糖尿病黄斑水肿中光相干断层扫描生物学标志物研究进展

糖尿病视网膜病变(DR)是糖尿病患者常见的眼部并发症,而糖尿病黄斑水肿(DME)是DR患者视力丧失的主要原因,因此DME的早期诊治有重要临床意义。光相干断层扫描(OCT)检查可实现视网膜和脉络膜各个层次的高质量成像,已广泛应用于临床,可用于DME的诊断和治疗效果的长期随访。近年来研究发现DME在OCT图像上视网膜和脉络...     

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。     

Comparison of mean macular thickness using optical coherence tomography and visual acuity in diabetic retinopathy

BACKGROUND: The purpose of the present study was to quantitatively assess the mean macular thickness in diabetic patients using optical coherence tomography and its correlation with visual acuity. METHODS: A prospective case series study was undertaken of consecutive diabetic patients referred to a tertiary eye care centre for an eye check up from January 2003 to June 2003. One hundred and five eyes from 55 patients with varying degree of diabetes underwent optical coherence tomography examination. The study patients were divided into four groups: group I, non-proliferative diabetic retinopathy (NPDR); group II, NPDR with clinically significant macular oedema (CSME); group III, proliferative diabetic retinopathy (PDR); and group IV, PDR with CSME. RESULTS: The mean macular thickness of the entire group was 256.0 +/- 129.7 microm. A positive correlation (r = 0.424, P < 0.0001) was evident between mean macular thickness and visual acuity. CONCLUSION: Optical coherence tomography is a useful tool for objectively monitoring macular thickness in patients with diabetic retinopathy. Mean macular thickness correlates with visual acuity.     

频域相干光断层扫描对糖尿病黄斑区厚度的应用研究

目的 利用频域相干光断层扫描(OCT)测量并分析糖尿病( DM)患者的黄斑区视网膜厚度.方法 DM组90例(90只眼),并分为分无糖尿病视网膜病变(NDR) 、非增殖期(NPDR) 及增殖期(PDR) 病变3组,每组各30例(30只眼),正常对照组30例(30只眼).分别行最佳矫正视力(BCVA)、裂隙灯、眼底彩照、荧...     

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）     

Correlation between optical coherence tomography, multifocal electroretinogram findings and visual acuity in diabetic macular edema

AIM: To compare the effects of yellow (577 nm) subthreshold micropulse laser (SML) and intravitreal (IV) anti-vascular endothelial growth factor (VEGF) treatment in patients with diabetic macular edema (DME) with relatively better visual acuity [best corrected visual acuity (BCVA) ≤0.15 logMAR]. METHODS: The medical records of 76 eyes of 47 patients underwent IV (0.5 mg) anti-VEGF injection or SML for the DME with relatively better BCVA were reviewed. The IV group received three consecutive monthly IV anti-VEGF injections, then were retreated as needed. The laser treatment group was treated at baseline and 3mo, and then retreated at 6 and 9mo if needed. All participants were followed up for one year. The mean BCVA and mean central macular thickness (CMT) values changes over the follow-up were evaluated. RESULTS: Twenty-four and 23 patients were assigned to the SML and IV subgroups, respectively. The mean number of treatments was 3.64±0.76 in SML group and 5.85±1.38 in IV group (P<0.05). The subgroups were similar with regard to the mean BCVA score at baseline and at the 1st and 3rd months, but the score of SML group was better than that of IV group at the 6th, 9th and 12th months (P<0.05). The decrease in the mean CMT values from baseline values was higher in SML group at the 6th, 9th, and 12th months (P<0.05). CONCLUSION: Yellow SML treatment is superior to IV anti-VEGF injection in DME patients with relatively better BCVA for increasing visual acuity and decreasing CMT at 6, 9, and 12mo. SML can be a good alternative first-line therapy for DME with BCVA ≤0.15 logMAR.     

糖尿病黄斑水肿患者黄斑中心凹下脉络膜厚度观察

目的 观察糖尿病黄斑水肿（DME）患者中心凹下脉络膜厚度（SFCT）的变化。方法 横断面观察研究。20例DME患者32只眼纳入研究。男性12例,女性8例。平均年龄（57.6±9.3）岁。均行最佳矫正视力（BCVA）、频域（SD）光相干断层扫描（OCT）、验光检查。根据OCT黄斑水肿形态,分为弥漫水肿型、囊样水肿型、浆液性神经上皮脱离型、硬性渗出为主型。应用Cirrus HD-OCT对患眼黄斑区行加强深度扫描（EDI）,测量SFCT。与国内同年龄段正常人群平均SFCT值（286.84±28.80） μm进行比较。患者年龄、屈光度、糖尿病病程、空腹血糖、BCVA、中央视网膜厚度与SFCT的相关性应用Pearson相关分析;不同类型黄斑水肿间SFCT差异比较行单因素变量分析。结果 患眼SFCT 120.50～361.50 μm,平均SFCT（223.81±43.74） μm,与正常人群平均SFCT值比较,厚度下降63.03 μm,差异有统计学意义（95%可信区间-78.80～-47.26 μm,P＜0.01）;相关性分析结果显示,SFCT与患者年龄（r=0.124）、屈光度（r=0.277）、糖尿病病程（r=0.286）、空腹血糖水平（r=0.408）、BCVA（r=0.087）、中央视网膜厚度（r=0.036）无相关性（P＞0.05）;不同类型黄斑水肿之间SFCT值比较,差异无统计学意义（F=0.042,P＞0.05）。结论 DME患者SFCT较同年龄段正常人群明显变薄。     

关注糖尿病黄斑水肿的光学相干断层扫描分型及相关影像特征

糖尿病性视网膜病变(DR)是目前成人第一致盲眼病。其中,糖尿病性黄斑水肿(DME)是导致糖尿病患者中心视觉功能严重障碍的主要原因。DME不同表现及分型对确定其严重程度及选择治疗方式至关重要。光学相干断层成像(OCT)是目前测量视网膜厚度,评估DME形态及微细结构的主要检查手段。DME的OCT检查有多种形态表现及伴随影像,各种表现反映不同的病理基础。为此,笔者强调通过DME形成机制,理解DME病理基础上的OCT分型方法,掌握相关影像特征及其临床意义,为判断疾病严重程度、选择治疗方案及疾病的预后提供更明确的信息。     

光相干断层扫描及血管成像在糖尿病黄斑水肿诊疗中的应用研究现状

糖尿病黄斑水肿(DME)是糖尿病视网膜病变患者中心视力丧失甚至失明的首要原因。相较于传统的FFA检查,OCT能快速获得高分辨率的三维立体图像,从而便捷地反映眼底组织的细节并实现定量测量。OCT血管成像(OCTA)作为一种新兴的血管成像技术,对观察视网膜及脉络膜不同层面的血管结构形态,量化一定范围内的血流密度及病灶面积有其无可比拟的优势。因此,结合OCT和OCTA的检查结果对DME患者进行形态学、血管及血流定性和定量分析,对DME的诊断及分型、指导治疗、评估预后具有指导性作用。     

非增生型糖尿病视网膜病变患者黄斑水肿与中心凹下脉络膜厚度的关系

目的 观察非增生型糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)伴临床有意义的黄斑水肿(clinically significant macular edema,CSME)时黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)的情况,探讨糖尿病患者SFCT与糖尿病视网膜病变发生发展的关系.方法 按2014年我国糖尿病视网膜病变临床诊疗指南分期标准将NPDR患者分为伴CSME(NPDR CSME+)组15例(21眼),不伴CSME(NPDR CSME-)组21例(36眼).比较两组之间最佳矫正视力、黄斑中心凹视网膜厚度(central retinal thickness,CRT)及SFCT是否存在差异性.采用SPSS 18.0软件进行统计学分析处理.结果 NPDR CSME+组与NPDR CSME-组间性别、眼别、年龄、眼轴长度、眼压相比差异均无统计学意义(均为P＞0.05),两组间最佳矫正视力相比差异有统计学意义(P =0.001).NPDR CSME+组SFCT为(328.24±101.92) μm,NPDR CSME-组为(235.31±66.98)μm,两组间差异具有统计学意义(t=4.156,P=0.000).NPDR患眼CRT与SFCT呈正相关关系(r=0.473,P=0.000).结论 NPDR伴有CSME时,SFCT显著增厚,并且SFCT的增厚与CSME的发生发展具有一定相关性.     

