糖尿病黄斑水肿对抗VEGF药物治疗的不同反应与糖尿病视网膜病变程度的相关性

目的：通过观察糖尿病黄斑水肿(diabetic macular edema,DME)患者对于玻璃体腔注射抗VEGF治疗的不同反应和糖尿病视网膜病变(diabetic retinopathy,DR)的不同程度之间的相关性,进一步阐释糖尿病黄伴水肿的发病机制和治疗策略。

方法：选择非增生性糖尿病视网膜病变(non proliferative diabetic retinopathy,NPDR)伴发DME的患者27例33眼,增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)伴发DME的患者32例34眼。均给予玻璃体腔注射抗VEGF药雷珠单抗,观察两组患者对该药的不同反应,并进行统计学比较。

结果：分别把患者治疗3、6mo时的最佳矫正视力(best corrected visual acuity,BCVA)和黄斑中心视网膜厚度(central macular thickness,CMT)和治疗前的BCVA、CMT作比较,NPDR组有统计学差异(P<0.05),PDR组无统计学差异(P>0.05)。NPDR组和PDR组比较,3、6mo时的BCVR和CMT均有统计学差异(P<0.05)。

结论：糖尿病视网膜病变的不同程度影响着糖尿病黄斑水肿对抗VEGF治疗的反应。     

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.     

全视网膜光凝治疗糖尿病视网膜病变后黄斑区视功能的评价

目的 探讨糖尿病视网膜病变(diabetic retinopathy,DR)患者全视网膜光凝(panretinal photocoagulation,PRP)治疗后黄斑区视功能的变化及其与黄斑形态改变的相关性.方法 选取DR患者24例(41眼),行PRP治疗后随访3个月,对比分析患者PRP治疗前后患眼的中心视力,多焦视网膜电图(multifocal electroretinography,mfERG)和光学相干断层扫描(optical coherence tomography,OCT)检测黄斑区视功能的变化与黄斑形态改变,探讨PRP治疗后黄斑区视功能的变化及其与黄斑形态改变的相关性.结果 DR患者PRP治疗后3个月的中心视力和黄斑中心凹厚度分别为0.52 ±0.28、(257.55±124.30)μm,与治疗前的0.57±0.32、(241.15±103.43)μm相比,差异均无统计学意义(t=1.27,P=0.22;t=-1.00,P=0.33).mfERG N波4、5环及P1波3、5环的反应密度较PRP治疗前明显降低,差异均有统计学意义(t=2.48、3.69、2.23、2.40,均为P<0.05),但各波潜伏期相比差异均无统计学意叉(均为P>0.05);黄斑中心凹厚度与mfERG的测量结果无相关性(均为P>0.05).结论 PRP治疗虽然没有引起DR患者中心视力及视网膜厚度的变化,但导致了邻近未接受光凝区域的视网膜功能障碍,表现为mfERG反应密度的降低.     

OCT及mfERG在DR早期及非增殖期中的应用

目的：用光学相干断层扫描（optical coherence tomo-graphy,OCT）测定糖尿病视网膜病变早期（non-diabetes retinopathy,NDR）及非增殖期（non-proliferative diabetes retinopathy,NPDR）的视网膜形态学改变及用多焦视网膜电图（multifocal electroretinogram,mfERG）测定其视网膜电活动的改变,评价不同分期糖尿病视网膜病变（diabetic retinopathy,DR）的严重程度。 方法：选取50~70岁的老年人30例30眼作为正常组,已确诊为2型糖尿病患者50例50眼做为实验组。分别在标准状态下行OCT及mfERG检查,并对结果进行统计学分析。 结果：对于NPDR的患者,视网膜形态的变化：视网膜黄斑区大部分神经上皮层变厚,说明对于糖尿病这个危险因素,视网膜的功能在不断的下降,视网膜黄斑区神经上皮层在NDR中变化并不明显而在NPDR明显变厚,说明黄斑区形态在糖尿病早期变化并不大,随着糖尿病的病情加重,形态发生了很大变化。电生理学改变：mfERG的P1波随着病情的加重,其反应密度逐渐下降,在NDR就明显减低,而在NPDR,下降更为明显,说明在黄斑区,视网膜形态改变前,电活动已经减弱,在形态发生变化后,电活动的下降更为明显。 结论：OCT联合mfERG测定黄斑区域的形态改变及电活动改变,两种检查手段在疾病的早期观察、随访和进一步治疗的选择上具有很高的应用价值。     

