糖尿病性视网膜病变毛细血管无灌注区的FFA分布特点

目的 分析糖尿病性视网膜病变(DR)的毛细血管无灌注区(NP)的分布特点。方法 回顾分析182例DR患者(299只眼)荧光素眼底血管造影(FFA)资料。采用按象限、距视盘DD数的分区方法，分别对DR患眼的NP分布情况进行统计。结果 182例(299只眼)DR得中，有102例(145只眼)存在NP。NP出现在视网膜鼻侧、下方、上方及颞侧的发生率分别为82．76％(120／145)、76．55％(111／145)、62．07％(90／145)、52．41％(76／145)；NP出现在视网膜中周部、周边部及后极部的发生率分别为83．45％(121／145)、42．07％(61／145)、13．79％(20／145)。结论 视网膜鼻侧象限，NP出现最多；视网膜中周部是NP最易、最常发生的部位。     

Distribution of capillary nonperfusion in early-stage diabetic retinopathy

Using composite super-wide fluorescein angiography, 152 eyes with nonproliferative diabetic retinopathy were evaluated for capillary nonperfusion. Four basic types of eyes were distinguished according to the location of capillary nonperfusion: peripheral type 4 eyes, midperipheral type 93 eyes, central type 40 eyes and generalized type 15 eyes. The rate of enlargement of nonperfused area was more rapid in peripheral type, midperipheral type, central type and the generalized type in the ascending order. Eyes belonging to midperipheral and central types evolved into other, usually generalized type during the course of observation. There is a positive correlation between the initial site of occurrence of capillary nonperfusion and its progression in nonproliferative diabetic retinopathy. A proper recognition of the typing is claimed to be of prognostic value.     

Clinical examination accurately locates capillary nonperfusion in diabetic retinopathy

PURPOSE: To help the ophthalmologist who wishes to know the perfusion status of the retina outside the macula, we determined whether clinical examination can predict capillary nonperfusion in diabetic retinopathy (DR) as accurately as fluorescein angiography (FA). DESIGN: Prospective observational case series. METHODS: Setting: Clinical practice. STUDY POPULATION: Both eyes of 20 patients with clinically significant diabetic macular edema (CSME). OBSERVATION PROCEDURE: The location of capillary nonperfusion was recorded following 90-diopter lens slit-lamp biomicroscopy, and the same measurements made on FA. MAIN OUTCOME MEASURE: In the nasal and temporal quadrants of each eye, the clinical results were compared with the "gold standard" FA. RESULTS: Most patients (84%) had definite peripheral capillary nonperfusion. Biomicroscopy results were highly correlated with angiography, with only a few differences of clinical importance. CONCLUSIONS: Clinical examination can determine the location of capillary nonperfusion in DR with a high degree of accuracy.     

Retinal sensitivity loss and structural disturbance in areas of capillary nonperfusion of eyes with diabetic retinopathy

PURPOSE: To assess light sensitivity and morphologic changes of capillary nonperfused areas in diabetic retinopathy. DESIGN: Prospective, observational cross-sectional study. METHODS: Seventeen consecutive patients (20 eyes) with areas of capillary nonperfusion resulting from severe nonproliferative or proliferative diabetic retinopathy were included in the study. All eyes underwent fluorescent angiography and fundus-related microperimetry. Nonperfused areas of the retina were scanned with optical coherence tomography (OCT). RESULTS: In all 20 diabetic eyes, areas of capillary nonperfusion detected by fluorescein angiography were associated with the loss of retinal sensitivity. At the edges of the nonperfused area, retinal sensitivity tended to be reduced. The OCT images suggested a structural disturbance of the inner retina and high-reflectivity deposition located between the outer segments of photoreceptor and the retinal pigment epithelium corresponding to the areas of capillary nonperfusion. CONCLUSIONS: Areas of capillary nonperfusion resulting from severe nonproliferative or proliferative diabetic retinopathy show morphologic changes of the retinal structure, which may lead to a loss of sensitivity.     

增生型糖尿病视网膜病变患眼视网膜毛细血管无灌注区面积的定量分析

目的:对比观察增生型糖尿病视网膜病变（PDR）患眼荧光素眼底血管造影（FFA）和扫频源光相干断层扫描血管成像（SS-OCTA）视网膜毛细血管无灌注区面积测量结果。方法:横断面研究。2019年9月至2020年1月于河南省人民医院眼科确诊为PDR的11例患者18只眼纳入研究。采用德国Heidelberg公司Spectral...     

