糖尿病视网膜病变黄斑区视网膜厚度变化的研究

目的探讨糖尿病视网膜病变(diabetic retinopathy,DR)黄斑区视网膜厚度变化规律及与荧光素眼底血管造影、静脉血糖化血红蛋白AIC(HbAIC)的关系.方法正常对照组30例(30眼),糖尿病(diabetes mellitus,DM)病人84例(107眼)并分为无糖尿病视网膜病变(DM无DR)、糖尿病视网膜病变Ⅰ、Ⅱ、Ⅲ、Ⅳ期(DRⅠ、Ⅱ、Ⅲ、Ⅳ期)5组.采用光学相干断层成像仪(OCT)测量以黄斑中心凹为中心的6mm直径区域视网膜厚度,以地形图分9区显示.对各组间黄斑区视网膜厚度进行比较.观察糖尿病病人黄斑区荧光素渗漏与视网膜厚度变化关系;对黄斑中心凹1mm直径范围视网膜厚度与HbAIC值进行相关分析.结果正常人黄斑中心凹1mm直径区域视网膜厚度为(168±17)μm,糖尿病病人各组相应区域视网膜厚度分别为(179±16)μm、(205±34)μm、(217±43)μm、(291±96)μm、(408±117)μm.DRⅠ、Ⅱ期间视网膜厚度无显著性差异(P＞0.2),其余各组均有显著性差异(P＜0.05).仅弥漫性荧光素渗漏时视网膜厚度显著增加(P＜0.05),视网膜厚度与HbAIC无关.结论糖尿病视网膜病变早期黄斑区视网膜厚度已有增加,并随着病程的发展,视网膜厚度增加明显,但与HbAIC无关.     

频域光学相干断层扫描对糖尿病患者黄斑部视网膜厚度分区测定的研究

目的应用频域OCT分区测量正常人及各期糖尿病视网膜病变患者黄斑部视网膜厚度、黄斑部视网膜的平均厚度及黄斑部的总体积,探讨2型糖尿病患者黄斑部视网膜厚度及体积的特点以及与正常人之间的相关性。方法 2010年1月至2011年9月在我院确诊的2型糖尿病患者185例(317眼),通过常规散瞳眼底检查、眼底照相及FFA检查并依据2002年糖尿病视网膜病变国际临床分型标准将这317眼2型糖尿病患者分为3组:糖尿病正常视网膜(NDR组)患者50例(89眼)、非增生性糖尿病视网膜病变(NPDR组)患者73例(126眼)、增生性糖尿病视网膜病变(PDR组)患者62例(102眼),第4组为正常组52例(98眼)。用频域OCT对上述4组进行黄斑部的扫描,并用分析软件进行九分区的自动分析,记录各区视网膜厚度数据和黄斑区视网膜平均厚度及黄斑区总的体积。结果黄斑区以中心凹1mm为直径视网膜厚度正常组、NDR组、NPDR组、PDR组分别为(246.37±17.50)μm、(252.13±16.24)μm、(316.28±56.99)μm、(407.90±214.89)μm。4组黄斑区平均视网膜厚度分别为(285.07±10.42)μm、(289.45±11.19)μm、(332.31±39.71)μm、(390.20±64.17)μm;总体积分别为(10.22±0.39)mm3、(10.12±1.03)mm3、(11.99±3.29)mm3、(13.87±5.13)mm3。与正常组相比,NPDR、PDR组黄斑部A1-A9区视网膜厚度、黄斑部平均视网膜厚度、黄斑部总体积差异均有统计学意义(均为P<0.05);NDR组与正常组相比,A1-A9区视网膜厚度、黄斑部平均视网膜厚度、黄斑部总体积差异均无统计学意义(均为P>0.05);NDR、NPDR、PDR3组间以上各指标两两比较差异均有统计学意义(均为P<0.05)。结论黄斑区视网膜厚度及体积与DR程度相关。频域OCT能定量定性地观察糖尿病患者黄斑区的细微变化,为糖尿病患者黄斑病变早期诊断及治疗提供可靠的检测手段。     