糖尿病视网膜病变患者脉络膜厚度和血流动力学参数的变化及其影响因素

目的：：研究糖尿病视网膜病变患者脉络膜厚度和血流动力学参数的变化及其影响因素。方法：选取2013-01/2015-01在我院诊断为2型糖尿病的患者100例100眼,将患者分为3组：无糖尿病视网膜病变( non-diabetic retinopathy,NDR)组患者34例,非增殖期糖尿病视网膜病变( non-proliferative diabetic retinopathy, NPDR)组36例,增殖期糖尿病视网膜病变( proliferative diabetic retinopathy,PDR)组30例。再根据OCT的视网膜黄斑区扫描结果,将糖尿病视网膜病变患者分成两组：糖尿病黄斑水肿( diabetic macular edema,DME)组28例,无糖尿病黄斑水肿组38例。选择同期在我院接受体检的35例正常人群作为对照组。比较各组患者距黄斑中心凹不同距离的脉络膜厚度和鼻侧睫状后动脉的血流动力学参数及其影响因素。结果：随着患者糖尿病视网膜病变的加重,距黄斑中心凹不同距离的脉络膜厚度均呈下降趋势,NPDR和PDR组患者距黄斑中心凹不同距离的脉络膜厚度薄于对照组,差异有统计学意义(P<0.05),NDR组患者距黄斑中心凹不同距离的脉络膜厚度与对照组比较,差异无统计学意义(P>0.05)。糖尿病视网膜病变合并DME患者和非DME患者距黄斑中心凹不同距离的脉络膜厚度比较,差异无统计学意义( P>0.05)。 Pearson相关性分析显示,糖尿病视网膜病变患者脉络膜厚度与糖尿病病程、空腹血糖、HbA1 c、眼轴长度、收缩压及舒张压均无显著相关性(P>0.05),而与logMAR BCVA之间有相关性( P<0.01)。 NDR组和NPDR组患者的PSV和EDV明显低于对照组, RI高于对照组, PDR组患者的PSV和EDV明显低于其他三组,RI高于其他三组,差异有统计学意义(P<0.05)。结论：随着2型糖尿病患者视网膜病变程度的加重,脉络膜厚度呈下降的趋势,脉络膜厚度监测有利于全面分析2型糖尿病视网膜病变患者的病情。     

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)     

频域OCT与FFA在糖尿病视网膜病变患者中的应用

目的 对比频域光学相干断层扫描(optical coherence tomography,OCT)及眼底荧光血管造影(fundus fluorescein angiography,FFA)在各期糖尿病视网膜病变患者中的应用.方法 选择2型糖尿病患者80例152眼为研究对象,其中糖尿病正常视网膜(normal diabetes retina,NDR)组28例54眼、非增生性糖尿病视网膜病变(nonproliferative diabetic retinopathy,NPDR)组31例56眼、增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)组21例42眼.所有患眼均行频域OCT及FFA检查,频域OCT测量记录以黄斑中心凹为中心的6 mm直径区域内视网膜形态及厚度,FFA检查按常规进行,所有检查结果均由同一位有经验的眼底病医师判读,并对两种检查记录结果进行比较.结果 所有患眼行FFA检查确诊有糖尿病黄斑水肿(diabetic macular edema,DME)者8眼(58.6％),未发现DME者63眼(41.4％),其中黄斑局限性水肿31眼,弥漫性水肿28眼,弥漫性水肿伴囊样变性30眼.频域OCT检查NDR组、NPDR组、PDR组黄斑中心凹6 mm直径区域内视网膜厚度分别为(289.45±11.19)μm、(332.31±39.71) μm、(390.20±64.17) μm,与NDR组相比,NPDR组、PDR组黄斑部视网膜厚度均增加(均为P＜0.05);频域OCT确诊有DME者102眼(67.1％),未发现DME者50眼(32.9％).其中视网膜海绵样肿胀42眼,黄斑部囊样水肿14眼,浆液性神经上皮的脱离4眼,视网膜海绵样肿胀+黄斑部囊样水肿24眼,视网膜海绵样肿胀+浆液性神经上皮的脱离18眼.频域OCT及FFA检出阳性率间差异有统计学意义(P＜0.05).结论 DME在DR的各期均有分布,频域OCT和FFA在各期DR中表现不同,二者相结合能更有效地了解糖尿病患者黄斑部的结构和生理功能.     

