore, the inner and outer plexiform layers (OPLs), which sandwich the leaky capillaries in the inner nuclear layer, would be expected to confine the bulk of the intraretinal fluid to the inner nuclear layer. Yet, as is beautifully illustrated in the article, diabetic macular edema predominantly affects the outer nuclear layer (ONL) and only minimally affects the inner nuclear layer.