糖尿病视网膜病变黄斑水肿的检查比较

目的运用裂隙灯前置镜、眼底荧光血管造影(FFA)及光学相干断层扫描术(OCT)对正常人及糖尿病视网膜病变黄斑水肿(DME)进行检测,客观定量分析糖尿病性黄斑水肿,以期早期发现糖尿病性黄斑水肿。方法正常对照组20例(40只眼)。回顾性分析我院2003年5月~2005年10月间非增生性糖尿病患者76例(114只眼),分别行裂隙灯前置镜、FFA和OCT检查。裂隙灯前置镜、FFA检查按常规进行,OCT测量以黄斑中心凹为中心的6mm直径区域内视网膜形态及厚度,对各种检查记录进行比较。结果所有眼均行裂隙灯前置镜检查,肯定有DME者75只眼(65%),怀疑有者9只眼(8%),肯定无者30只眼(18%)。FFA确诊有DME者89只眼(78%),未发现DME者25只眼(22%),其中黄斑局限性水肿占18%,弥漫性水肿占32%,弥漫性水肿伴囊样变性占28%。用OCT检查正常对照组黄斑中心凹6mm直径区域内视网膜平均厚度为(157±10)μm,在糖尿病组同样区域内无黄斑区视网膜增厚者10只眼(9%),有黄斑区视网膜增厚者104只眼(90%),局限性水肿组视网膜平均厚度为(257±43)μm,弥漫性水肿伴囊样变性组视网膜平均厚度为(379±122)μm。经比较,OCT检查的敏感性大大高于裂隙灯前置镜检查,FFA检查无DME组中有15只眼经OCT检查与正常对照组间比较,有显著性差异(P<0.05),另外局限视网膜病变荧光渗漏组、弥漫性荧光渗漏伴囊变组间两两比较也均有显著性差异(P<0.05)。结论对于糖尿病视网膜病变黄斑区水肿,OCT检查其敏感性大大高于裂隙灯前置镜检查,并随着病程的延长,黄斑水肿加重,视网膜厚度及形态改变明显。OCT与FFA检查相互配合,才能较准确评估DME的发生及发展。     

无明显视力下降的糖尿病患者黄斑区视网膜厚度的研究

目的:分析无明显视力下降的糖尿病患者与正常人黄斑区视网膜厚度的差异。方法:选取2018-04/2019-06在我院确诊为2型糖尿病且无明显视力下降(最佳矫正视力≥0.8)的患者40例79眼为观察组,同期选取健康志愿者64例119眼为对照组。采用3D OCT获得两组受检者黄斑区9个区域平均视网膜厚度和黄斑区中心凹视网膜厚度(CRT)、平均视网膜厚度(ART)及视网膜体积(TV),并分析两组受检者之间的差异。结果:观察组患者CRT、ART、TV(193.99±14.58μm、291.07±12.24μm、8.22±0.35mm 3)均明显高于对照组受检者(187.38±12.24μm、280.54±8.71μm、7.92±0.25mm 3),且观察组患者黄斑区9个区域平均视网膜厚度均明显高于对照组受检者,差异均有统计学意义(P<0.05)。结论:无明显视力下降的2型糖尿病患者早期黄斑区视网膜厚度和体积较正常人增加。     

多波长激光治疗糖尿病性视网膜病变临床观察

目的探讨多波长激光光凝对糖尿病性视网膜病变的疗效。方法30例（52只眼）糖尿病性视网膜病变行荧光素眼底血管造影（FFA）及黄斑区相干光断层扫描（OCT）,对重度非增生性及增生性糖尿病性视网膜病变分别进行绿光、黄光、红光激光光凝。黄斑水肿患者同时行黄斑格栅光凝,分4次进行泛视网膜光凝。光凝后观察视力、黄斑中心凹厚度及FFA情况。结果随访6个月,35只眼视力不同程度提高,14只眼视力维持激光治疗前的水平,3只眼因黄斑水肿加重视力下降,激光治疗前OCT显示黄斑部中央凹平均厚度为（430．35±98．53）μm,治疗后6个月平均厚度（178．48±42．56）μm。结论多波长激光治疗糖尿病视网膜病变能有效提高或保存患眼视功能。     

