外伤性黄斑裂孔的频域光相干断层扫描观察

目的:探讨外伤性黄斑裂孔的频域光相干断层扫描的形态特征及临床价值.方法:我院2008-01/2011-01经采用国际标准视力表、裂隙灯显微镜、直接及间接检眼镜、三面镜确诊的外伤性黄斑裂孔患者29例29眼,进行频域光相干视网膜断层扫描(FD-OCT)检查,分析其图像特征.结果:患者29例29眼中黄斑板层裂孔3例3眼(10%),OCT表现为黄斑区神经上皮层部分缺失;黄斑全层裂孔26例26眼(90%),OCT图像均可见黄斑区神经上皮层全层缺失.其中黄斑全层裂孔中单纯性黄斑裂孔3例3眼;黄斑全层裂孔伴孔周神经上皮层水肿6例6眼;伴神经上皮层局限性脱离5例5眼;伴黄斑区脉络膜裂伤7例7眼;伴孔周神经上皮层局部萎缩变薄3例3眼;伴视网膜前膜2例2眼.结论:频域OCT能清晰的观察到外伤性黄斑裂孔的形态及其周围组织损害,有利于外伤性黄斑裂孔的诊断及病情评估.     

光学相干断层扫描在糖尿病性黄斑水肿的诊断

目的阐明糖尿病性黄斑水肿的光学相干断层扫描(Optical coherence tomography,OCT)特征.方法对37例61眼糖尿病合并黄斑区水肿患者进行OCT检查及资料分析.结果 (1)黄斑区局限性水肿者OCT图像:①11眼表现为局限性视网膜层间海绵样增厚;②2眼为单纯性小范围神经上皮层浆液性脱离.(2)黄斑区及其周围弥漫性水肿者OCT图像:①12眼表现弥漫性视网膜层间海绵样膨胀增厚;②7眼可见包括中心凹的视网膜层间海绵样膨胀在内的神经上皮层脱离;③29眼表现为黄斑囊样水肿.(3)61跟中发现有22眼伴玻璃体部分后脱离,5眼伴玻璃体完全性后脱离.结论糖尿病性视网膜黄斑水肿的OCT图像为临床提供类似病理学的直观资料,尤其对治疗的随诊及判定预后具有重要参考价值.     

糖尿病性黄斑水肿的光学相干断层成像

目的:观察糠尿病性黄斑水肿(diabetic macular edema,DME)的光学相干断层成像(optical coherence tomography,OCT)图像特征,分析其黄斑视网膜厚度与视力的关系.方法:对50例80眼经检眼镜或荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查确诊为糖尿病视网膜病变伴黄斑水肿的患者进行经黄斑中心凹水平和垂直线性扫描的OCT检查.结果:10眼表现为黄斑中心凹局限性水肿改变,21眼表现为黄斑中心凹囊样改变伴神经上皮层浆液性脱离,49眼表现为黄斑区视网膜神经上皮层弥漫性增厚.DME患者黄斑视网膜厚度与视力呈负相关关系(r=-0.60,P=0.000).结论:DME的主要OCT图像特征为黄斑视网膜弥漫性水肿、黄斑囊样水肿伴神经上皮层脱离和黄斑局限性水肿改变;DME患者黄斑水肿越严重,视力越差.     

糖尿病性黄斑水肿的光学相干断层成像

目的：观察糠尿病性黄斑水肿(diabetic macular edema,DME)的光学相干断层成像(optical colnerence tomographly,OCT)图像特征,分析其黄斑视网膜厚度与视力的关系。方法：对50例80眼经检眼镜或荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查确诊为糖尿病视网膜病变伴黄斑水肿的患者进行经黄斑中心凹水平和垂直线性扫描的OCT检查。结果：10眼表现为黄斑中心凹局限性水肿改变,21眼表现为黄斑中心凹囊样改变伴神经上皮层浆液性脱离,49眼表现为黄斑区视网膜神经上皮层弥漫性增厚。DME患者黄斑视网膜厚度与视力呈负相关关系(r=-0．60,P=0．000)。结论：DME的主要OCT图像特征为黄斑视网膜弥漫性水肿、黄斑囊样水肿伴神经上皮层脱离和黄斑局限性水肿改变;DME患者黄斑水肿越严重,视力越差。     

糖尿病视网膜病变患者黄斑病变的 光学相干断层扫描

目的观察糖尿病视网膜病变患者黄斑病变的光学相干断层扫描(optical coherence tomography,OCT)图像特征。方法对60例糖尿病黄斑病变患者以及30例正常对照者进行OCT检查。其中54例糖尿病黄斑病变患者同时行荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查,对两种检查方法的结果进行比较。结果OCT检查糖尿病黄 斑病变患者中心凹平均厚度为(314.54±154.13)μm。视网膜水肿者占57.1%,视网膜水肿合并黄斑囊样水肿(cystoid macular edema,CME）者占38.5%,合并神经上皮脱离者 占9.2%,合并CME及神经上皮脱离者占16.9%。OCT检查黄斑正常厚度及轻度水肿者,FFA主要呈限局性渗漏;中重度水肿者,FFA呈弥漫性渗漏。CME检出率FFA检查者为28.6%,OCT检 查者为58.9%,二者比较差异有显著性意义(t=3.39,P<0.05) 。结论糖尿病黄斑病变者的OCT图像有视网膜水肿、CME及神经上皮脱离3种形态特征。OCT在检测发现CME等方面优于FFA。(中华眼底病杂志,2001,17:184-186)     

光学相干断层扫描对黄斑疾病的诊断意义

目的 评价光学相干断层扫描（optical coherence tomography,OCT)在诊断黄斑部疾病中的价值。方法 采用OCT检测了111例126只有黄斑部病变的眼：中心性浆液性脉络膜视网膜病变20眼，黄斑裂孔20眼，老年黄斑变性20眼，黄斑水肿26眼，视网膜前膜20眼，裂孔性视钢膜脱离累及黄斑部经手术复位后20眼。结果 黄斑部疾病的OCT示黄斑区视钢膜多种形态学改变。中心性浆液性脉络膜视网膜病挛 OCT见神经上皮层脱离和（或）色素上皮层脱离；黄斑裂孔的OCT见黄斑中心凹处神经上皮层全层或部分缺损，可伴神经上皮层脱离或增厚；湿性型年龄相关性黄斑变性的OCT见神经上皮层下呈不规则的高反射层（脉络膜新生血管膜），部分伴视网膜神经上皮层和（或）色素上皮层脱离；黄斑水肿及囊性水肿的OCT见黄斑区的神经上皮层厚度增厚和（或）层间液性囊腔；视网膜前膜的OCT见视网膜内层前有一高反射的光带；视网膜脱离术后的OCT见神经上皮层与色素上皮相贴良好或有液性腔隙存在。结论 OCT对黄斑部疾病诊断有独特的临床应用价值。     

糖尿病性黄斑水肿的光学相干断层扫描与荧光血管造影图像的对比分析

目的对比分析糖尿病视网膜病变患者的光学相干断层扫描(optical coherence tomography,OCT)与荧光血管造影(fluorescein angiographic,FA)图像。方法回顾性分析不同阶段糖尿病视网膜病变70例患者95眼的OCT和FA图像。结果OCT图像显示视网膜水肿占70.5%,囊样黄斑水肿(cystoid macular edema,CME)占13.7%,浆液性黄斑脱离并发水肿占4.2%,浆液性黄斑脱离并发水肿和CME占2.1%,正常黄斑结构占9.5%。结论OCT为糖尿病视网膜病变黄斑结构的变化提供了依据,特别是对FA未能发现的早期黄斑结构改变的诊断具有重要意义。     

闭合性眼外伤致黄斑裂孔的光相干断层扫描图像分析

目的 观察外伤性黄斑裂孔的光相干断层扫描（OCT）形态特征及其临床意义。方法 对采用国际标准视力表、裂隙灯显微镜、直接或间接检眼镜、三面镜检查确诊的74例闭合性眼外伤致黄斑裂孔患者74只眼进行光相干断层扫描（OCT）检查。利用OCT分析软件对外伤性黄斑裂孔进行定量测量,并根据OCT图像特征对外伤性黄斑裂孔进行分型。OCT检查完毕用Topcon眼底照相机进行眼底50°彩色照相。回顾分析患者黄斑裂孔与平均视力、病程、孔缘神经上皮层厚度、裂孔底径、孔径之间的相互关系。结果 74只眼的OCT图像特征可分为5种类型。其中,黄斑裂孔伴神经上皮层对称性水肿27只眼,占36.5%;黄斑裂孔伴神经上皮层不对称性水肿12只眼,占16.2%;单纯性黄斑裂孔14只眼占18.9%;黄斑裂孔伴神经上皮层局限性脱离17只眼,占23.0%;黄斑裂孔伴神经上皮层变薄4只眼,占5.4%。不同类型的黄斑裂孔之间视力比较,差异无统计学意义（F=1.574, P=0.191）;其视力与孔缘平均神经上皮层厚度呈正相关 （r＝0.342,P＝0.003）,与致伤时间、年龄、裂孔直径无明显相关关系（r＝-0.022～-0.134,P＝0.863～0.261）。黄 斑裂孔伴神经上皮层局限脱离者,病程较其它各型黄斑裂孔者病程短;病程90 d及以上的患者中,黄斑裂孔伴神经上皮层对称性水肿最多。各型黄斑裂孔的孔缘神经上皮层厚度之间比较,差异有统计学意义（F=13.921, P=0.000）。结论 外伤性黄斑裂孔可根据OCT形态特征分为5种类型,不同类型的外伤性黄斑裂孔临床特征存在差异。     

频域OCT定性定量分析葡萄膜炎性黄斑水肿

目的 观察葡萄膜炎患者黄斑水肿的光学相干断层扫描(OCT)图像特征及与临床的关联,探讨频域OCT在葡萄膜炎性黄斑水肿定性和定量分析中的应用价值.方法 连续临床病例横断面研究.对河南省眼科研究所在2009年4月至2011年3月就诊的葡萄膜炎并黄斑水肿169只眼进行频域OCT检查,分析黄斑水肿的类型及各参数与视力的相关性,并与FFA结果对比分析.结果 (1)黄斑水肿分型:囊样水肿占43.19％,弥漫性水肿占34.91％,单纯神经上皮脱离占10.06％,11.83％同时出现3种改变;囊样水肿发生率最高.(2)光感受器内外节连接体断裂者54只眼(31.95％),玻璃体后脱离者33只眼(19.53％);存在明显玻璃体视网膜牵拉者15只眼(8.88％),黄斑前膜者33只眼(19.53％).(3)囊样水肿组平均黄斑厚度高于弥漫性水肿组,两组视网膜厚度均与视力呈负相关;连接体断裂组视力较完整组低;存在黄斑前膜组视力较低.(4) OCT与FFA对黄斑水肿的检出一致率为86.39％.结论 葡萄膜炎所导致的黄斑水肿其形态可表现为多种不同的类型,OCT可以对这些改变进行有效观察,其中有些改变与视力密切相关.     

糖尿病性黄斑水肿OCT和FFA形态学分类的对比分析

目的探讨糖尿病性黄斑水肿相干光断层扫描(OCT)和眼底荧光素血管造影(FFA)的形态学特征、分类及相互关系。设计前瞻性病例系列。研究对象临床有意义糖尿病性黄斑水肿(CSME)患者102例177眼。方法分别对CSME组患者进行OCT及FFA检查,观察两种分类之间的相互关系,并与中心凹中心厚度、最佳矫正视力等临床资料进行对比分析。主要指标CSME患者的OCT及FFA类型、中心凹中心厚度、最佳矫正视力。结果FFA分类的局限水肿型在OCT1型中所占的比例为70.6%,高于弥漫水肿型(27.2%)和囊样水肿型(2.2%)(P<0.05)。FFA弥漫水肿型在OCT2型中占47.9%,明显高于局限水肿型(25.0%)和囊样水肿型(27.1%)(P<0.05)。FFA分类的囊样水肿型在OCT3型(3A型 3B型)中占56.8%,明显高于局限水肿型(10.8%)和弥漫水肿型(32.4%)(P<0.05)。OCT1型及FFA局限水肿型的矫正视力最好,黄斑中心凹中心厚度值最小(P<0.05)。结论CSME患者OCT与FFA的形态学类型密切相关。结合两种检查方法,可更加全面地反映CSME患者黄斑区视网膜的变化,为揭示糖尿病性黄斑水肿的病理机制、寻求每种类型的最佳治疗方案提供参考。     

Retinal thickness in diabetic retinopathy: comparison of optical coherence tomography, the retinal thickness analyzer, and fundus photography

BACKGROUND: Optical coherence tomography (OCT) and the retinal thickness analyzer (RTA) have proved their ability to measure retinal thickness in healthy subjects and diabetics reliably. In the present study, both techniques were compared for the same study population of diabetic patients, and the findings were related to macular edema shown by stereo fundus photography (SFP). METHODS: Maculas of 124 eyes from 69 patients with diabetes mellitus were examined with OCT and the RTA. Measurements of retinal thickness were compared with signs of macular edema shown by SFP. For each eye, nine different sectors were analyzed (a foveal sector, four parafoveal sectors, and four extrafoveal sectors). Thirteen eyes with a normal macula served as controls. Sensitivity and specificity of detecting clinically significant macular edema (CSME) were calculated. RESULTS: Of 111 eyes, 64 showed signs of CSME by SFP. Mean retinal thickness +/- SD of the foveal sector was 249 +/- 104 microm by RTA and 295 +/- 124 microm by OCT measurements. There was a moderate overall correlation between OCT and the RTA (r = 0.66). The correlation was best in the foveal sector (r = 0.82). Overall correlation with SFP was better for OCT (r = 0.77) than for the RTA (r = 0.62). Sensitivity of detecting CSME was consistently higher with OCT, while the RTA showed higher specificity. CONCLUSION: Both measuring techniques yielded similar results when examining eyes of patients with diabetes, although absolute values differed. OCT seems to be more suitable in the clinical screening for macular edema due to its high sensitivity (>90%) with appropriate analysis parameters. The RTA is more prone to erroneous or missing thickness readings particularly under difficult measuring conditions.     

Quantitative assessment of retinal thickness in diabetic patients with and without clinically significant macular edema using optical coherence tomography

PURPOSE: To assess patients with diabetic macular edema quantitatively using optical coherence tomography (OCT). METHODS: OCT was performed in 14 eyes with diabetic retinopathy and ophthalmoscopic evidence of clinically significant macular edema (CSME) and in 19 diabetic eyes without CSME. Retinal thickness was computed from the tomograms at fovea and other 36 locations throughout the macula. RESULTS: The mean +/- standard deviation foveal thickness was 255.6 +/- 138.9 microm in eyes with CSME, and 174.6 +/- 38.2 microm in eyes without CSME (p = 0.051). Within 2000 microm of the center of the macula, eyes with CSME had significantly thicker retina in the inferior quadrant than those without CSME (p < 0.01). The foveal thickness was correlated with logMAR visual acuity (gamma = 0.68, p < 0.01). OCT identified sponge-like retinal swelling and/or cystoid macular edema in 11 (58%) eyes without CSME, and in 12 (86%) eyes with CSME. CONCLUSIONS: Criteria of CSME seem to be insufficient in really identifying macular edema. OCT may be more sensitive than a clinical examination in assessing diabetic macular edema and is a quantitative tool for documenting changes in macular thickening.     

Retinal thickness study with optical coherence tomography in patients with diabetes

PURPOSE: To quantitatively assess retinal thickness by optical coherence tomography (OCT) in normal subjects and patients with diabetes. This study was intended to determine which retinal thickness value measured with OCT best discriminates between diabetic eyes, with and without macular edema. METHODS: OCT retinal thickness was measured by a manual technique in a total of 26 healthy volunteers (44 control eyes) and 85 patients with diabetes (148 eyes) with the clinical diagnosis of no diabetic retinopathy (45 eyes), nonproliferative diabetic retinopathy without clinically significant macular edema (CSME; 54 eyes), proliferative diabetic retinopathy without CSME (21 eyes), and 28 eyes with diabetic retinopathy with CSME. Independent predictors of the presence of CSME were quantified by using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were generated to evaluate and compare the predictor variables. The correlation of retinal thickness measurements and visual acuity was calculated. RESULTS: There were statistically significant differences in foveal thickness between control eyes and all the other eye groups (P = 0.001). Diabetic eyes with CSME had a statistically significant greater thickness in each of the areas compared with the other groups. In a multivariate logistic regression model, foveal thickness was a strong and independent predictor of CSME (odds ratio [OR], 1.037; 95% confidence interval [CI] 1.02-1.05). The area under the ROC curve of this predictor variable was 0.94 (P = 0.001). For a cutoff point of 180 microm, the sensitivity was 93%, and specificity was 75%. Foveal thickness correlated with visual acuity in a log minimum angle of resolution (logMAR) scale (Spearman's rho = 0.9, P = 0.001). CONCLUSIONS: These results suggest that foveal thickening over 180 microm measured by OCT may be useful for the early detection of macular thickening and may be an indicator for a closer follow-up of the patient with diabetes.     

Optical coherence tomography after laser photocoagulation for clinically significant macular edema

BACKGROUND AND OBJECTIVE: To demonstrate the utility of optical coherence tomography (OCT) for documenting an early response to laser photocoagulation in clinically significant macular edema (CSME) secondary to diabetes. PATIENTS AND METHODS: Five eyes of four patients were selected for review based on the diagnosis of CSME. All eyes had a clinical diagnosis of CSME based on slit lamp biomicroscopy. All eyes underwent focal/grid laser photocoagulation to areas of retinal thickening detected by OCT and clinical exam. Pre and post-treatment optical coherence tomograms were obtained for all patients. RESULTS: All eyes selected for review had an early positive response to focal laser photocoagulation. OCT was useful for demonstrating areas of retinal thickening prior to laser treatment. Serial macular maps demonstrated the resolution of retinal thickening after laser photocoagulation in all eyes. CONCLUSION: OCT is a useful tool for evaluating and documenting CSME both before and after focal/grid laser photocoagulation. OCT is capable of detecting an early positive response to photocoagulation for macular edema.     

Diabetic macular edema: correlation between microperimetry and optical coherence tomography findings

PURPOSE: To compare the changes in macular sensitivity (microperimetry) and macular thickness with different degrees of diabetic macular edema. METHODS: Sixty-one eyes of 32 consecutive diabetic patients were included in this cross-sectional study. All included eyes underwent functional and morphologic examination of the macular area. Best corrected visual acuity (ETDRS charts), macular sensitivity, and macular thickness were quantified. Lesion-related macular sensitivity and retinal fixation were investigated with an advanced, automatic microperimeter. Optical coherence tomography (OCT) was used to quantify macular thickness. RESULTS: The 61 included eyes were graded, by two retinal specialists, for diabetic macular edema as follows: 16 were graded as no macular edema (NE), 30 as non-clinically significant macular edema (NCSME), and 15 as clinically significant macular edema (CSME). Macular thickness significantly increased from the NE to the CSME group (P<0.0001), whereas macular sensitivity significantly decreased from the NE to the CSME group (P<0.0021). A significant correlation coefficient was noted between retinal sensitivity and normalized macular thickness (r=-0.37, P<0.0001). Linear regression analysis showed a decrease of 0.83 dB (P<0.0001) for every 10% of deviation of retinal thickness from normal values. Visual acuity and central macular sensitivity correlated significantly in the NCSME group (r=-0.6, P=0.0008), but not in the NE (r=-0.144, P=0.6) or in the CSME (r=-0.46, P=0.11) groups. CONCLUSIONS: Macular edema may be better documented by adding macular sensitivity mapping by microperimetry to macular thickness measurement by OCT and visual acuity determination because macular sensitivity seems to be a relevant explanatory variable of visual function, independent of macular thickness data. Moreover, microperimetry may be of value in predicting the outcome of diabetic macular edema, because it incorporates a functional measure that may supplement the predictive value of OCT and visual acuity.     

Macular thickness measured by optical coherence tomography (OCT) in diabetic patients

PURPOSE: 1) To compare macular thickness (MT) by optical coherence tomography (OCT) in diabetics and controls; 2) to assess the relationship between MT and stage of diabetic retinopathy (DR) and macular edema (ME); 3) to quantify MT changes after laser treatment for ME. METHODS: One-hundred and thirty-seven patients with diabetes mellitus (216 eyes) were admitted to the study and examined by stereo-color fundus photos, retinal fluorangiography and OCT. DR was classified as: 1) no DR (46 eyes: 21.3%); 2) background DR (66 eyes: 30.6%); 3) pre-proliferative DR (50 eyes: 23.1%); 4) proliferative DR (54 eyes: 25%). The study group was then divided into three ME groups: 1) no edema (65 eyes: 30.1%); 2) not clinically significant ME (no CSME) (45 eyes: 20.8%); 3) clinically significant macular edema (CSME) (106 eyes: 49.1%). Three-month follow-up tomograms were taken to evaluate eyes laser-treated only for ME. The control group consisted of 50 eyes of 50 non-diabetic, age- and sex-matched subjects. RESULTS: MT was 369.3 +/- 163.2 microm in diabetics and 161.9 +/- 12.9 microm in controls (p < 0.001). In the four DR groups it was: 1) 211.0 +/- 37.6 microm; 2) 370.8 +/- 159.6 microm; 3) 419.1 +/- 138.2 microm; 4) 456.1 +/- 162.0 microm (p<0.001). In the three ME groups, MT was: 1)227.8 +/- 53.4 microm; 2) 321.8 +/- 124.2 microm; 3) 476.2 +/-146.6 microm (p < 0.001). In the 52 eyes treated with laser photocoagulation of the posterior pole only and with a follow-up > 3 months, MT before and after treatment was 468.2 +/- 83. 17 microm and 372.1 +/- 120.63 microm. CONCLUSIONS: MT was greater in diabetics than controls and tended to increase with DR and ME severity. OCT is a sensitive technique for detecting early diabetic macular abnormalities and quantifying their reduction after laser treatment.     

Can optical coherence tomography predict the outcome of laser photocoagulation for diabetic macular edema?

BACKGROUND AND OBJECTIVE: To assess the outcome of laser photocoagulation in patients with diabetic macular edema. PATIENTS AND METHODS: Forty-seven patients (51 eyes) with clinically significant macular edema (CSME) undergoing grid laser photocoagulation were included. Clinical examination and optical coherence tomography (OCT) were performed at baseline and 3 to 4 months after treatment. The central foveal thickness, mean inner macular thickness (average retinal thickness in fovea and inner macular circle), and mean macular thickness were calculated. Based on the greatest OCT thickness at baseline, patients were grouped according to mild (< 300 microm; Group 1), moderate (300 to 399 microm; Group 2), and severe (> or = 400 microm; Group 3) macular edema. RESULTS: Group 2 showed significant reductions in central foveal thickness (23 microm, P = .02), mean inner macular thickness (18 microm, P = .02), and mean macular thickness (9 microm, P = .04) with slight improvement in visual acuity. Groups 1 and 3 did not show any significant change in macular thickness values and there was a statistically insignificant worsening of visual acuity in these groups. CONCLUSIONS: Patients with moderate macular thickening of 300 to 400 microm benefit most from laser treatment. OCT may help in choosing the appropriate treatment for CSME based on the degree of macular thickening. Long-term studies are warranted to confirm these findings.     

Prevalence of and risk factors for diabetic macular edema in a northeastern Chinese population

AIM:To estimate the prevalence of diabetic macular edema(DME) and clinically significant macular edema(CSME),and to assess their risk factors in a population with type 2 diabetic mellitus(T2DM) located in northeast China.METHODS:Patients were included from the Fushun Diabetic Retinopathy Cohort Study(FS-DIRECT),a community-based study conducted in northeast China.The presence of DME and CSME was determined by the Early Treatment Diabetic Retinopathy Study(ETDRS) retinopathy scale of fundus photographs.The age-standardized prevalence of DME and CSME was estimated.The association between DME/CSME and risk factors was analyzed in a multivariate Logistical analysis.RESULTS:A total of 292(15.4%) and 166(8.8%) patients were diagnosed as DME and CSME,yielding the age and sex standardized prevalence of 13.5%(95%CI:11.9%-15.0%),and 7.1%(95%CI:5.9%-8.3%),respectively.Female patients had a higher prevalence of DME compared to their male counterparts(15.7% vs 10.4%,P=0.03).Multivariable Logistic regression analysis showed that younger age,insulin use,proteinuria,longer duration of diabetes,and higher glycosylated hemoglobin A1c,were associated with the prevalence of DME and CSME.Patients with higher fasting plasma glucose,systolic blood pressure,and blood urea nitrogen were also found to be associated with DME.CONCLUSION:Early fundus screening in diabetic patients is invaluable and given the relatively high prevalence of DME and CSME in this study cohort,those with a high risk of sight threatening maculopathy would invariably benefit from earlier detection.     

Persistent diabetic macular edema is associated with elevated hemoglobin A1c

PURPOSE: To assess the correlation between persistent diabetic macular edema and hemoglobin A1c (HbA1C). DESIGN: Retrospective study. METHODS: Records of type 2 diabetic patients who received eye care for persistent clinically significant macular edema (CSME) from January 2002 to January 2004 were reviewed. Subjects who met one of two criteria were identified: 1) persistent CSME, detected by contact lens biomicroscopy and fluorescein angiography, despite at least two focal laser photocoagulations (FLP) performed at least 3 months before the current diagnosis, or 2) a history of CSME with resolution of macular edema at the time of examination. Patients also needed to have had their HbA1C measured at the Johns Hopkins Hospitals within 3 months of meeting these criteria. RESULTS: The study identified 92 patients (152) eyes with persistent CSME and 32 patients (56 eyes) with resolved CSME. HbA1C values ranged from 5.3% to 15.6% (mean, 8.9%; median, 8.7%) and 5.3% to 9.7% (mean, 6.7%; median, 6.6%) among patients with persistent and resolved edema (P = .0005). Among the 32 patients with persistent unilateral CSME, mean HbA1C was 8.6% (median 8.5%), and among the 60 patients with bilateral CSME, mean HbA1C was 9.1% (median, 8.9%). Of patients with persistent CSME, 74% had HbA1C greater than 7.5% compared with 12.5% of the patients with resolved CSME (P = .0005). CONCLUSIONS: Persons with type 2 diabetes and persistent CSME have higher HbA1C at time of their disease than patients with resolved CSME. Patients with bilateral disease have more elevated HbA1C than those with unilateral disease.     

黄斑水肿的光相干断层扫描分析

目的 观察黄斑水肿的光相干断层扫描（OCT）图像特征；探讨黄斑中心凹厚度与最佳矫正视力之间的关系。 方法 对50例正常对照者以及47例54只经直接、间接检眼镜、三面镜及荧光素眼底血管造影（FFA）诊断为黄斑水肿的患眼进行OCT检查，通过黄斑中心凹的水平或垂直方向线性扫描，测量黄斑中心凹的厚度，对比分析两组受检者的黄斑形态及中心凹厚度值，根据形态学特点对黄斑水肿者的OCT图像进行分类并将其中心凹厚度与其最佳矫正视力进行相关分析。 结果 正常对照组与黄斑水肿组黄斑形态及中心凹厚度差异有显著性的意义。黄斑水肿患眼的OCT图像表现为3种特征，20只眼表现为黄斑区视网膜海绵样肿胀，占37.1%；26只眼表现为黄斑囊样水肿，占48.1%；8只眼表现为浆液性视网膜神经上皮脱离，占14.8%。黄斑水肿者黄斑中心凹厚度与其最佳矫正视力呈负相关（r=－0.569, P=0.000）。 结论 黄斑水肿的OCT图像主要包括视网膜海绵样肿胀、黄斑囊样水肿及神经上皮浆液性脱离。黄斑水肿患者的黄斑中心凹厚度明显增厚，黄斑中心凹厚度越厚，视力越差。 （中华眼底病杂志，2004，20：152-155）