玻璃体切割术对PDR患者黄斑区视网膜结构及功能的影响

目的:观察增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者玻璃体切割术前与术后黄斑区视网膜结构及功能的变化.方法:对33例44眼行玻璃体切割术的PDR患者及30例44眼正常对照组采用光学相干断层扫描(optical coherence tomography,OCT)及多焦视网膜电图(multifocal electroretinogram,mf-ERG)进行检查,观察PDR患者术前与术后及正常对照组黄斑区视网膜厚度的改变及P1波、N1波5环和4象限的振幅密度及潜伏期的变化.结果:术后随访2mo,正常对照组、PDR患者组术前及术后两两比较:P1波振幅密度正常组及PDR组术前、术后两两比较,5环及4象限差异均有统计学意义(P＜0.05);P1波潜伏期1环正常对照组与PDR组术前比较,3,4,5环正常对照组与PDR组术后比较,第2,3象限正常对照组与PDR组术后比较差异无统计学意义(P＞0.05),其余均有统计学意义(P ＜0.05);N1波振幅1环正常对照组与PDR组术后比较,无统计学意义(P＞0.05),其余均有统计学意义(P ＜0.05);N1波潜伏期3环PDR组术前及术后比较,差异无统计学意义(P＞0.05),其余均有统计学意义(P＜0.05);黄斑中心凹视网膜厚度两两比较,差异均有统计学意义(P＜0.05).结论:玻璃体切割术可有效改善视网膜的感光及传导功能,从而成为治疗该病并改善部分视力的有效方法.     

增生型糖尿病视网膜病变多焦视网膜电图的观察分析

目的:观察增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的多焦视网膜电图(multifocal electroretinogram,mf-ERG)的图像特征及临床意义.方法:对临床确诊的PDR患者40例44眼(PDR组)和正常对照组40例40眼进行mf-ERG检查,并对所得数据进行统计分析.结果:PDR患者组mf-ERG 1~5环的反应密度均低于正常对照组,且有显著性差异,N1波潜伏期在4环、P1波潜伏期在2~5环与正常对照组相比显著延长.结论:Mf-ERG可有效地评价PDR患者视网膜的功能.     

多焦视网膜电流图用于近视眼视网膜功能的研究

目的应用多焦视网膜电流图(mltifocal electroretinogram,mERG)探讨不同程度近视眼不同部位视网膜的功能状态,并与正常人作比较,评价其差异。方法收集我院眼科门诊就诊的18～32岁的病例68例(101眼),分为中低度近视组(23例40眼)、高度近视组(24例40眼)和正常对照组(21例21眼)。所有病例均应用德国罗兰公司的mERG仪记录各环N1波、P1波的潜伏期和振幅密度,再比较3组各检查结果之间的差别。结果 3组N1波和P1波的振幅密度在第1环最大,随离心度的增加而逐渐降低;潜伏期在第1环最小,随离心度增加而逐渐延长。经统计学处理,高度近视组N1波和P1波各环的振幅密度较正常对照组及中低度近视组低,差异均有统计学意义(均为P<0.05);中低度近视组与正常对照组N1波和P1波各环的振幅密度比较,差异均无统计学意义(均为P>0.05)。高度近视组N1波P1波第1环潜伏期较正常对照组及中低度近视组延长,差异有统计学意义(P<0.05),其余组间比较差异均无统计学意义(P>0.05)。结论高度近视眼mERG各环振幅密度较正常眼下降,1环潜伏期较正常眼延长;中低度近视眼与正常眼振幅密度及潜伏期无明显变化。     