Nonproliferative diabetic retinopathy and macular edema progression after phacoemulsification: prospective study

PURPOSE: To determine the incidence of diabetic retinopathy (DR) progression after phacoemulsification in patients with type II diabetes. SETTING: Service of Ophthalmology, University of Sant Joan, Barcelona, Spain. METHODS: This prospective study evaluated 132 patients with diabetes mellitus who had monocular phacoemulsification. A control group comprised the patients' contralateral eyes. Data analysis included preoperative retinal findings and DR status; hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol, and triglycerides levels; insulin treatment; and arterial hypertension. RESULTS: Postoperative visual acuity increased by 2 or more lines in 105 patients (79.55%); the mean postoperative acuity was 0.63 +/- 0.28 (SD). Diabetic retinopathy in the operated eye progressed in 31 patients (23.48%) and in the fellow eye in 28 patients (21.21%). The progression was associated with high levels of HbA1c and diabetes mellitus duration in both groups. Diabetic macular edema occurred in the operated eye in 8 patients (6.06%) and in the fellow eye in 6 patients (4.54%). Pseudophakic macular edema developed in 2 eyes (1.52%). The progression of diabetic macular edema was not associated with the risk factors studied. CONCLUSION: Uneventful phacoemulsification cataract surgery may not cause DR progression.     

Increased capillary vulnerability in diabetic retinopathy

The retinal capillary network is isolated by Cogan and Kuwabara's method. During prolonged trypsinization the capillaries lose their endothelial cells and pericytes and are transformed into cell-free tubes consisting of basement membranes. This occurs earlier in patients with stage I or II retinopathy than in controls with normal carbohydrate metabolism and patients with stage I hypertension. Therefore, the intercellular junctions and the adhesion between endothelial cells and subendothelial basement lamella are more loosely structured in diabetics than normal subjects, and the cells do not resist the tryptic attack as well. The higher capillary vulnerability demonstrated in these experiments contributes to bleeding and exudation. Whether the local loss of cells in the microcirculation of diabetics occurs primarily in vivo or is only unmasked in vitro manifesting pre-existing cellular damage is discussed.     

The prognostic value of peripheral retinal nonperfusion in diabetic retinopathy using ultra-widefield fluorescein angiography

Graefe's Archive for Clinical and Experimental Ophthalmology - To investigate the prognostic value of peripheral retinal nonperfusion in patients with diabetic retinopathy using ultra-widefield...     

Foveal vasculature changes and nonperfusion in patients with diabetes types I and II with no evidence of diabetic retinopathy

Graefe's Archive for Clinical and Experimental Ophthalmology - To analyze the foveal avascular zone (FAZ) in patients with diabetes and no retinopathy vs. controls using OCT angiography...     

Reperfusion of occluded capillary beds in diabetic retinopathy

PURPOSE: To demonstrate the reperfusion of nonperfused capillary beds in diabetic retinopathy.METHODS: In a retrospective study, we reviewed 292 fluorescein angiograms of 94 eyes of 74 patients (mean age, 52 years; range, 20 to 68 years) with diabetic retinopathy. Fluorescein angiography was performed repeatedly (mean, three times; range, two to eight times) during a mean follow-up period of 2 years (range, 3 months to 12 years). None of the 94 eyes received laser photocoagulation.RESULTS: Reperfusion of occluded capillary beds was observed in 65 (69%) of 94 eyes. Reperfusion was characterized by recanalization in 22 (34%) of the 65 eyes or by intraretinal neovascularization in 54 (83%) of the 65 eyes. The former took place in small nonperfused areas and the latter in larger nonperfused areas. Reperfusion occurred throughout the entire fundus in six of 94 eyes, resulting in resolution of diabetic retinopathy. Reperfused capillary beds with intraretinal neovascularization left vascular remodeling, which was seen as twisted or kinked abnormal vessels.CONCLUSIONS: In diabetic retinopathy, occluded capillary beds may be reperfused. Twisted abnormal vessels may represent the reperfusion process through intraretinal neovascularization.     

Progressive capillary nonperfusion in temporal branch retinal vein obstruction

We studied 31 eyes with nonischemic temporal branch retinal vein obstruction (TBRVO) of six months' duration or less. Each eye had an initial and at least one follow-up fluorescein angiogram according to the clinical course. Five eyes had sufficient additional capillary nonperfusion by angiography to warrant reclassification into the ischemic category. This conversion to an ischemic TBRVO pattern was documented as early as one month and as late as 14 months (average 5.2 months) after initial evaluation. Males dominated the progressive group (P less than 0.005); age, sex, initial visual acuity, and associated medical and ocular conditions were not significantly different between progressive and nonprogressive eyes (P greater than 0.05). A nonischemic TBRVO may convert to an ischemic pattern, placing these eyes at increased risk for the subsequent development of neovascular complications.     

Perifoveal capillary network quantification in young diabetic patients with subclinical or no retinopathy

Objective

To assess the morphology of perifoveal capillary network with quantitative parameters in young patients with diabetes mellitus type I (DM I) using an algorithm.

Effect of anti-VEGF treatment on nonperfusion areas in ischemic retinopathy

In recent years, retinal ischemia such as that which occurs in diabetic retinopathy (DR) and retinal vein occlusion (RVO) has become a hotspot of ischemic retinopathy research. High levels of vascular endothelial growth factor (VEGF) are recognized as a major cause of macular edema (ME) in DR and RVO. High concentrations of VEGF in the vitreous can lead to serious retinal ischemia and hypoxia and form retinal nonperfusion areas (NPAs). Different levels of retinal ischemia can represent disease severity and progression. Anti-VEGF therapy as the first-line treatment for ME has been found to be effective in improving vision, but there are still disputes about whether anti-VEGF therapy could improve retinal ischemia and achieve reperfusion of previously developed retinal NPAs. Here, we review and summarize studies of the effects of anti-VEGF drugs on retinal ischemia, especially NPAs.     

Visual field loss with capillary non-perfusion in preproliferative and early proliferative diabetic retinopathy.

Thirty two eyes of 19 patients with capillary non-perfusion from preproliferative and early proliferative diabetic retinopathy underwent visual field testing on the 30-2 program of the Humphrey visual field analyser. The mean defect (MD) p value was < 5% in 30 (94%) eyes and the corrected pattern standard deviation (CPSD) was < 10% in 31 (97%) eyes. Areas of capillary non-perfusion demonstrated by fundal fluorescein angiography were closely associated with areas of reduced retinal sensitivity in these 31 eyes. More severe visual field defects were present in non-insulin dependent diabetics and in older patients. MD and CPSD p values of less than 0.5% and 1% respectively were found to be associated with non-insulin dependent diabetes (p < 0.05 and p < 0.01 respectively) and with the older age group (p < 0.05). There was no correlation between severity of field defects with hypertension and degree of retinopathy.     

Improved retinal capillary perfusion following treatment of severe proliferative diabetic retinopathy

The authors report a photodocumented case of improved retinal capillary perfusion accompanied by visual acuity improvement after treatment of severe proliferative diabetic retinopathy.     

Captopril inhibits capillary degeneration in the early stages of diabetic retinopathy

PURPOSE: This study was conducted to examine the effect of angiotensin-converting enzyme (ACE) inhibitors on the development of early stages of diabetic retinopathy. METHODS: Rats were made diabetic by injection of streptozotocin and treated with the ACE inhibitor captopril and the AT1 antagonist losartan. The extent of capillary degeneration and leukostasis in the retina were determined. RESULTS: Acellular capillaries and pericyte ghosts in the retina of diabetic animals were increased by approximately two-fold after 8 months of diabetes compared with the nondiabetic control, and captopril completely inhibited this capillary degeneration. Captopril and losartan also inhibited hyperglycemia-induced leukostasis at 6 weeks and 1 week in the retinal vasculature, respectively. In cultured retinal endothelial cells, angiotensin II-induced VCAM-1 expression was inhibited by losartan. CONCLUSIONS: Inhibition of the renin-angiotensin system can block retinal capillary degeneration and inflammation in the early stages of diabetic retinopathy.     

Effects of treatment for diabetic retinopathy on reperfusion of the capillary bed

PURPOSE: We studied the effects of treatment for diabetic retinopathy on reperfusion and obstruction of the capillary bed. SUBJECT AND METHODS: In a retrospective study, we studied fluorescein angiograms of 66 patients (98 eyes) with diabetic retinopathy treated in our hospital between January 1998 and July 2002. Fluorescein angiography was performed at the first visit and each treatment (vitrectomy, photocoagulation, and follow-up). Angiographic findings of reperfusion and obstruction in the temporal raphe area were evaluated. RESULTS: In the patients who had undergone vitrectomy, reperfusion of the capillary bed was observed in 10 of 24 (42%) eyes and regularity or obstruction was observed in 14 (58%). In the patients treated by photocoagulation, reperfusion was observed in 11 of 56 (20%) eyes and regularity or obstruction was observed in 45 (80%). In the patients without treatment, reperfusion was observed in 1 of 18 (6 %) eyes and regularity or obstruction was observed in 17 (94%). CONCLUSION: Reperfusion of the capillary bed was significantly greater in the vitrectomy patients than in the photocoagulation and follow-up patients. Treatment for diabetic retinopathy influenced reperfusion and obstruction of the capillary bed in the temporal raphe area.