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。     

多点扫描矩阵激光与氪黄激光治疗糖尿病性视网膜病变的对比研究

目的 应用光学相干断层扫描(optical coherence tomography,OCT)联合多焦视网膜电图(multifocal electroretinogram,mfERG)观察多点扫描矩阵激光全视网膜光凝治疗重度非增殖性糖尿病视网膜病变(severe non-proliferative diabetic retinopathy,severe NPDR)及增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)后激光对视网膜组织结构及视网膜功能的影响.方法 临床病例对照研究.对2010年4～11月在天津市眼科医院就诊的53例(64只眼)DR患者随机分为多点扫描矩阵激光(实验组);传统多波长氪黄激光组(对照组).随访时间3个月,光凝前进行最佳矫正视力(the best corrected visual acuity,BCVA)、裂隙灯生物显微镜、眼底、眼底荧光血管造影(fudus fluorescein angiography,FFA)、OCT及mfERG检查,术后1周、1月、3月进行BCVA、OCT及mfERG检查.比较两组异同.结果 激光术后两组黄斑中心凹厚度均出现明显增加,但两组差异无统计学意义(F值=20.722和23.752,P＞0.05).两组P1波、N1波振幅密度均出现不同程度下降,术后1周下降最显著,术后1～3月逐渐恢复,术后对照组各波振幅密度下降幅度较实验组明显且恢复速度慢.结论 本研究证实多点扫描矩阵激光与氪黄激光在治疗糖尿病视网膜病变上疗效相同,并对视网膜功能损伤较小.     

2型糖尿病患者干眼与糖尿病视网膜病变的相关分析

目的：：调查2型糖尿病患者干眼与不同程度糖尿病视网膜病变( diabetic retinopathy,DR)及黄斑水肿之间的关系。方法：采用横断面研究。选取340例340眼2型糖尿病患者,收集临床资料,分别检测泪河高度、泪液分泌试验(Schirmer Ⅰ test)、泪膜破裂时间(break-up time,BUT)、角膜荧光素染色。所有患者散瞳检查视网膜,评估DR程度及有无临床意义的黄斑水肿。结果：所有患者中,干眼患病率为49.41%。干眼患者的糖尿病病程为11.15±7.07a,无干眼患者的病程为6.92±5.45a,两者之间的差异具有显著统计学意义(P<0.01)。干眼与DR各分期具有明显关系,轻度非增殖性糖尿病视网膜病变( nonproliferative diabetic retinopathy, NPDR )、中度 NPDR、重度 NPDR 和增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者相对于无 DR患者的干眼发生可能性分别为1.097倍、1.724倍、2.86倍和5.43倍。黄斑水肿患者较无黄斑水肿患者的干眼发生可能性增加到3.697倍。结论：2型糖尿病患者常常伴发干眼。随着DR的发生及进展,罹患干眼的机会逐步增加。     

累及黄斑的孔源性视网膜脱离手术前后黄斑区光学相干断层扫描与多焦视网膜电图的变化

目的：观察累及黄斑区的孔源性视网膜脱离( RRD)患眼手术前后黄斑区光学相干断层扫描(OCT)与多焦视网膜电图（mfERG）表现的变化。 方法：回顾性研究。选择2013年9月至2014年7月在河南省眼科研究所确诊为累及黄斑的RRD并行巩膜扣带术的患者52例（52眼）,以对侧正常眼作对照。RRD患眼均行巩膜扣带手术治疗。手术前及手术后1周,术后1、3、6个月,进行OCT及mfERG检查,观察RRD患眼黄斑区微结构,以及黄斑区反应振幅密度及潜伏期的变化。采用t检验对术前患眼与正常眼进行比较,采用重复测景方差分析对患眼手术前后黄斑中心凹厚度变化与中央1环的N1、P1波反应密度和潜伏期比较分析;采用Pearson积矩相关分析法分析术后各时问点最佳矫正视力(BCVA)与黄斑中心凹厚度、中央1环的N1、P1波反应密度和潜伏期的相关性。 结果：所有患眼术后均成功复位。术前患眼黄斑中心凹厚度较正常眼明显增厚,为(534+44) μm,差异有统计学意义（t=17.127,P<0.05）,术后1周、1个月、3个月、6个月患者黄斑中心凹厚度,较术前明显降低,差异有统计学意义(P<0.01)。与正常眼相比较,术前患者中央1环Nl波和P1波振幅密度降低（t_N1=17.372、t_p1=23.943,P< 0.05）,潜伏期延长（t_Nl=5.291、t_Pl=7.306,P< 0.05）,差异均有统计学意义,术后1周、术后1、3、6个月中央1环N1波及P1波振幅密度较术前均提高（P<0.01）,潜伏期与术前差异无统计学意义。患者BCVA在术后1、3、6个月与黄斑中心凹厚度呈负相关(r=-0.801、-0.695、-0.643,P<0.05),l与中央1环N1波及P1波振幅密度呈正相关(r_N1=0.702、0.695、0.632,r_p1=0.811、0.713、0.648;P< 0.05),与潜伏期无相关性。 结论：OCT与mfERG可以客观综合观察RRD患者术后黄斑区的形态和功能,评估视网膜脱离后的手术疗效。     

Histological observation of trabecular meshwork in a patient with Axenfeld-Rieger syndrome—a new theory for the mechanism of ectropion uvea in congenital glaucoma

AIM: To analyze the clinical efficacy of intravitreal injection of ranibizumab on diabetic macular edema (DME) with multifocal electroretinography (mfERG) and optical coherence tomography (OCT). METHODS: A total of 41 patients (41 eyes) with DME were treated with intravitreal injection of ranibizumab (IVR). The best corrected visual acuity (BCVA), mfERG results, and OCT were analyzed to compare to the baselines, 1wk, 1 and 3mo after operation. RESULTS: The BCVA was significantly improved in all eyes at each time point (P<0.001). The macular area leakage and edema were reduced 1wk and 1mo after IVR, and the central fovea thickness (CFT) was significantly reduced compared to baseline (P<0.001). The mfERG, two-dimensional and three-dimensional images all showed that the macular fovea (1 ring) response density decreased, and the fovea and macular area spikes significantly decreased or disappeared. The amplitude density of the P1 wave was increased, and the latency of the P1 wave was shortened than preoperation (P<0.001). At 1wk and 1mo after the operation, there was a negative correlation between the amplitude density of P1 waves and CFT. CONCLUSION: OCT and mfERG fully demonstrate the importance of IVR for DME patients from the macular morphology and function, especially the significance of mfERG in this disease.     

Morphological and functional analyses of diabetic macular edema by optical coherence tomography and multifocal electroretinograms

PURPOSE: To determine the correlation between the tomographic features and the visual functions of eyes with diabetic macular edema. METHODS: Optical coherence tomographic (OCT) images and multifocal electroretinograms were obtained from 45 eyes of 25 patients with diabetic macular edema and from 21 eyes of 21 normal subjects. RESULTS: The OCT images showed cystoid macular edema in 18 eyes and diffuse retinal swelling without cystoid edema in the other 27 eyes. The fovea was significantly thicker in eyes with cystoid macular edema and in those with diffuse retinal swelling than in normal eyes. The fovea of eyes with cystoid edema was significantly thicker than the fovea of eyes with diffuse swelling. The best-corrected visual acuity and the electrical response density from the macular area were significantly reduced in eyes with diabetic macular edema, particularly in those with cystoid edema. The best-corrected visual acuity and macular response density of the multifocal ERGs were inversely correlated, and the implicit times were directly correlated with foveal thickness. CONCLUSION: The visual acuity was correlated significantly with morphological changes revealed by OCT and with multifocal ERGs. The combination of OCT and multifocal ERGs may provide objective criteria for the evaluation and assessment of diabetic macular edema.     

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）     

The correlation between optical coherence tomographic features and severity of retinopathy,macular thickness and visual acuity in diabetic macular edema

Purpose To investigate the correlation between the features of optical coherence tomography (OCT) and the severity of concurrent retinopathy, central macular thickness (CMT), and best-corrected visual acuity in clinically significant diabetic macular edema.Methods In a prospective study, OCT was performed in 55 eyes of 55 patients with clinically significant diabetic macular edema, in 58 eyes of 30 patients with diabetes without retinopathy, and in 40 eyes of 21 healthy control subjects. The OCT features were categorized into: type 1, sponge-like retinal swelling; type 2, cystoid macular edema; type 3, serous retinal detachment; and type 4, vitreofoveal traction.Results The CMT in eyes with diabetic macular edema was significantly higher than in eyes of healthy controls or in eyes of diabetic patients without retinopathy (P < 0.001). Visual acuity correlated with CMT in diabetic macular edema (r = 0.558, P < 0.001). The prevalence of OCT type 1 was significantly higher in eyes with mild-to-moderate non-proliferative retinopathy (NPDR) than in eyes with severe NPDR to proliferative retinopathy (PDR) (P = 0.0069). The prevalence of OCT types 3 and 4 was significantly higher in eyes with severe NPDR to PDR than in eyes with mild-to-moderate NPDR (P = 0.0056). OCT type 1 showed the least CMT (P < 0.001) and the best visual acuity (P = 0.002).Conclusions There was a significant correlation between OCT patterns of clinically significant diabetic macular edema and severity of retinopathy, CMT, and visual acuity.     

OCT观察视网膜色素变性患者黄斑中心凹厚度变化及黄斑部图像特点

目的:通过光学相干断层扫描(optical coherence tomography,OCT)观察视网膜色素变性(retinitis pigmentosa,RP)患者黄斑中心凹的厚薄改变及黄斑部图片特点.方法:选取2014-09/2016-09在本院门诊确诊的RP患者74例148眼,同时选取50例100眼正常人作为对照.对两组进行OCT检测和眼底拍照,观察患者视网膜黄斑部位的图像特征,并对患者眼底拍照的结果进行对比,测量黄斑中心凹颞侧面4mm位置、乳头黄斑束中点及黄斑中心凹厚度.结果:对两组研究对象测量视网膜厚度显示,RP患者黄斑中心凹视网膜和中心凹颞侧部4mm厚度与正常人相比,差异无统计学意义(P>0.05);RP患者乳头黄斑束中点厚度变薄,与正常人对比差异有统计学意义(P<0.05);RP患者黄斑区OCT检测图像表征有5种类型:视网膜黄斑区域水肿者19例38眼;视网膜色素脉络膜毛细血管层和上皮层变薄者18例36眼;视网膜色素上皮层发生萎缩者12例24眼;黄斑部视网膜厚度正常者12例24眼;色素上皮层厚薄表现不一者13例26眼.结论:OCT能在前期及时地发现RP患者黄斑部位的病变,帮助患者深入了解病情发展,为患者早期诊疗提供了临床依据.     

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.     

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.     

Tilted disc syndrome: an OCT and mfERG study

Purpose To evaluate retinal thickness and function in eyes with tilted disc syndrome with optical coherence tomography (OCT) and multifocal electroretinogram (mfERG). