Retinal thickness in diabetic retinopathy: a study using optical coherence tomography (OCT)

BACKGROUND AND OBJECTIVE: The authors conducted a controlled study to quantify macular retinal thickness in diabetic retinopathy using optical coherence tomography (OCT) as an objective and noninvasive tool. The relationship between retinal thickness and standard methods of evaluating macular edema was investigated. PATIENTS AND METHODS: A total of 136 patients in different stages of diabetic retinopathy were examined with OCT. In addition, fluorescein angiograms as well as standard eye examinations were conducted. The control group consisted of 30 individuals with a normal macula. RESULTS: In the controls, retinal thickness was 153 +/- 15 microm in the fovea, 249 +/- 19 microm in the temporal parafoveal region, and 268 +/- 20 microm in the nasal parafoveal region. In diabetic patients, retinal thickness was increased to 307 +/- 136 microm in the fovea, 337 +/- 88 microm in the temporal retina, and 353 +/- 95 microm in the nasal retina, respectively. The differences between diabetics and controls were highly significant (P < 0.001). Retinal thickening correlated with fluorescein leakage in the angiograms to some extent. There was an intermediate correlation between retinal thickness and visual acuity, particularly in patients without macular ischemia. Sensitivity of detecting clinically significant macular edema by measuring foveal retinal thickness was 89% and specificity was 96%. CONCLUSION: Optical coherence tomography allows us to quantify retinal thickness in diabetic retinopathy with excellent reproducibility. OCT is able to detect sight-threatening macular edema with great reliability.     

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.     

糖尿病视网膜病变黄斑厚度及黄斑体积定量分析

目的:研究不同分期糖尿病视网膜病变患者黄斑厚度及黄斑体积的变化特点.方法:选取2016-01-01/2017-01-01于我院眼科门诊就诊的40例78眼糖尿病视网膜病变患者作为研究对象,根据糖尿病视网膜病变(diabetic retinopathy,DR)的国际临床分类法分为非增殖期糖尿病视网膜病变(non prolifertive dibetic retinopthy,NPDR)组20例40眼,增殖期糖尿病视网膜病变(prolifertive dibetic retinopthy,PDR)组20例38眼.全部研究对象进行光学相干断层扫描(optical coherence tomography OCT)检查,以直径1、3、6mm ETDRS对黄斑区进行分区,分析随着糖尿病视网膜病变严重程度的增加,黄斑中心凹及其周围分区各象限视网膜厚度及体积的变化特点.结果:NPDR组及PDR组黄斑中心小凹的厚度(foveola thickness,FT)分别为252.57±31.36、362.47±20.81μm,分区中内环上方、鼻侧最厚,下方次之,颞侧最薄;外环鼻侧最厚,上方次之,颞侧、下方最薄;NPDR组黄斑中心凹厚度及分区各象限视网膜厚度数值均小于PDR组,差异具有统计学意义(P<0.05).NPDR组及PDR组黄斑中心小凹处体积(V)分别为0.20±0.02、0.28±0.16mm3,分区中内环上方、鼻侧最大,下方次之,颞侧最小;外环鼻侧最大,上方次之,颞侧、下方最小;NPDR组黄斑中心凹体积及分区各象限视网膜体积数值均小于PDR组,差异具有统计学意义(P<0.05).结论:糖尿病视网膜病变患者黄斑中心凹及分区各象限视网膜厚度及体积变化与糖尿病视网膜病变的病程进展有关.利用OCT对不同分期糖尿病视网膜病变患者黄斑厚度及黄斑体积进行定量分析,了解随着糖尿病视网膜病变严重程度的增加,黄斑区及其周围分区视网膜形态学变化的特点,为更好地分析不同严重程度糖尿病视网膜病变黄斑部位结构改变提供临床研究依据.     

单眼远视性弱视儿童黄斑区结构的光学相干扫描分析

目的：采用视网膜光学相干断层扫描( optical coherence tomography,OCT)对单眼弱视患儿的弱视眼和非弱视眼以及正常儿童测量黄斑部视网膜结构。
　　方法：选择单眼远视性弱视儿童56例及正常儿童右眼75例作为研究对象,用 OCT 检测黄斑区视网膜厚度及视网膜容积,并对结果进行统计学分析。
　　结果：弱视眼组黄斑中心区视网膜厚度最薄,内环视网膜厚度最厚,而外环视网膜厚度较内环略薄。内环的各个象限中,鼻侧视网膜最厚,为335.58依17.42μm;上方较鼻侧略薄,为326.42依15.36μm,再次为下方视网膜,颞侧视网膜最薄。外环各象限视网膜厚度变化与内环一致。非弱视眼组及正常对照眼组视网膜各区域变化与弱视眼组相同。弱视眼组黄斑中心区1mm 及内环的鼻侧和上方视网膜均比非弱视眼组、正常对照眼组对应象限的视网膜厚,差异具有统计学意义(P<0.05),弱视眼组外环的鼻侧和上方视网膜比非弱视眼组、正常对照眼组对应象限的视网膜厚,但差异无统计学意义(P>0.05),其它象限视网膜厚度均无统计学差异(P>0.05)。弱视眼组、非弱视眼组及正常对照眼组黄斑区视网膜容积最小,内环的鼻侧视网膜容积最大,其次为上方视网膜容积,再次为下方视网膜容积,颞侧视网膜容积最小。外环各象限视网膜容积变化与内环一致。弱视眼组黄斑中心区1mm 及内环的鼻侧和上方视网膜容积均比非弱视眼组及正常对照眼组对应各象限视网膜容积大,差异有统计学意义(P<0.05),其它各象限视网膜容积相比无统计学差异(P>0.05)。
　　结论：OCT 检测可以准确测量黄斑区视网膜结构,弱视眼的黄斑区结构与非弱视眼及正常眼存在差异,可能与弱视的外周发病机制有关。     

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.     

行全视网膜光凝时不同象限顺序对治疗效果影响的临床研究

目的:利用光学相干断层扫描仪(OCT)视网膜地形图,探讨糖尿病性视网膜病变患者行不同顺序全视网膜光凝术前后对黄斑水肿的影响。方法:随机选择发生糖尿病性视网膜病变Ⅲ和Ⅳ期患者共19例(30眼),按不同象限顺序行全视网膜光凝。分成3组,每组10眼。第1组光凝顺序鼻侧、下方、上方、颞侧象限;第2组下方、鼻侧、上方、颞侧象限;第3组颞侧、下方、鼻侧、上方象限。每周一个象限,共4周完成。分别在术前、术后1,2,3,4,8wk测量视网膜地形图,比较各组间黄斑水肿程度及视力有无差异。结果:第1组和第2组术后8wk视力较术前轻度提高,第3组术后8wk视力较术前轻度下降,差异无统计学意义(P>0.05);第1组和第2组术后4wk黄斑视网膜厚度较术前增加,差异有统计学意义(P<0.05);第3组术后4wk黄斑视网膜厚度较术前增加,差异有统计学意义(P<0.01);术后8wk3组黄斑视网膜厚度均较术前变薄,前两组比第3组减轻幅度大,第1组、第2组在中心环处视网膜水肿减轻同术前比差异有统计学意义(P<0.05),第3组中心环处视网膜厚度同术前相比差异无统计学意义(P>0.05),余各处3组较术前相比差异均无统计学意义(P>0.05)。结论:对于Ⅲ期和Ⅳ期糖尿病性视网膜病变全视网膜光凝时,第2组获得较好视力,引起黄斑水肿较轻;通过OCT检查视网膜地形图是观察糖尿病性视网膜病变激光手术前后黄斑水肿的一种有效、敏感方法。     

不同类型视网膜病变患者视网膜外层厚度变化研究

目的　探讨不同类型视网膜病变（diabetic retinitis,DR）患者视网膜外层厚度的变化特点。方法　选择糖尿病（diabetes mellitus，DM）患者194例（194眼），其中无糖尿病视网膜病变（non-diabetic retinopathy，NDR）患者75例为NDR组，增殖型糖尿病视网膜病变组（proliferative diabetic retinitis，PDR）组患者64例为PDR组，糖尿病视网膜病变黄斑水肿（diabetic macular edema，DME）组患者55例为DME组，并选择50名50眼正常健康人作为对照组，均进行光学相干断层扫描成像检查，测定黄斑中心凹及距黄斑中心凹750 μm处鼻上、颞上等方位视网膜光感受器外节厚度（photoreceptor retinal photoreceptor outer segmen，PROS）、视网膜光感受器厚度（total length of the photoreceptors，TLP）、视网膜神经纤维层厚度（retinal nerve fiber layer，RNFL），并分析上述指标与患者视力变化的关系。结果　四组患者黄斑中心凹PROS、TLP、RNFL比较差异均有统计学意义（均为P<0.05），PDR组、DME组黄斑中心凹PROS［（35.61±4.41）μm,(32.58±6.74)μm］、TLP［（48.14±3.26）μm,(44.11±2.71)μm］、RNFL［（53.02±5.44）μm,(49.85±4.36)μm］均低于对照组与NDR组（均为P<0.05），DME组均低于PDR组，其旁黄斑中心凹鼻上、颞上RNFL又低于PDR组，差异均有统计学意义（均为P<0.05）；四组患者最佳矫正视力比较差异均有统计学意义（均为 P<0.05），PDR、DME组最佳矫正视力(0.81±2.24，0.55±0.23)低于对照组与NDR组（均为P<0.05），DME组低于PDR组（P<0.05）；DR患者黄斑中心凹PROS、TLP及RNFL均与患者最佳矫正视力呈正相关（均为P<0.05）。结论　PDR、DME患者PROS、RNFL、TLP均较正常健康人与非DR患者变薄或缩短，且其变化与患者视力变化存在紧密关联。     

Macular thickness and systemic markers for diabetes in individuals with no or mild diabetic retinopathy

Background:  The relationship between diabetic risk factors and macular thickness in individuals without clinically detectable diabetic macular oedema has yet to be formally explored. The purpose of this study was to assess the correlation between macular thickness and diabetes control and duration.
Methods:  This was a prospective, cross-sectional study. All subjects underwent digital retinal imaging and Stratus OCT macular thickness scanning both eyes. Mean retinal thickness was determined for quadrants, rings, hemispheres, and for the central fovea (CFT), total fovea (TFT) and total macula (TMT).
Results:  We evaluated 92 non-diabetic controls, 92 diabetic subjects with no diabetic retinopathy (DR) and 24 subjects with mild DR at the Veteran's Hospital in Jamaica Plain, MA. In subjects with diabetes, there was a significant negative correlation between retinal thickness and diabetes duration in all macular quadrants, rings and hemispheres, and for CFT, TFT and TMT (CFT: P  = 0.0025, r  = −0.28; TFT: P  = 0.0062, r  = −0.25; TMT: P  = 0.0026, r  = −0.28). There was no significant relationship between retinal thickness and HbA1c level (average of last three readings), systolic or diastolic blood pressure, or triglyceride levels. Additionally, no significant differences in retinal thickness were found between controls, subjects with no DR and subjects with mild DR.
Conclusions:  In subjects with no or mild DR, macular and foveal thickness is significantly thinner with longer duration of disease. This may reflect neurodegenerative changes in the diabetic retina.     

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.     

糖尿病患者视网膜神经纤维层OCT测量的形态学观察

背景 传统的观点认为,糖尿病视网膜病变（DR）的主要病理机制是视网膜的微血管病变,但近年来发现糖尿病患者的视功能改变发生于DR的微血管病变发生之前,传统的观点无法解释糖尿病患者在出现可辨认的血管改变之前已有视功能改变的现象. 目的 应用频域光学相干断层扫描（OCT）观察无视网膜血管改变的糖尿病患者、非增生性糖尿病视网膜病变（NPDR）患者视网膜神经纤维层（RNFL）厚度的改变,分析糖尿病患者RNFL厚度与DR的关系. 方法 收集2012年10月至2013年9月于山西省眼科医院就诊且确诊的2型糖尿病患者56例60眼,按DR国际临床分型标准分为非糖尿病视网膜病变（NDR）组26例30眼和NPDR组（轻中度NPDR）30例30眼,同期纳入年龄和性别匹配的健康志愿者30人30眼作为对照.应用OCT对受试者行RNFL厚度测量,包括视盘周围及中心凹周围视网膜360°平均RNFL厚度及鼻上、颞上、颞侧、颞下、鼻下、鼻侧区域的RNFL厚度,比较各组患者RNFL厚度的变化. 结果 NDR组、NPDR组和正常对照组受试者视盘周围平均RNFL厚度分别为（97.46±8.65）、（100.69±16.35）和（109.22±8.69）μm,其中NDR组、NPDR组受试者视盘周围平均RNFL厚度值均低于正常对照组,差异均有统计学意义（P=0.001、0.006）;NDR组视盘周围各象限RNFL厚度均较正常对照组变薄,颞上、颞侧、颞下和鼻下象限RNFL厚度的差异均有统计学意义（P=0.001、0.001、0.001、0.010）;NPDR组视盘周围各象限RNFL厚度均较正常对照组变薄,其中颞上、鼻侧区域RNFL厚度的差异均有统计学意义（P=0.001、0.046）.NDR组、NPDR组和正常对照组平均黄斑区RNFL厚度分别为（33.47±3.39）、（36.81±3.21）、（38.18±2.16）μm,NDR组、NPDR组受试者黄斑区平均RNFL厚度值均低于正常对照组,其中NDR组与正常对照组比较差异有统计学意义（P=0.001）;NDR组黄斑区各区域RNFL厚度较正常     

不同分期糖尿病视网膜病变患者黄斑区结构和微血管改变定量分析

目的：通过光相干断层扫描(OCT)和光相干断层扫描血管造影(OCTA)检查,观察不同分期糖尿病视网膜病变(DR)患者黄斑区神经节细胞-内丛状层(GCIPL)厚度及各象限视网膜浅层毛细血管密度特征并作定量分析。

方法：回顾性病例对照研究。选取2019-12/2020-05我院确诊DR患者33例54眼,并根据眼底情况分为无糖尿病视网膜病变(NDR)组6例8眼、非增殖型糖尿病视网膜病变(NPDR)组18例28眼和增殖型糖尿病视网膜病变(PDR)组9例18眼。选取同期与患者年龄相匹配的健康志愿者18例26眼作为对照组。观察并定量分析不同分期DR患者黄斑区GCIPL厚度及各象限视网膜浅层毛细血管线性密度(VD)和血管灌注密度(PD)。

结果：DR组患者黄斑区各象限视网膜浅层毛细血管VD、PD及GCIPL厚度最小值均小于对照组(P<0.05)。不同分期DR患者黄斑区GCIPL厚度最小值及各象限视网膜浅层毛细血管VD组间比较均有差异(P<0.05),下方视网膜浅层毛细血管VD对DR的诊断价值最高(AUC=0.807、最佳诊断界限值为18.60mm^-1、灵敏度为0.923、特异度为0.648)。DR患者黄斑区GCIPL厚度最小值与各象限视网膜浅层毛细血管VD均呈正相关(r=0.342、0.480、0.384、0.342,均P<0.05)。

结论：OCT结合OCTA检查为早期评估及定期随访DR的进展提供了可重复、可定量的检测方法和监测指标。     

早期糖尿病视网膜病变患者黄斑神经节细胞层厚度及视盘参数的变化

目的:使用Cirrus HD-OCT比较早期糖尿病视网膜病变患者和健康对照者之间的视盘参数、视盘周围视网膜神经纤维层(pRNFL)厚度和黄斑神经节细胞层(mGCL)厚度改变。方法:横断面比较研究。选取45例无糖尿病视网膜病变(NDR)、52例轻度非增殖期糖尿病视网膜病变(NPDR)及55例中度NPDR的2型糖尿病患者和64例年龄匹配的健康对照者纳入本研究。采集患者的空腹血糖、糖尿病病程、糖化血红蛋白及既往史。通过Cirrus HD-OCT测量视盘参数(即双眼RNFL厚度对称性百分比、盘沿面积、视盘面积、杯盘比、杯容积)、pRNFL厚度和mGCL厚度。组间比较采用单因素方差分析。结果:与健康对照组比较,NDR、轻度NPDR、中度NPDR组双眼RNFL厚度对称性百分比、盘沿面积明显降低,平均C/D、垂直C/D明显增加(均P<0.05)。与健康对照组比较,NDR、轻度NPDR、中度NPDR组患眼视盘周围各象限(上方、颞侧、下方、鼻侧)及平均RNFL厚度和黄斑(平均、最小、上方、颞上方、颞下方、下方、鼻上方、鼻下方)GCL厚度显著变薄(均P<0.05)。结论:与健康对照者相比,早期...     

Effects of pseudophakic lens capsule opacification on optical coherence tomography of the macula

PURPOSE: To report observations on the influence of posterior lens capsule opacification on optical coherence tomographic imaging quality and measurements of macular thickness. METHODS: The retrospective study included 13 eyes in 12 patients of which 2 eyes had a healthy macula and 11 eyes had maculopathy. In all eyes posterior lens capsule fibrosis was present. A clinical examination including biomicroscopy of the macula and an in-vivo macular optical coherence tomography (OCT) before and after YAG-laser membranotomy had been performed. RESULTS: Foveal retinal thickness before and after membranotomy were highly correlated (R = 0.98), and no systematic difference was found between values obtained before vs. after membranotomy (mean thickness 318.7 +/- 92.7 microm vs. 322.2 +/- 97.4 microm; p = 0.221). The signal-to-noise ratio increased in 11 out of 13 eyes after membranotomy (mean signal-to-noise ratio before 47.1 +/- 6.6 dB vs. 52.6 +/- 4.0 dB after; p = 0.004, the change ranging from -1.5 dB to 17 dB). CONCLUSIONS: The qualitative effect of the posterior lens capsule opacification on the OCT-scan consists primarily of a loss of signal and consequently of intraretinal detail, whereas total foveal retinal thickness seems to be reliably assessed even when posterior lens capsule opacification interfering with the biomicroscopic evaluation of retinal edema are present. YAG-laser membranotomy results in a measurable improvement in the OCT signal-to-noise ratio, but OCT seems to yield reliable measurements of foveal retinal thickness before treatment. Consequently the OCT seems to reliably diagnose a macular thickening although not the type of this until after removal of the posterior lens capsule opacification.     

Foveal thickness in occult macular dystrophy

PURPOSE: Occult macular dystrophy (OMD) is an inherited macular dystrophy characterized by a progressive macular dysfunction without any visible fundus abnormality. We studied the foveal thickness in patients with OMD using optical coherence tomography (OCT). DESIGN: Observational case series. Foveal thickness by OCT images. METHODS: Foveal thickness obtained from 22 eyes of 11 patients with OMD was compared with that from 27 eyes of 20 age-matched normal controls. RESULTS: Mean foveal thickness in the patients group (96.5 +/- 19.5 microm) was significantly thinner than that in the normal controls (133.3 +/- 9.0 microm, P <.0001, Mann-Whitney U test). Eighteen of 22 eyes with OMD had foveal thickness that were thinner than the lower limit of the normal range. There was no statistically significant correlation between the foveal thickness and visual acuity, age, or duration from onset. CONCLUSION: These results demonstrated that there are significant anatomic changes in the macula of patients with OMD.     

不同注视性质的远视性弱视儿童黄斑区视网膜厚度分析

目的:通过对4~8岁远视性屈光不正性弱视患儿注视性质、黄斑各分区视网膜厚度的测量、眼轴长度的检查,探讨远视性弱视儿童注视性质与其黄斑各分区视网膜厚度间的相关性;并进行远视性弱视儿童视网膜厚度及其相关因素的研究。方法:前瞻性非随机同期对照研究试验。将2018-09/12首次就诊且之前未进行过任何弱视训练的患儿共计44例57眼纳入该研究。选取屈光不正性远视性弱视儿童36眼作为远视性弱视组,视力正常儿童21眼作为正常对照组,两组均利用光学相干断层扫描技术(OCT)进行黄斑各分区视网膜厚度测量;同时将入组患儿在直接眼底镜检查下分为黄斑中心注视组32眼,旁中心注视组25眼,进行黄斑各分区视网膜厚度测量;用SPSS19.0统计软件分别分析两组间视网膜厚度及差异。结果:黄斑中心注视组在黄斑中心凹、黄斑内环鼻侧处视网膜厚度均小于旁中心注视组(P<0.05);而两组间余黄斑各分区视网膜厚度对比均无差异(P>0.05)。远视性弱视组的黄斑中心凹、黄斑内环鼻侧、黄斑内环下方及黄斑外环上方处视网膜厚度均大于正常对照组(P<0.05);而两组黄斑区内环颞侧、上方、外环鼻侧、外环颞侧、外环下方处视网膜厚度比较均无差异(P>0.05)。远视性弱视组眼轴长度较正常对照组短(P<0.05)。结论:黄斑中心注视儿童在黄斑区中心凹、内环鼻侧处视网膜厚度增加;远视性弱视儿童在黄斑区中心凹、内环鼻侧、内环下方、外环上方处视网膜厚度增加;远视性弱视儿童眼轴长度变短。     

A comparison of macular structure imaged by optical coherence tomography in preterm and full-term children

PURPOSE: Macular anatomic abnormalities were examined by optical coherence tomography (OCT) imaging in premature children and compared with those of full-term children. METHODS: In a prospective case-control study, premature patients 7 to 14 years of age were divided into three groups (group I, laser-treated retinopathy of prematurity [ROP]; group II, spontaneously regressed ROP; group III, no ROP), and age-matched children (group IV). All the eligible 74 eyes had normal-appearing posterior pole, myopia < or =3 D, and best corrected visual acuity 1.0. When both eyes of a subject were eligible for the study, one eye was randomly selected (10 eyes of 10 children in each group). Retinal thicknesses of the macula measured by OCT3 were compared. The correlation between central foveal thickness and prematurity (gestational age at birth < or = 30 weeks; birth weight < or = 1250 g) or ROP was determined. RESULTS: The mean foveal and central retinal thicknesses decreased significantly in group I (laser-treated ROP) and group IV (term birth). Significant differences in central retinal thickness were found between the premature groups and full-term children (Mann-Whitney U test). The cutoff point of central retinal thickness, determined by receiver operating characteristic curve was 209 microm. The general estimating equation model statistics found a significant effect of ROP severity (P = 0.003), P value for the category of prematurity was 0.063. CONCLUSIONS: The central retinal thickness was significantly higher in the preterm groups than in the full-term group. This subtle macular modification may be related mainly to ROP. Prematurity had only a marginally significant role.     

白内障超声乳化手术后黄斑区光学相干断层扫描

目的:观察白内障超声乳化吸除联合人工晶状体植入术后黄斑中心凹厚度的改变。方法:对行白内障超声乳化吸除联合人工晶状体植入术,且术前、术中无并发症患者56例56眼,行术前及术后1,3mo黄斑区OCT检查,观察术眼黄斑中心凹厚度变化及视力变化。结果:56眼黄斑中心凹视网膜平均厚度术前为241.3±9.9μm,术后1mo为(260.7±16.8)μm,术后3mo为(245.6±17.6)μm,术后1mo与术前比较,差异有显著性意义(P=0.000),术后3mo与术前比较,差异无显著性意义(P=0.137)。术后1mo,2眼出现黄斑囊样水肿,术后3mo,1眼黄斑囊样水肿消退,另1眼黄斑囊样水肿较前略降低,其余眼未出现黄斑囊样水肿。结论:白内障超声乳化吸除联合人工晶状体植入术后1mo黄斑中心凹厚度明显增加,术后3mo大部分黄斑水肿消退。     

Diurnal variation in clinically significant diabetic macular edema measured by the Stratus OCT

PURPOSE: To investigate diurnal variation in clinically significant macular edema (CSME) using the Stratus OCT (Carl Zeiss Meditec). METHODS: Fifteen eyes of 15 diabetic patients with CSME and 10 healthy subjects (controls) underwent four optical coherence tomography (OCT) measurements of macular thickness with the fast macular thickness mapping protocol of the Stratus OCT at 9 am, 12 pm, 3 pm, and 6 pm. Early Treatment Diabetic Retinopathy Study visual acuity and refraction data were also collected at each time. Retinal thickness measurements from each of the nine macular Early Treatment Diabetic Retinopathy Study areas of the retina map, visual acuity, and refraction were plotted over time. RESULTS: Mean retinal thickness remained unchanged in all retinal sectors over the course of the day for the controls and the 6 diabetic patients with a baseline foveal thickness of <300 mum, and it significantly decreased in 7 of the 9 retinal sectors for the 9 diabetic patients with a baseline foveal thickness of > or =300 microm (ANOVA model for repeated measures). In these patients, the mean initial foveal thickening +/- SD of 211 +/- 104 microm was reduced by an average of 6.1%, 15.2%, and 21.2% at 12 pm, 3 pm, and 6 pm, respectively. Two of these nine patients also had an increase in visual acuity without change in refraction. There were no changes in refractive errors over the course of the study in the two groups. A positive correlation between initial central thickening and decrease in thickness was found (r = 0.732; P = 0.002). CONCLUSION: This study suggests that macular thickening, as measured by the Stratus OCT, may spontaneously decrease in some patients with more severe CSME over the course of the day, and it confirms previous findings. However, in our study, the entity of this decline was relatively small and not relevant from a clinical standpoint.     

全视网膜光凝术对糖尿病视网膜病变视网膜神经纤维层及黄斑区视网膜的影响

目的　探讨全视网膜光凝术（ｐａｎｒｅｔｉｎａｌｐｈｏｔｏｃｏａｇｕｌａｔｉｏｎ,ＰＲＰ）对糖尿病视网膜病变（ｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＤＲ）视网膜神经纤维层（ｒｅｔｉｎａｌｎｅｒｖｅｆｉｂｅｒｌａｙｅｒ,ＲＮＦＬ）及黄斑区视网膜的影响。方法　选取２０１０年６月至２０１３年１２月于我院行ＰＲＰ治疗的１２０例（１２０眼）ＤＲ患者,其中非增生性糖尿病视网膜病变（ｎｏｎ-ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＮＰＤＲ）６０例（ＮＰＤＲ组）,增生性糖尿病视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＰＤＲ）６０例（ＰＤＲ组）,同时选取同期于我院健康体检的６０例（６０眼）正常志愿者作为正常对照组。ＰＲＰ手术前后使用ＯＣＴ横向扫描视盘旁ＲＮＦＬ厚度和黄斑区,将视盘旁ＲＮＦＬ和黄斑区分为上方、鼻侧、下方和颞侧４个象限进行扫描,获取各象限及全周平均视盘旁ＲＮＦＬ厚度及黄斑区视网膜厚度,并对结果进行统计分析。结果　与正常对照组相比,ＮＰＤＲ和ＰＤＲ组ＰＲＰ前视盘上方、下方、鼻侧象限、全周平均ＲＮＦＬ厚度均降低（均为Ｐ＜０．０５）,但颞侧象限ＲＮＦＬ厚度差异均无统计学意义（均为Ｐ＞０．０５）;ＮＰＤＲ组和ＰＤＲ组ＰＲＰ前不同象限及全周平均ＲＮＦＬ厚度相比,差异均无统计学意义（均为Ｐ＞０．０５）。与ＰＲＰ前相比,ＮＰＤＲ、ＰＤＲ组ＰＲＰ后各象限及全周平均ＲＮＦＬ厚度均变薄,但只有上方、下方及全周平均ＲＮＦＬ厚度差异均有统计学意义（均为Ｐ＜０．０５）;与ＮＰＤＲ组相比,ＰＤＲ组上方、下方、鼻侧及全周平均ＲＮＦＬ厚度变薄更明显,差异均有统计学意义（均为Ｐ＜０．０５）。与正常对照组相比,ＮＰＤＲ和ＰＤＲ组ＰＲＰ前各象限及平均黄斑区视网膜厚度均增加,差异均有统计学意义（均为Ｐ＜０．０５）,且ＰＤＲ组较ＮＰＤＲ组增加更为明显,差异均有统计学意义（均为Ｐ＜０.０５）。与ＰＲＰ前相比,ＮＰＤＲ、ＰＤＲ组ＰＲＰ后各象限及平均黄斑区视网膜厚度均增加,差异均有统计学意义（均为Ｐ＜０．０５）,且ＰＤＲ较ＮＰＤＲ组增加更为明显,差异均有统计学意义（均为Ｐ＜０．０５）。结论　ＰＲＰ对ＤＲ患者ＲＮＦＬ有一定损伤,应选择适当的激光能量与曝光时间,最大限度地降低对ＲＮＦＬ的影响。     

Characterization of macular edema from various etiologies by optical coherence tomography

PURPOSE: To use optical coherence tomography (OCT) to characterize the intraretinal changes associated with macular edema (ME) according to its etiology. DESIGN: Observational case series. METHODS: Seventy-eight eyes of 78 patients with ME were examined retrospectively by OCT, using the Humphrey 2000 OCT system (Humphrey Co., San Leandro, California). ME etiologies were diabetic retinopathy (27 cases), central retinal vein occlusion (18 cases), pseudophakia (15 cases), posterior uveitis (10 cases), and retinitis pigmentosa (eight cases). Macular thickness was measured using OCT mapping software. It was correlated with logarithmic visual acuity. RESULTS: In 72 of 78 cases (92%), ME was located in the outer retinal layers. Serous retinal detachment was present in 29 of 78 cases (37%). It was most frequent in central retinal vein occlusion (10 of 18 cases, 56%). There were no significant differences in visual acuity (P = .26) or macular thickness (P = .95) whether or not serous retinal detachment was combined with ME. The posterior hyaloid was partially detached in 17 of 78 cases (22%) of overall cases. Serous retinal detachment did not correlate with partial posterior hyaloid detachment (P = .6). Mean macular thickness ranged from 506 microm in central retinal vein occlusion to 373 microm in retinitis pigmentosa. Visual acuity correlated with macular thickness in diabetic retinopathy (R = 0.55; P = .0027) and pseudophakia cases (R = 0.66; P = .016). CONCLUSIONS: OCT characterized the retinal morphologic changes associated with ME, especially the vitreomacular relationship and sub-clinical serous macular detachment. This detachment did not correlate with poor visual acuity. Macular thickening only correlated with visual loss in diabetic retinopathy and pseudophakia.