糖尿病视网膜病变黄斑区视网膜厚度与mERG的观察研究

目的探讨糖尿病视网膜病变(DR)黄斑区视网膜厚度与多焦视网膜电图(mERG)的变化及相互关系。方法采用视网膜厚度分析仪(RTA)对34例(68眼)糖尿病患者及mERG对23例(45眼)糖尿病患者进行检测。结果从无视网膜病变的糖尿病(NDR)患者到Ⅰ期、Ⅲ期DR患者的黄斑区视网膜厚度呈增加趋势,Ⅲ期DR患者的黄斑区各部位视网膜厚度均较正常对照组增加,经统计学分析差异有显著性意义(P<0.01或0.05);且与视力呈显著负相关(P<0.05)。Ⅰ期DR患者的P1波及N2波反应密度较NDR患者减少(P<0.01或0.05),Ⅲ期DR患者的N1波、P1波、N2波潜伏期分别较NDR患者或Ⅰ期DR患者延长,各波反应密度分别较NDR或Ⅰ期DR患者减少(P<0.01或0.05)。中心凹区视网膜平均厚度与P1波潜伏期及反应密度呈显著相关(P<0.05);黄斑区及旁中心凹区的视网膜平均厚度与N2波反应密度及潜伏期呈显著相关(P<0.01或0.05)。结论当黄斑区视网膜厚度增加时,相应的视网膜功能出现损害,RTA结合mERG的检查,可更加全面地反映DR患者黄斑区视网膜的变化。     

玻璃体切割术对PDR患者黄斑区结构与功能的影响

目的：观察增生性糖尿病视网膜病变（proliferative diabetic retinopathy,PDR）患者玻璃体切割术前与术后黄斑区视网膜结构及功能的变化。方法：对33例44眼行玻璃体切割术的PDR患者及30例44眼正常对照组志愿者采用光学相干断层扫描（optical coherence tomography,OCT）及多焦视网膜电图（multifocal electroretinogram,mf-ERG）进行检查,观察PDR患者术前与术后及正常对照组黄斑区视网膜厚度的改变及P1波、N1波5环和4象限的振幅密度及潜伏期的变化。结果：术后随访2mo,正常对照组、PDR组术前及术后两两比较：P1波振幅密度正常组及PDR组术前、术后两两比较,5环及4象限差异均有统计学意义（P〈0.05）;P1波潜伏期第1环正常对照组与PDR组术前比较,第3环、第4环、第5环、第2象限、第3象限正常对照组与PDR组术后比较,差异无统计学意义（P〉0.05）,其余均有统计学意义（P〈0.05）;N1波振幅第1环正常对照组与PDR组术后比较,无统计学意义（P〉0.05）,其余均有统计学意义（P〈0.05）;N1波潜伏期第3环PDR组术前及术后比较,第1环、第2环、第4象限正常对照组与PDR组术前比较,第5环、第2象限、第3象限正常对照组与PDR组术后比较,差异无统计学意义（P〉0.05）,其余均有统计学意义（P〈0.05）;黄斑中心凹视网膜厚度两两比较,差异均有统计学意义（P〈0.05）。黄斑中心凹视网膜厚度与P1波、N1波振幅密度及潜伏期的相关性分析显示,除N1波潜伏期在第3象限存在相关性外,其余均无相关性（P〉0.05）。结论：通过应用OCT和mf-ERG对PDR患者玻璃体切割手术前后黄斑区结构与功能的评估,说明玻璃体切割术可有效减轻视网膜黄斑水肿并改善视网膜的感光及传导功能。     

多焦视网膜电图的增龄变化

目的:探讨不同年龄正常人多焦视网膜电图(mul-ticalelectroretinogrammERG)在视网膜的分布特征,以获得正常参考值。方法:应用法国Metrovision公司生产的VisionMonitor视觉诱发系统检测20例(28眼)正常人mERG,分为2组,其中年龄≥50岁者,为10例(15眼),年龄<50岁者;为10例(13眼)。检测视野的水平视角±30°,垂直视角±23°,采用ERG-jet接触镜电极,于5min记录61个视网膜部位的反应。结果:黄斑中心凹第1环及第2环N1波、P1波、N2波的振幅密度值两组比较差异有显著意义(P<0.05),而潜伏期值P1波两组比较差异有显著意义(P<0.05)。第3、第4环N1波、P1波、N2波的潜伏期均较其他各区缩短。结论:随着年龄的增长mERG的各波振幅密度值及潜伏期值的变化,与视网膜感光细胞功能逐渐减低有关。     

玻璃体切割术对增生性糖尿病视网膜病变患者黄斑区视网膜的影响

目的 观察和分析玻璃体切割术对增生性糖尿病视网膜病变(proliferativediabeticretinopathy,PDR)患者黄斑区视网膜的影响。方法 选取2010年6月至2012年6月我院收治的40例(54眼)PDRⅤ期患者作为观察组,同时选取40例(54眼)正常志愿者作为对照组。观察组患者均应用标准三切口玻璃体切割术联合超声乳化人工晶状体植入术进行治疗。两组均行裂隙灯、验光、眼压、眼底等常规眼部检查,利用光学相干断层扫描(opticalcoherencetomography,OCT)检查黄斑区视网膜厚度,同时利用多焦视网膜电图(multifocalelectroretinogram,mfERG)检查P1波、N1波5环、4个象限(鼻上象限、鼻下象限、颞下象限、颞上象限)的振幅密度及潜伏期等。结果 观察组患眼术前、术后黄斑中心凹视网膜厚度分别为(352.9±127.6)μm和(263.8±27.3)μm,对照组黄斑中心凹视网膜厚度为(137.6±18.5)μm,观察组患眼术后的黄斑中心凹视网膜厚度较术前显著眼科新进展 2014年7月 第34卷 第7期降低,差异均有统计学意义(P<0.05),但均显著高于对照组,差异均有统计学意义(均为P<0.05)。观察组患眼的1环、2环、鼻上象限、鼻下象限的术后P1波振幅密度较术前显著提高,差异均有统计学意义(均为P<0.05),而3环、4环、5环、颞下象限、颞上象限的术后P1波振幅密度较术前显著降低,差异均有统计学意义(均为P<0.05)。观察组患眼术前和术后5环和颞上象限的P1波振幅密度显著低于对照组,差异均有统计学意义(均为P<0.05)。观察组术前1环的P1波潜伏期与对照组比较,差异无统计学意义(P>0.05);观察组术后3环、4环、5环的P1波潜伏期与对照组比较,差异均无统计学意义(均为P>005);观察组术后鼻下象限、颞下象限P1波潜伏期与对照组比较,差异均无统计学意义(均为P>0.05);其余组间两两比较,差异均有统计学意义(均为P<0.05)。观察组术后1环的N1波振幅与对照组比较,差异无统计学意义(P>0.05);除此之外,观察组术前和术后的N1波振幅均显著低于对照组,差异均有统计学意义(均为P<0.05)。观察组术前和术后的N1波潜伏期均显著低于对照组,差异均有统计学意义(均为P<0.05)。结论 玻璃体切割术治疗PDR患者可显著改善视网膜的感光和传导     

用多焦视网膜电图方法研究弱视眼视网膜功能

目的用多焦视网膜电图的方法对两种类型单眼弱视弱视眼与健眼的视网膜功能进行对比分析,探讨不同弱视的视网膜功能状况。方法使用视觉诱发电位仪,刺激图形为黑白同心圆形阵列,共有63个刺激单元,刺激野30°,检测52例单眼弱视儿童,对弱视眼与健眼一阶反映的P1波振幅密度值及潜伏期值进行比较。结果(1)弱视眼与健眼第一环P1波振幅密度值差异有明显统计学意义,双眼第二至第五环P1波振幅密度值、双眼各环P1波潜伏期值均无统计学差异。(2)所有弱视眼与健眼在第一环P1波振幅密度值差异均有统计学意义,但弱视眼第一环P1波振幅密度值在不同程度及类型弱视中比较均无统计学差异。结论(1)弱视眼黄斑区视网膜功能存在异常,而周边视网膜功能无异常改变,信息传导时间在视网膜层无异常。(2)不同程度及类型的弱视眼黄斑区视网膜功能异常的程度未见明显差别。     

无黄斑水肿的NPDR患者中心凹区mfERG与视网膜厚度的研究

目的：分析非增生性糖尿病视网膜病变(nonproliferative diabetic retinopathy,NPDR)无黄斑水肿的患者黄斑中心凹区视网膜功能及厚度间的关系。

方法：选取NPDR患者20例35眼患眼为糖尿病视网膜病变(diabetic retinopathy,DR)组,行多焦视网膜电图(multifocal electronic retinography, mfERG)及Spectralis 相干断层扫描(Spectralis optical coherence tomography,Spectralis OCT)检查。以15例20眼正常眼为OCT对照组,以19例20眼正常眼为mfERG对照组,OCT对照组做Spectralis OCT检查,mfERG对照组做mfERG检查。

结果：与对照组相比,DR组黄斑中心凹mfERG1环的P1波反应密度减小,P1波及N1波隐含期改变无统计学意义; DR组无水肿的黄斑中心凹视网膜厚度、神经上皮层厚度仍有显著增加。

结论：应用mfERG可以在视网膜无可见明显结构改变之前发现视网膜功能上的异常变化; Spectralis OCT可以测量视网膜各层厚度,反映视网膜精细结构变化,验证视网膜功能上的异常改变,二者联合应用为极早期发现糖尿病视网膜病变视功能改变提供有效的证据,并为及时治疗提供资料。     

视网膜颞上分支静脉阻塞合并黄斑水肿的多焦视网膜电图特征

目的 分析视网膜颞上分支静脉阻塞合并黄斑水肿的多焦视网膜电图各参数的特征.方法 时视网膜颞上分支静脉阻塞合并黄斑水肿的病例进行多焦视网膜电图检查,分析其一阶反应,比较不同程度黄斑水肿、患眼与对侧眼N1、P1波振幅密度及潜伏期的差异.结果 局限性黄斑水肿组1环N1波振幅密度和潜伏期分别为:(25.17±2.45)nV·deg-2、(20.48±5.02)ms,黄斑囊样水肿组分别为(18.26±2.20)nV·deg-2、(24.07±3.49)ms,2组间比较差异均有统计学意义(分别为P=0.040、P=0.035);P1波振幅密度在局限性黄斑水肿组为(63.26±22.02)nV·deg-2,弥漫性黄斑水肿组为(42.03±16.25)nV·deg-1,黄斑囊样水肿组为(41.71±15.24)nV·deg-2,3组间差异均有统计学意义(均为P＜0.05).患眼1环、2环及3～5环N1、P1波振幅密度及N1波潜伏期与时侧眼差异有统计学意义(P＜0.05);2环P1波潜伏期与对侧眼差异存在统计学意义(P＜0.05).患眼颞上象限N1波和P1振幅密度分别为(6.24±3.18)nV·deg-2、(15.53±7.52)nV·deg-2,N1波和P1波潜伏期分别为(22.24±1.93)ms、(40.37±3.56)ms,与对侧眼比较差异均有统计学意义(均为P＜0.05).结论 视网膜分支静脉阻塞合并黄斑水肿在多焦视网膜电图上表现以中心凹处的改变最明显;P1波振幅密度及N1波潜伏期可做为敏感评价指标.     

脉络膜厚度对糖尿病患者视网膜病变病情影响的研究

目的研究脉络膜厚度对糖尿病患者视网膜病变病情的影响。方法选取于我院2013年1月至2015年12月收治的90例糖尿病患者作为治疗对象,早期糖尿病视网膜病变(DR)治疗研究(ETDRS)标准规定DR可分为5类:无DR无糖尿病黄斑水肿(DR-/DME-)组17例(17只眼);非增生型糖尿病视网膜病变(NPDR)无糖尿病黄斑水肿(NPDR+/DME-)组23例(23只眼);增生型糖尿病视网膜病变(PDR)无糖尿病黄斑水肿(PDR+/DME-)组10例(10只眼);NPDR伴糖尿病黄斑水肿(NPDR+/DME+)组34例(34只眼);PDR伴糖尿病黄斑水肿(PDR+/DME+)组6例(6只眼)。对照组选取同期在我院体检中心进行体检的90例健康体检者。全部研究对象进行增强深部成像相干光断层扫描(EDI-OCT)。对中心凹下脉络膜厚度(SFCT)进行比较,判断其在不同阶段DR中存在的差异,分析脉络膜厚度对DR病情的影响。结果对照组、无DR无糖尿病黄斑水肿组、NPDR无糖尿病黄斑水肿组、PDR无糖尿病黄斑水肿组、NPDR伴糖尿病黄斑水肿组、PDR伴糖尿病黄斑水肿的SFCT平均值分别为(273士24)、(272±23)、(260±26)、(244士25)、(227±27)、(214±30);对照组各组SFCT均大于观察组,差异具有统计学意义(P<0.05),其中PDR无糖尿病黄斑水肿(PDR+/DME-)组SFCT值小于无DR无糖尿病黄斑水肿(DR-/DME-)组,差异具有统计学意义(P<0.05),NPDR伴糖尿病黄斑水肿(NPDR+/DME+)组SFCT值小于PDR无糖尿病黄斑水肿(PDR+/DME-)组,差异具有统计学意义(P<0.05)。结论脉络膜厚度的变化与DR之间存在联系,二者相互影响,使病情加重,对患者脉络膜厚度进行监测,将有助于综合分析糖尿病患者的视网膜病变情况。     

Differences in pulsatile ocular blood flow among three classifications of diabetic retinopathy

PURPOSE: Choroidal blood flow may be determined by pulsatile ocular blood flow (POBF) measurements. In the present study, the POBF of diabetic patients with increasingly severe retinopathy was compared with that in nondiabetic control subjects. METHODS: The study was a masked cross-sectional analysis. Seventy-seven diabetic subjects, including 13 with mild or no retinopathy, 36 with moderate to severe retinopathy, and 28 with proliferative diabetic retinopathy (PDR), previously treated with panretinal photocoagulation (PRP). Fifty-six nondiabetic control subjects served as the comparison group. All subjects underwent masked measurement of POBF in the right eye by Langham pneumotonometry. Analysis of variance (ANOVA) determined whether differences existed between groups. Pair-wise comparisons between groups were conducted by Student's t-test. RESULTS: The main outcome measures were ophthalmic pulse amplitudes, intraocular pressure (IOP), heart rate, and POBF. Patients with moderate to severe nonproliferative diabetic retinopathy (NPDR) had POBF 18% higher than the control (mean OBF, 943 microL/min). Among PRP-treated subjects with PDR, ocular blood flow was 22% below the control (mean OBF, 619 microL/min), and 34% less than moderate to severe nonproliferative diabetic retinopathy. Diabetic patients with no retinopathy or mild NPDR had OBF indistinguishable from the control (785 vs. 797 microL/min). Differences between the four groups were statistically significant by ANOVA (P < 0.0001). CONCLUSIONS: POBF is unaffected early in diabetic retinopathy, but increases significantly in eyes with moderate to severe NPDR. POBF is decreased in eyes with laser-treated PDR. These experimental data represent the largest published assessment of POBF in NPDR. This is the first study to examine POBF in subjects with PRP-treated PDR.     

Multifocal electroretinogram delays predict sites of subsequent diabetic retinopathy

PURPOSE: To examine the potential of abnormal mfERGs to predict the development of diabetic retinopathy at corresponding retinal locations 1 year later. METHODS: One eye of 11 diabetic patients with nonproliferative diabetic retinopathy (NPDR) and 11 diabetic patients without retinopathy were retested 12 months after initial testing. At each time, mfERGs were recorded from 103 retinal locations, and fundus photographs were taken within 1 month of each recording. Local mfERG implicit times were measured and their z-scores were calculated based on results obtained from 20 age-matched control subjects. mfERG abnormalities were defined as z-scores of 2 or more for implicit time and z-scores of -2 or less for amplitude (P < or = 0.023). mfERG z-scores were mapped onto fundus photographs, and the relationship between baseline abnormal z-scores and new retinopathy at follow-up was examined. RESULTS: New retinopathy developed in 7 of the eyes with NPDR after 1 year. In these eyes, 70% of the mfERGs in areas of new retinopathy had abnormal implicit times at baseline. In contrast, only 24% of the responses in regions that remained retinopathy free were abnormal at baseline. Relative risk of development of new retinopathy over 1 year in the areas with abnormal baseline mfERG implicit times was approximately 21 times greater than that in the areas with normal baseline mfERGs (odds ratio = 31.4; P < 0.001). Eyes without initial retinopathy did not develop new retinopathy within the study period, although 4 of these 11 eyes had abnormal implicit times at baseline. mfERG implicit times tended to be more delayed at follow-up than at baseline in NPDR eyes, but not in eyes without retinopathy and control eyes. mfERG amplitudes had no predictive power. CONCLUSIONS: Localized functional abnormalities of the retina reflected by mfERG delays often precede the onset of new structural signs of diabetic retinopathy. Those functional abnormalities predict the local sites of new retinopathy observed 1 year later.     

Multifocal electroretinogram in diabetic subjects

PurposeTo identify local retinal abnormalities and evaluate the nature and extent of retinal dysfunction in diabetics using full field electroretinogram (ERG) and multifocal ERG (MF-ERG) and to determine the correlation between features of optical coherence tomography (OCT) and MF-ERG.MethodsTwenty-eight normal subjects (Control Group; 56 eyes) and 37 patients (72 eyes) with diabetes mellitus (DM Group) were evaluated. In the DM Group, 17 eyes had no retinopathy (grade 1), 18 eyes had early non proliferative diabetic retinopathy (NPDR) (grade 3), 16 eyes had late NPDR (grade 4), 21 eyes had proliferative diabetic retinopathy (PDR) (grade 5). Full field ERG and MF-ERG, were used to assess the effects of diabetic retinopathy on retinal function. OCT and fluorescein angiography were used to assess and compare morphological changes with functional changes in diabetes mellitus.ResultsIn diabetic patients without retinopathy (17 eyes), the amplitudes of the second order component of MF-ERG were reduced and implicit times were delayed, while only implicit times of first order component of MF-ERG were delayed but the amplitudes of first order component were normal. In diabetic patients with retinopathy (55 eyes), the overall amplitudes were reduced and peak implicit time increased in the first order component and second order component.OCT of the DM Group showed the fovea of eyes with edema were thicker than the Normal Group. The fovea of eyes with cystoid macular edema (CME) were significantly thicker than the fovea of eyes with diffuse swelling. The implicit times of MF-ERG were directly correlated with foveal thickness.ConclusionMF-ERG reveals local retinal dysfunction in diabetic patients. MF-ERG offers the advantage of topographic mapping of retinal dysfunction. The magnitude of delay of MF-ERG implicit time reflects the degree of local clinical abnormalities in eyes with retinopathy. Local response delays found in eyes without retinopathy detects subclinical local retinal dysfunction in diabetics. The combination of OCT and MF-ERG may provide objective criteria for evaluation and assessment of diabetic retinopathy.     

重度非增生型糖尿病视网膜病变mfERG的定量分析

目的研究重度非增生型糖尿病视网膜病变（NPDR）多焦视网膜电图（mfERG）的特征及临床意义。方法30例（40眼）重度NPDR患者为NPDR组和35例（35眼）正常人为对照组。以国际分期作为NPDR诊断纳入标准,mfERG记录过程遵循国际临床视觉电生理学会的标准化方案,每个受试者在接受检查前均取得知情同意。结果与对照组相比,NPDR组患者mfERG2～5环的P1波、N1波反应密度明显下降,差异均有统计学意义（P〈0.05～0.01）;mfERG第Ⅱ象限和第Ⅲ象限的P1波、N1波反应密度明显降低,差异均有统计学意义（P〈0.05～0.01）。NPDR患者mfERG3～5环P1波、N1波隐含时较对照组明显延长,差异均有统计学意义（P〈0.05～0.01）;第Ⅰ象限和第Ⅲ象限隐含时显著延迟,差异均有统计学意义（P〈0.05～0.01）。结论NPDR可导致视网膜黄斑区视功能的损伤,mfERG能够客观、定量地反映黄斑区功能损害的程度。     

眼底无可见视网膜病变的糖尿病患者多焦视网膜电图特征

目的 检测眼底无视网膜病变糖尿病患者的多焦视网膜电图(multifocol electmretinogram, mf-ERG),评价其在糖尿病患者早期视网膜功能改变中的作用.方法 应用mf-ERG检测30例(56只眼)正常对照组和32名(58只眼)无眼底镜下可查见的视网膜病变的糖尿病患者.对两组mf-ERG中a波和b波的潜伏期、振幅总和以及b波的振幅密度进行分析比较.结果 在糖尿病组,除0环和颞下象限之外.b波的潜伏期均明显延迟,而a波和b波振幅总和及b波的振幅密度减低主要集中在黄斑周围区域(0～1环)和颞上象限,差别有统计学意义(P<0.05).结论 mf-ERG能在DR出现之前客观定量地评定视网膜功能的变化程度和范围.     

Multifocal electroretinogram delays reveal local retinal dysfunction in early diabetic retinopathy.

PURPOSE: To identify local retinal abnormalities in diabetic patients with and without retinopathy, by using the multifocal electroretinogram (M-ERG). METHODS: Electroretinograms were recorded at 103 discrete retinal locations in each eye of eight persons with nonproliferative diabetic retinopathy (NPDR) and eight diabetic persons without retinopathy, using VERIS (EDI, San Mateo, CA). The amplitude and implicit time of each local (first-order) retinal response were derived and compared with normal values obtained from 16 age-matched, nondiabetic subjects. Maps of local response amplitude and implicit time were compared with fundus photographs taken at the time of testing. RESULTS: In eyes with NPDR, the implicit times of responses from retinal sites manifesting clinical pathologic fundus lesions (e.g., microaneurysms and focal edema), were markedly delayed (e.g., up to 7 msec from normal). Responses from adjacent retinal sites that were more normal in clinical appearance were also delayed, but to a lesser extent (e.g., 2-5 msec). Smaller, yet significant local response delays were also found in eyes without retinopathy. By contrast, local response amplitudes bore no consistent relationship to fundus abnormalities in eyes with retinopathy, and amplitudes were typically normal in eyes without retinopathy. CONCLUSIONS: The M-ERG reveals local retinal dysfunction in diabetic eyes even before retinopathy. The magnitude of delay of local ERG implicit time reflects the degree of local clinical abnormality in eyes with retinopathy. Local response delays found in some eyes without retinopathy suggest that the M-ERG detects subclinical local retinal dysfunction in diabetes. Analysis of M-ERG implicit time, independent of amplitude, improves the sensitivity of detection of local retinal dysfunction in diabetes.     

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。     

糖尿病视网膜病变严重程度与角膜上皮基底神经丛变化间的相关性

目的：探讨糖尿病视网膜病变(DR)严重程度与角膜上皮基底神经丛(SNP)变化间的相关性。

方法：研究纳入我院2018-01/2021-05收治2型糖尿病(T2DM)患者132例132眼和年龄相关性白内障患者80例80眼,其中T2DM患者中包括非DR(NDR)患者52例52眼,非增生性DR(NPDR)患者40例40眼及增生性DR(PDR)患者40例40眼,分析一般资料和角膜激光扫描共焦显微镜检查资料,采用Spearman秩相关分析评价DR临床分期与神经纤维长度间相关性。

结果：四组性别和年龄比较均无差异(P>0.05); PDR组糖尿病病程显著长于NPDR组、NDR组(P<0.05); NPDR组糖尿病病程显著长于NDR组(P<0.05); 年龄相关性白内障组空腹血糖和糖化血红蛋白水平均显著低于其他三组(P<0.05); PDR组最佳矫正视力显著低于NPDR组、NDR组(均P<0.05); NPDR组最佳矫正视力显著低于NDR组(P<0.05); 年龄相关性白内障组神经纤维长度值均显著大于NDR组、NPDR组及PDR组(P<0.05); PDR组神经纤维长度值显著小于NPDR组(P<0.05); Spearman秩相关分析结果显示,DR分期与神经纤维长度间呈负相关(r_s=-0.347,P<0.001)。

结论：DR病情严重程度与角膜上皮基底神经丛变化间具有相关性,PDR患者神经纤维长度较NPDR显著缩短; PDR和NPDR均存在神经结构缺失,T2DM眼底病变治疗时注意对眼表病变情况评估及处理。