视网膜神经纤维层厚度与糖尿病视网膜病变程度的相关性研究

目的通过光学相干断层扫描(optical coherence tomography,OCT)仪观察具有不同视网膜病变程度的2型糖尿病患者及正常人视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度,探讨RNFL厚度与糖尿病视网膜病变(diabetic retinopathy,DR)的程度是否有相关性。方法正常对照组50人89眼,2型糖尿病患者75例130眼,按DR国际临床分型标准分为无糖尿病视网膜病变(non-diabetic retinopathy,NDR)组37例70眼、非增生性糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)组21例33眼、增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)组17例27眼,所有患者均行眼科常规检查和OCT检查;OCT测量数据包括:视盘周围360°平均及上方、下方、鼻侧和颞侧平均RNFL厚度。结果正常对照组RNFL厚度视盘360°平均为(106.80±9.28)μm、上方(130.24±16.13)μm、下方(137.50±14.12)μm、鼻侧(75.02±8.90)μm、颞侧(84.20±12.39)μm;NDR组RNFL厚度360°平均为(104.20±7.12)μm、上方(120.46±20.40)μm、下方(137.63±11.18)μm、鼻侧(74.42±6.50)μm、颞侧(84.38±12.58)μm;NPDR组RNFL厚度360°平均为(86.67±4.22)μm、上方(105.97±7.22)μm、下方(114.97±5.29)μm、鼻侧(52.93±7.86)μm、颞侧(72.81±6.91)μm;PDR组RNFL厚度360°平均为(127.92±6.44)μm、上方(154.48±9.28)μm、下方(167.22±9.59)μm、鼻侧(83.33±9.83)μm、颞侧(106.63±10.40)μm。与正常对照组相比,NPDR、PDR组各方位RNFL厚度差异均有统计学意义(均为P<0.05),NPDR组变薄而PDR组变厚;NDR组与正常对照组比较,只有360°平均及上方有统计学意义(均为P<0.05);NDR、NPDR、PDR三组间两两比较,差异均有统计学意义(均为P<0.05)。结论糖尿病患者RNFL厚度的变化与DR的程度具有相关性,NDR及NPDR患者RNFL厚度变薄提示眼底开始出现神经节细胞凋亡的可能,当RNFL厚度由薄转为增厚则提示出病变的进行性加重,对临床早期诊断及治疗具有指导意义。     

使用OCT评估中心性浆液性脉络膜视网膜病变患者脉络膜厚度的变化

目的:使用光谱域光学相干断层成像(SD-OCT)技术研究中心性浆液性脉络膜视网膜病变(CSCR)3mo后脉络膜厚度的变化。方法:前瞻性研究。共纳入60眼,20眼(平均年龄:33.65±5.24岁)典型急性单侧中心性浆液性脉络膜视网膜病变以及对侧正常眼,20眼为健康对照组。进行荧光素血管造影和OCT检查。测量中心凹下脉络膜厚度(SFCT),黄斑中心凹视网膜厚度(CMT),到中央凹和视网膜下液1000μm处颞部和鼻部。结果:在三个不同的位置,三组间的SFCT差异有统计学意义。中心性浆液性脉络膜视网膜病变眼中心凹下脉络膜厚度(372.40±34.39μm)在基线和随访3mo后均显著大于对侧正常眼(302.10±8.9μm)和对照组眼(279.80±14.49μm)。CSCR眼平均CMT为317±141.86μm,并且SFCT与CMT呈显著正相关。结论:不同部位脉络膜厚度的增加,以及被称为“厚脉络膜”的过度扩张和高渗透血管,似乎在包括中心性浆液性脉络膜视网膜病变在内的广泛疾病中起着重要作用。     