曲安奈德玻璃体腔注射治疗视网膜静脉阻塞和糖尿病视网膜病变继发黄斑水肿分析

目的 观察玻璃体腔注射曲安奈德(TA)治疗视网膜静脉阻塞(RVO)继发黄斑水肿和糖尿病性黄斑水肿的疗效以及二者疗效比较.方法 对经间接检眼镜、荧光素眼底血管造影(FFA)以及光学相干断层扫描(OCT)检查确诊的RVO继发黄斑水肿患者91例91只眼,其中中央视网膜静脉阻塞(CR-VO)55只眼(缺血型13只眼,非缺血型42只眼),分支视网膜静脉阻塞(BRVO)36只眼(缺血型10只眼,非缺血26眼).糖尿病性黄斑水肿患者67例73只眼,非增殖性糖尿病视网膜病变(PPDR)17只眼,增殖性糖尿病视网膜病变(PDR)56只眼,行TA玻璃体腔注射,治疗后随访3月至1年,对比分析术前术后的视力、眼底、FFA表现,观察OCT显示黄斑水肿高度.结果 最终随访RVO组视力提高者48只眼(52.7%),视力不变者39只眼(42.9%),视力下降者4只眼(4.40%).OCT形态恢复正常者50只眼(54.9%),改善者27只眼(29.7%),无改善者14只眼(15.4%).DR组视力提高者25(34.2%)只眼,,视力不变者45只眼(61.6%),视力下降者3只眼(4.11%).OCT形态恢复正常者24只眼(32.9%),改善者22只眼(30.1%),无改善者27只眼(37.0%).两组有效率行统计学分析,有显著性差异.RVO组24只眼术后出现一过性眼压升高,一眼白内障,一眼眼内炎,8只眼2次注射.DR组14眼术后出现一过性眼压升高,2只眼白内障,9只眼2次注射.结论 玻璃体腔注射TA是一种安全有效的治疗视网膜静脉阻塞继发黄斑水肿和糖尿病性黄斑水肿的方法,治疗视网膜静脉阻塞继发黄斑水肿的疗效好于糖尿病性黄斑水肿.     

Evaluation of changes of macular thickness in diabetic retinopathy after cataract surgery

Purpose

To assess the macular thickness changes after cataract surgery in diabetic patients using optical coherence tomography (OCT).

Methods

We retrospectively reviewed the records of 104 diabetic patients who underwent cataract surgery. We examined the changes of macular thickness using OCT before cataract surgery and 1 week, 1-, 2- and 6-months after surgery. The central subfield mean thickness (CSMT) was used to evaluate macular edema which was defined as an increase of CSMT (ΔCSMT) > 30% from the baseline. The association between prior laser treatment or severity of diabetic retinopathy and macular thickness were also analyzed.

Results

Macular edema occurred in 19 eyes (18%) from the diabetic group and 63% of macular edema developed at 1 month after surgery. Thirteen (68%) out of 19 eyes with macular edema showed the resolution of macular edema by 6 months after surgery without treatment. ΔCSMT of eyes without a history of laser treatment was statistically greater compared to eyes with a history of laser treatment in at 1- and 2-months after surgery, but was not different than eyes who had laser treatment at 6-months after surgery. The severity of diabetic retinopathy was not significantly correlated to macular edema, but there was statistical difference when patients who had a history of prior laser treatment were excluded.

Conclusions

The incidence of macular edema after cataract surgery in diabetic patients was 18%. Its peak incidence was at 1 month post surgery and it resolved spontaneously in 68% of patients by 6 months post surgery. Prior laser treatment might prevent postoperative macular edema until 2 months after cataract surgery in diabetic patients. However, macular edema did not affect the severity of diabetic retinopathy.     

Stargardt病的频域相干光断层扫描图像分析

目的 应用频域相干光断层扫描(OCT)技术评价Stargardt病患者黄斑区视网膜容积与中心视力之间的关系.方法 回顾性病例系列研究.收集10例(20只眼)Stargardt病的临床资料进行回顾性分析.所有患者均使用频域OCT分别测量黄斑中心凹区视网膜厚度、黄斑中心凹区光感受器细胞内外节缺失宽度、黄斑中心凹区直径3 mm和1 mm范围内的视网膜容积.运用线性回归分析法,比较最小分辨角对数(logMAR)视力与黄斑中心凹区视网膜厚度、黄斑中心凹区光感受器细胞内外节(IS/OS)缺失宽度、黄斑中心凹区直径3 mm和1 mm范围内视网膜容积的关系.结果 18只眼的logMAR视力为0.30～1.22,黄斑中心凹区光感受器细胞内外节缺失宽度为847～5306μm,黄斑中心凹区视网膜厚度为20～126 μm,黄斑中心凹区直径3 mm和1 mm范围内的视网膜容积分别为1.06～1.76 mm3、0.06～0.13 mm3.logMAR视力与黄斑中心凹区光感受器细胞内外节缺失宽度呈正相关(r=0.695,P＜0.05),与黄斑中心凹区视网膜厚度呈负相关(r=-0.601,P＜0.05),与黄斑中心凹区直径3 mm范围内的视网膜容积呈负相关(r=-0.725,P＜0.05),与黄斑中心凹区直径1 mm范围内的视网膜容积无相关性(r=-0.364,P＜0.05).结论 频域OCT技术可以清晰观察Stargardt 病患者各层视网膜结构,频域OCT检测获得的黄斑区视网膜容积与中心视力间存在一定的相关性.

Abstract：

Objective To assess the relationship between central visual acuity and retinal volume of macular fovea in patients with Stargardt disease by spectral-domain optical coherence tomography ( SD OCT). Methods It was a retrospective case series study. Twenty eyes of 10 patients with Stargardt disease were investigated by three-dimensional spectral-domain optical coherence tomography. SD OCT images were obtained and retrospectively analyzed. The retinal volumes of macular fovea were measured by SD OCT,whose diameters were set as 3 mm and 1 mm separately ( volume 3 and volume 1). The retinal thickness of macular fovea (macular thickness) and the width of IS/OS conjunction loss of macular fovea (IS/OS loss)were also measured by SD OCT. We correlated the logMAR BCVA with IS/OS loss, macular thickness,volume 3 and volume 1 by linear regression analysis. Results LogMAR BCVA was from 0. 3 to 1. 22.IS/OS loss was from 847 μm to 5306 μm. Macular thickness was from 20 μm to 126μm. Volume 3 and volume 1 was from 1. 06 to 1. 76 mm3 and 0. 06 to 0. 13 mm3. LogMAR BCVA correlated with the IS/OS loss (r = 0.695,P＜0. 05) , macular thickness (r= - 0. 601 ,P ＜ 0. 05), and volume 3 ( r = -0.725,P＜0. 05 ). LogMAR BCVA did not correlate with volume 1 ( r = - 0. 364, P ＞ 0. 05). Conclusions SD OCT could demonstrate the retinal structure of Stargardt disease clearly. The retinal volume of macular fovea accessed by SD OCT correlated with the visual acuity of Stargardt disease.     

糖尿病性黄斑水肿的治疗进展

糖尿病性黄斑水肿（DME）是糖尿病视网膜病变（DR）患者视力下降的重要原因,除有效控制血糖、血压、血脂,以及保持全身的良好健康状态外,激光光凝依然是最基本的治疗手段,新的Pascal激光器展现了比原本激光器更强大的技术优势。用于治疗DME的激素类玻璃体植入缓释系统虽展示了良好的应用前景,但还处于临床验证阶段。难治性的弥漫性黄斑水肿可考虑光凝与玻璃体注射曲安奈德、抗血管内皮生长因子类药物,甚至玻璃体手术联合治疗以提高疗效。各种新疗法以及联合疗法已经体现了较好的治疗效果,但依然没有充足的证据证明任何一种疗法或联合疗法比单一的光凝治疗要好,尚需要大规模的随机对照实验来证明其长期应用的安全性和有效性。     

光凝对糖尿病视网膜病变黄斑区视网膜厚度的早期影响

目的 探讨视网膜光凝术对糖尿病视网膜病变(diabetic retinopathy, DR)黄斑区视网膜厚度的早期影响。 方法 应用Zeiss-Humphrey光学相干断层扫描成像仪观察和定量分析21例30只眼 Ⅲ～Ⅳ 期DR患者视网膜光凝术前、术后第3天和第7天的黄斑中心凹和距离黄斑中心凹750 μm处神经上皮厚度和色素上皮厚度的改变。 结果 光凝术后第3天，黄斑中心凹神经上皮厚度较术前显著增加，其变化值与年龄、血糖、DR病程呈显著的正相关，术后第7天恢复至术前水平；距黄斑中心凹750 μm处的神经上皮厚度和色素上皮厚度无显著改变。 结论 视网膜光凝术能够引起DR眼术后早期的黄斑水肿或使原有的黄斑水肿加重，表现为黄斑中心凹神经上皮厚度的增加，老龄、血糖水平高、DR病程长可能加重术后黄斑水肿的程度。 (中华眼底病杂志, 2002, 18:031-33)     

Volcano like pattern in optical coherence tomography in chronic diabetic macular edema

In this article we herein report an interesting vitreo-macular interface abnormality associated with chronic diabetic cystoid macular edema. It is an observational case study of three diabetic patients examined in the diabetic clinic. All the patients had proliferative diabetic retinopathy with chronic macular edema. A serial cross sectional OCT examination and tracking of both the longitudinal progression of macular thickening and vitreo-macular interface revealed cystoid macular edema with a characteristic hyperreflective vitreous shadow emerging from the vitreofoveal interface. All the patients had dehiscence of inner retinal layers.This particular morphological feature at the vitreo-foveolar interface, which we name as “volcano sign”, has not been described earlier. The probable mechanism of such a finding probably could be due to slow progressive leakage of chronic cytoid fluid into the vitreous with condensation of the overlying vitreous. Vitreo-macular traction followed by posterior vitreous detachment probably would have contributed to such a morphological event.     

非增生型糖尿病视网膜病变黄斑水肿伴发浆液性黄斑脱离的脉络膜微结构改变

[目的]观察非增生型糖尿病视网膜病变(NPDR)黄斑水肿(DME)伴发浆液性黄斑脱离(SMD)的脉络膜微结构改变的光相干断层扫描图像(OCT)特征.[方法]NPDR单眼发生DME伴SMD(SMD组)的9只眼以及对侧只有DME而无SMD(无SMD组)的9只眼纳入研究.患者中,既往行全视网膜激光光凝(PRP)治疗6只眼,按是否行PRP治疗分为PRP治疗组和非PRP治疗组,分别为6、12只眼.均行增强深部成像技术(EDI)频域光相干断层扫描(EDI-OCT)和眼底彩色照相检查.测量中心凹处脉络膜厚度,应用Image Plus Pr0 6.0软件计算以中心凹为中心的EDI-OCT水平扫描所提示的脉络膜模拟面积.采用配对t检验对比分析有无SMD眼检测结果的差异;F检验对比分析PRP治疗组与非PRP治疗组间差异.[结果]SMD组视网膜神经上皮脱离区域呈梭型或圆顶状的低信号暗区,外界膜均保持完整,光感受器内外节连接层与视网膜色素上皮-Bruch膜之间发生分离.SMD组中心凹脉络膜平均厚度和脉络膜平均模拟面积均高于无SMD组,差异有统计学意义(t=2.306、2.306,P＜0.05).PRP治疗组脉络膜平均模拟面积大于非PRP治疗组脉络膜平均模拟面积,差异有统计学意义(F=5.227,P＜0.05);两组间中心凹脉络膜平均厚度比较,差异无统计学意义(F=3.276,P＞0.05).[结论]NPDR中DME伴发SMD眼脉络膜微结构改变的OCT图像特征是视网膜神经上皮脱离区域呈梭型或圆顶状的弱信号暗区.     

Patterns of diabetic macular edema with optical coherence tomography

PURPOSE: We report cross-sectional images of diabetic macular edema and correlation between tomographic features and visual acuity with best correction by means of optical coherence tomography. METHOD: In a prospective study, optical coherence tomography was performed in 59 eyes of 42 patients with diabetic macular edema and in 10 eyes of 10 normal control subjects. RESULTS: Optical coherence tomography showed three patterns of structural changes in diabetic macular edema: sponge-like retinal swelling (52 [88%] of 59 eyes), cystoid macular edema (28 [47%] of 59 eyes), and serous retinal detachment (9 [15%] of 59 eyes). Some eyes had more than one pathologic change. Retinal swelling was more pronounced in the outer rather than the inner retinal layers. Cystoid macular edema was located mainly in the outer retinal layers. In eyes with long-standing cystoid macular edema, cystoid spaces had fused, resulting in a large cystoid cavity involving almost the entire retinal layer. Hard exudates were seen as highly reflective areas located in the outer retinal layers. The retinal thickness at the central fovea and the visual acuity with best correction showed an intermediate negative correlation in eyes without cystoid macular edema (correlation coefficient: -0.61, P < .01). CONCLUSIONS: Diabetic macular edema involved three structural changes, including sponge-like retinal swelling (88%), cystoid macular edema (47%), and serous retinal detachment (15%). Visual acuity with best correction moderately correlated with retinal thickness regardless of the different tomographic features.     

玻璃体视网膜手术治疗糖尿病性黄斑水肿的疗效观察

目的探讨玻璃体视网膜手术治疗糖尿病性黄斑水肿的疗效。方法对连续21例(12只眼)反复光凝无效的糖尿病性黄斑水肿患眼行玻璃体手术,手术前后分别进行光学相关断层成像术(OCT)和多焦视网膜电图(mf-ERG)检查。结果21例(21只眼)手术后最佳矫正视力、黄斑区mf-ERG和中心凹厚度较术前明显改善( P<0.05)。结论玻璃体视网膜手术是治疗难治性糖尿病性黄斑水肿的有效方法,OCT和mf-ERG可以精确的评价术后黄斑区解剖和功能的恢复情况。     

Sensitivity and specificity of time-domain versus spectral-domain optical coherence tomography in diabetic macular edema

Purpose:

The purpose was to evaluate the sensitivity and specificity of measurements of central macular thickness (CMT) in diabetic macular edema using stratus time-domain and cirrus spectral-domain optical coherence tomography (OCT; Carl Zeiss Meditec, Dublin, CA).

Materials and Methods:

A total of 36 eyes from 19 patients with clinically significant diabetic macular edema (DME) were included. All participants underwent automated scanning patterns using cirrus HD-OCT and stratus OCT examinations on the same day. The sensitivity/specificity of retinal thickness measurements was calculated from published normative data. Agreement was calculated using Bland--Altman method. The receiver operating characteristic curves (ROC) and areas under the ROC were plotted.

Results:

The mean difference between the cirrus HD-OCT and stratus OCT in the central foveal zone was 49.89 μm. Bland--Altman analysis confirmed that the retinal thickness measurements had poor agreement in patients with DME. The areas under the ROC for retinal thickness measurements were 0.88 using cirrus HD-OCT and 0.94 with stratus.

Conclusions:

In patients with DME, the cirrus HD-OCT gives a higher reading than stratus OCT with poor agreement between the devices in most regions within the nine subfield zones. The sensitivity and specificity of the stratus OCT was comparable to the cirrus.