频域OCT与FFA在糖尿病视网膜病变患者中的应用

目的 对比频域光学相干断层扫描(optical coherence tomography,OCT)及眼底荧光血管造影(fundus fluorescein angiography,FFA)在各期糖尿病视网膜病变患者中的应用.方法 选择2型糖尿病患者80例152眼为研究对象,其中糖尿病正常视网膜(normal diabetes retina,NDR)组28例54眼、非增生性糖尿病视网膜病变(nonproliferative diabetic retinopathy,NPDR)组31例56眼、增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)组21例42眼.所有患眼均行频域OCT及FFA检查,频域OCT测量记录以黄斑中心凹为中心的6 mm直径区域内视网膜形态及厚度,FFA检查按常规进行,所有检查结果均由同一位有经验的眼底病医师判读,并对两种检查记录结果进行比较.结果 所有患眼行FFA检查确诊有糖尿病黄斑水肿(diabetic macular edema,DME)者8眼(58.6％),未发现DME者63眼(41.4％),其中黄斑局限性水肿31眼,弥漫性水肿28眼,弥漫性水肿伴囊样变性30眼.频域OCT检查NDR组、NPDR组、PDR组黄斑中心凹6 mm直径区域内视网膜厚度分别为(289.45±11.19)μm、(332.31±39.71) μm、(390.20±64.17) μm,与NDR组相比,NPDR组、PDR组黄斑部视网膜厚度均增加(均为P＜0.05);频域OCT确诊有DME者102眼(67.1％),未发现DME者50眼(32.9％).其中视网膜海绵样肿胀42眼,黄斑部囊样水肿14眼,浆液性神经上皮的脱离4眼,视网膜海绵样肿胀+黄斑部囊样水肿24眼,视网膜海绵样肿胀+浆液性神经上皮的脱离18眼.频域OCT及FFA检出阳性率间差异有统计学意义(P＜0.05).结论 DME在DR的各期均有分布,频域OCT和FFA在各期DR中表现不同,二者相结合能更有效地了解糖尿病患者黄斑部的结构和生理功能.     

中心视网膜厚度对非增生型糖尿病视网膜病变眼底血管充盈状态的影响

目的 观察中心视网膜厚度对非增生型糖尿病视网膜病变(NPDR)眼底血管充盈状态的影响.方法 眼科及内分泌科住院治疗的无眼底病变的糖尿病患者及NPDR患者248例248只右眼纳入研究.所有患者均行光相干断层扫描(OCT)、荧光素眼底血管造影(FFA)、眼部彩色多普勒血液成像(CDFI)检查.排除中心视网膜有明显水肿、出血、渗出的其它眼底病变者.OCT测量距黄斑中心注视点1、1～3、3～6 mm处中心视网膜厚度,将患者按中心视网膜厚度分人视网膜厚度正常、变薄、增厚组.确定中心视网膜厚度正常范围为216.4～304.9 μm.中心视网膜厚度介于216.4～304.9 μm者纳入视网膜厚度正常组,＜216.4 μm者纳入视网膜厚度变薄组,＞304.9 μm者纳入视网膜厚度增厚组.FFA检查时,观察并记录臂-视网膜循环时间、视网膜动脉期-静脉期(A-V)荧光充盈时间.CDFI检查时,检测各组患者眼动脉(OA)、视网膜中央动脉(CRA)及睫状后短动脉(PCA)的收缩峰值速度(PSV)、搏动指数(PI)及阻力指数(RI).对比观察不同视网膜厚度组眼底血管充盈状态及眼部血流动力学指标异同.结果 视网膜厚度正常、变薄、增厚组患者的臂-视网膜循环时间分别为(10.42±0.51)、(10.36±0.64)、(12.94±0.46)s;视网膜A-V荧光充盈时间分别为(9.15±1.36)、(6.36±1.15)、(13.56±2.04)s.视网膜厚度增厚组与视网膜厚度正常组间(t=1.93,P=0.04)、视网膜厚度增厚组与视网膜厚度变薄组间(t=4.49,P=0.00)臂-视网膜循环时间比较,差异有统计学意义;视网膜厚度变薄组与视网膜厚度正常组间(t=2.13,P=0.03)、视网膜厚度增厚组与视网膜厚度正常组间(t=2.49,P=0.02)、视网膜厚度增厚组与视网膜厚度变薄组间(f=5.38,P=0.00)视网膜A-V荧光充盈时间比较,差异有统计学意义.视网膜厚度增厚组与视网膜厚度变薄组间OA、CRA、PCA的PSV(t=3.290、-5.520、-4.900)、PI(t=-4.310、-5.230、-4.390)、RI(t=4.970、6.160、5.990)比较,差异均有统计学意义(P＜0.05).结论 中心视网膜厚度对无眼底病变的糖尿病患者及NPDR患者眼底血管充盈状态有明显影响.     

氩激光视网膜光凝术联合羟苯磺酸钙治疗糖尿病性视网膜病变

目的:探讨氩激光视网膜光凝术联合羟苯磺酸钙治疗糖尿病性视网膜病变(DR)的临床价值。方法:前瞻性研究。纳入2017-08/2019-08我院收治的DR患者182例326眼,按随机数字表法分为观察组行氩激光视网膜光凝术联合羟苯磺酸钙治疗(91例164眼)与对照组仅行氩激光视网膜光凝术(91例162眼),治疗前、治疗6mo均进行闪光视网膜电图检查,记录a、b波振幅、峰值时间变化;并检测两组患者最佳矫正视力(BCVA)、视网膜新生血管荧光素渗漏面积、黄斑中心凹厚度(CMT)及视网膜微循环参数的变化,记录两组患者视网膜水肿、出血及渗出吸收时间,统计两组患者术后并发症发生率。结果:治疗6mo,两组患者a、b波振幅均较治疗前降低(P<0.001),观察组b波振幅高于对照组(P<0.05),但a、b波峰值时间及a波振幅比较无差异(P>0.05);治疗6mo,两组患者均较治疗前BCVA改善,黄斑区渗漏面积、CMT降低(P<0.001),观察组BCVA优于对照组,黄斑区渗漏面积、CMT低于对照组(P<0.001),视网膜中央动脉峰值血流速度、平均血流速度高于对照组,血管阻力指数及搏动指数低于对照组(P<0.001),水肿、出血及渗出吸收时间短于对照组(P<0.001);两组患者手术并发症发生率无差异(P>0.05)。结论:氩激光视网膜光凝术联合羟苯磺酸钙治疗DR疗效优于单独应用氩激光视网膜光凝,可促进视力改善,减少荧光素渗漏,促进视网膜水肿、出血及渗出吸收,有助于改善视网膜微循环,抑制新生血管再生。     

Correlation of leaking microaneurysms with retinal thickening in diabetic retinopathy

AIM: To investigate the contribution of fluorescein angiographic leaking microaneurysms (leak-MA) versus non-leaking microaneurysms (non-leak-MA) to retinal thickening in diabetic retinopathy. METHODS: A consecutive series of 38 eyes from 24 patients with diabetic retinopathy was included. Leak-MA and non-leak-MA in each eye were selected in pairs at corresponding topographic location. Leaking was defined by late phase fluorescein angiograms compared to early phase. Retinal thickness was measured with Heidelberg Spectralis OCT topographically aligned on early phase angiograms at the MA site and within a 1 mm circle. RESULTS: In all eyes, significant retinal thickening at the site of leaking compared to non-leaking microaneurysms was observed (356±69μm vs 318±56μm, P <0.001), showing a mean increase in thickness in the areas of leak-MA vs non-leak-MA of 38±39μm (95% confidence interval 25-51μm, P<0.001). All 1mm area measurements also showed significant (P<0.001) thickening of the leak-MA with average thickness of leak-MA vs non-leak-MA as 351±67μm vs 319±59μm; minimum thickness 311±62μm vs 284±60μm; maximum thickness 389±78μm vs 352±66μm; and retina volume 26.4±6.0mm vs 23.6±3.7mm3, respectively. CONCLUSION: Leaking of microaneurysms on fluorescein angiography appears to cause focal thickening of retina, which can be measured with high-resolution OCT. Therefore, targeting leaking microaneursyms in diabetic retinopathy has the potential to reduce retinal thickening.     

糖尿病视网膜病变黄斑无血管区图像定量研究

目的：研究糖尿病视网膜病变diabetic retinopathy，DR)患者黄斑无血管区(foveal avascualr zone,FAZ)的大小与形态可发生的改变。 方法：运用计算机图像处理系统，对糖尿病视网膜病变98只眼和健康人120只正常眼的眼底荧光血管造影(fundus fluorescein angiography,FFA)负片进行定量研究．测量FAZ面积与视盘面积的比值。 结果：DR组的FAZ面帜与视盘面积的比值显著大于正常对照组；且增值型DR组的FAZ面积与视盘面积的比值显著大于单纯型DR组．在DR组中，有35只眼的FAZ形态不规则，边缘断裂，周围有微动脉瘤。 结论：DR可出现FAZ面积扩大、形态不规则和边缘断裂，其周围可有微动脉瘤。 （中华眼底病杂志，1995，11：229-231）     

光凝治疗增殖型糖尿病性视网膜病变

目的 观察光凝治疗增殖型糖尿病性视网膜病变的疗效。方法 对患有增殖型糖尿病性视网膜病变的１４３例２６０眼光凝前和光凝后３～６个月进行眼底、视力和荧光血管造影检查,并对造影的特征指标静脉渗漏荧光、出血遮蔽荧光、视网膜微动脉瘤、无灌注区以及视力进行比较和统计分析。结果 光凝后视力较光凝前提高及荧光血管造影特征指标好转均非常明显,差异有极显著性（Ｐ〈０．０００１）。结论 全视网膜光凝对增殖型糖尿病性视网     

Disappearance and formation rates of microaneurysms in early diabetic retinopathy.

AIM: To analyse the formation and disappearance rates of individual microaneurysms in mild background retinopathy. METHODS: Three fluorescein angiograms were taken at 1 year intervals during a 2 year follow up from 24 type 1 diabetics with mild background retinopathy. Microaneurysms were identified and localised twice from each angiogram using a computerised system for retrieval of the coordinates for each microaneurysm. Microaneurysms identified similarly in both sessions were then processed further to obtain rates of microaneurysm formation and disappearance, and microaneurysm count changes. RESULTS: In the whole material the total number of microaneurysms increased from 298 to 436 from baseline to 2 years. During the 2 year follow up 395 new microaneurysms formed and 258 microaneurysms disappeared. Of the microaneurysms present at baseline 174 (58%) were still present at the 1 year and 142 (48%) at the 2 year follow up. In patients with good glucose control (HbA1c < or = 7.5 mmol) microaneurysm formation showed a trend of being decreased whereas microaneurysm disappearance did not correlate with glucose control. CONCLUSION: Background diabetic retinopathy is a dynamic process. A significant proportion of microaneurysms present disappear within 2 years. This is compensated for by formation of new microaneurysms, the resultant net changes in microaneurysm counts being small. Microaneurysm formation and disappearance rates are new variables of diabetic retinopathy and may prove to be more sensitive indicators of the progression patterns of background diabetic retinopathy than microaneurysm count changes.     

Grading of diabetic retinopathy from non-stereoscopic color fundus photographs--relationship to fluorescein angiography findings and three-year prognosis

PURPOSE: To evaluate the grading of diabetic retinopathy from non-stereoscopic color fundus photographs, we examined the relation of the photos to fluorescein angiography findings and to the three-year prognosis. METHODS: Fifty diabetic patients(70 eyes) who had severe non-proliferative diabetic retinopathy or early proliferative retinopathy without photocoagulation treatment were graded regarding 11 items of four-field fundus photographs using a 50-degree mydriatic camera. Fluorescein angiography was performed and the relation of the images to the grades of diabetic retinopathy were analyzed. In 51 eyes, the relation between the grading and the progression and treatment of diabetic retinopathy were evaluated. RESULTS: The grading of microaneurysms and retinal hemorrhages (p < 0.001), soft exudates (p = 0.01), intraretinal microvascular abnormalities (p < 0.001), arteriolar white threads (p = 0.003), venous loops (p = 0.01), and new vessels (p < 0.001) was significantly related to the nonperfused areas on fluorescein angiograms. The grading of diabetic retinopathy was also significantly related to the threeyear prognosis. CONCLUSION: These results indicated that the grading of diabetic retinopathy from fundus photographs may have a potential advantage over conventional classifications of diabetic retinopathy.     

Efficacy of verteporfin photodynamic therapy on laser-induced choroidal neovascularization and the ancillary effect on diabetic microvasculopathy

PURPOSE: To demonstrate the efficacy of photodynamic therapy (PDT) in treating choroidal neovascularization (CNV) induced by laser photocoagulation for diabetic macular edema and its ancillary effect on surrounding diabetic microvascular abnormalities. METHODS: A retrospective interventional case series study in a clinical practice setting of four patients with proliferative diabetic retinopathy and clinically significant macular edema who had developed classic CNV in proximity to the area of previous laser photocoagulation. The lesions were treated with verteporfin PDT and followed with serial fluorescein angiography. RESULTS: Compared to the pre-treatment angiogram, an acute reduction in leakage from CNV was noted as soon as 5 days post-PDT and persisted in some areas up to three months post-treatment within the zone of the typical dark choroid pattern. No evidence of any closure of microaneurysms was noted. CONCLUSIONS: Serial fluorescein angiograms demonstrate that PDT appears to have a beneficial effect on CNV induced by laser photocoagulation for diabetic macular edema without any tangible beneficial effect on diabetic microvasculopathy. PDT had no effect on existing microaneurysms.     

全视网膜激光光凝顺序差异对重度非增殖期糖尿病视网膜病变的效果影响

目的介绍一种新的全视网膜光凝（PRP）方法并比较其与传统PRP方法对重度非增殖期糖尿病视网膜病变的远期效果。设计治疗新技术评价。研究对象100例（200眼）FFA诊断重度非增殖期视网膜病变伴黄斑区微动脉瘤且OCT检查无临床意义黄斑水肿者。方法患者左眼常规PRP光凝（自颞下、鼻下、颞上分四次行全视网膜光凝）,右眼采用新光凝方法（全视网膜镜黄斑C型光凝联合黄斑区微动脉瘤封闭,而后行赤道部光凝、下方远周边部、上方远周边部光凝）。术后2周、1个月、3个月、6个月,而后每年随诊1次直至5年。主要指标视力及黄斑厚度,视网膜无灌注区情况以及玻璃体积血、牵拉性视网膜脱离、新生血管性青光眼发生率。结果随诊5年者82例（164眼,82％）。到最后随诊时传统光凝法及新方法的平均视力分别为（0．45±0．02）、（0．62±0．04）（P〈0．05）;黄斑厚度分别为（182．32±32．31）、（158．49±42．06）μm（P〈0．05）。传统光凝法70眼发生黄斑水肿,新方法为28眼。传统光凝法15眼发生玻璃体积血,新方法为3眼。传统光凝法10眼发生牵拉性视网膜脱离,新方法为1眼。传统光凝法12眼5年后可见视网膜新生血管,新方法为3眼。其中传统光凝法1眼发展为新生血管性青光跟。结论新的PRP光凝方法较常规方法可显著减轻黄斑水肿、再次玻璃体积血、牵拉性视网膜脱离及新生血管发生率,更好地保留患者中心视力。     

Diabetic retinopathy in children and adolescents under 18 years of age]

We found ophthalmoscopically microaneurysms in 22 patients from 189 diabetics (11.6%). The youngest patients with microaneurysms were two 11-years-old girls with 3 and 5 years lasting disease. The chance of retinopathy was growing with the duration of the diabetes. By fluorescein angiography we discovered retinopathy in 52 patients out of 126 diabetics (41.3%). The retinopathy was more often found among girls. Just in one case we found the early stage of preproliferative retinopathy. The retinopathy was more often found in diabetics with higher levels of glyconated hemoglobin. The extent of foveolar avascular zone is decreasing with the longer course of the diabetes. We recorded lower occurrence of diabetic retinopathy in patients treated at the Ist Department of Pediatrics in Bratislava. In the group evaluated in the years 1986-89 the occurrence of the diabetic retinopathy diagnosed ophthalmoscopically was lower than in the group of 1981-84.     

Oral fluorescein angiography with the scanning laser ophthalmoscope in diabetic retinopathy: a case controlled comparison with intravenous fluorescein angiography

AIM: To compare the performance of oral fundus fluorescein angiography with a confocal scanning laser ophthalmoscope (SLO) with intravenous fundus fluorescein angiography (IVFFA) with a fundus camera in the assessment of sight-threatening diabetic retinopathy. PATIENTS AND METHODS: A total of 25 patients undergoing IVFFA to investigate their diabetic retinopathy were recruited. Participants returned 1 week later and an oral angiogram with the SLO was performed. Six facets of the oral and intravenous angiograms were scored and compared: visualization of the foveal avascular zone (FAZ); branch retinal identification; macular leakage; identification of microaneurysms in areas of macular leakage; peripheral nonperfusion, and leakage from neovascular complexes. RESULTS: Compared to IVFFA, the FAZ was unreliably visualized with oral angiography (Kappa 0.1, 95% CI 0-0.3). In contrast, macular leakage (Kappa 0.78, 95%, CI 0.72-0.83), identification of microaneurysms in areas of macular leakage (Kappa 0.78, 95%, CI 0.72-0.83), and neovascular complexes (Kappa 1.0) were reliably seen. Analysis of the visualization of peripheral nonperfusion was complicated by the finding that profuse dye leakage from neovascular complexes obscured the view of the peripheral retina. If the five angiograms in which this occurred were excluded, oral angiography identified 23 of the 24 eyes in which significant nonperfusion was found on IVFFA. CONCLUSION: Oral angiography with the SLO can provide high-quality angiograms that allow judgments to be made about the presence of treatable diabetic maculopathy, proliferative diabetic retinopathy, and peripheral nonperfusion. In the presence of coexisting macular oedema, it proved to be an unreliable technique with which to investigate foveal ischaemia.     

Influence of pregnancy on the evolution of background retinopathy

Previous reports have suggested that pregnancy does not influence the development of diabetic retinopathy.Since 1979 a prospective study using fluorescein angiography has been in progress. Preliminary results include 22 diabetic women with or without moderate background retinopathy studied until delivery. They were maintained under good metabolic control (mean HbA1: 7.68%). Five clinical and fluorescein angiography examinations were performed at prefixed intervals (before the 15th week, at the 28th and 35th weeks of pregnancy, and 6 and 15 months after delivery).The analysis of fluorescein angiography which did not induce any side effect showed that the mean number of microaneurysms increased from 42.7 before pregnancy to 56.7 at the 28th week and to 79.7 at the 35th week. Six months later the number was 62.7, and 15 months later 60.3, still higher than at the initial examination.This study suggests that pregnancy has an unfavourable influence on the background retinopathy in diabetic patients even when a good metabolic control is achieved and retinopathy is minimal.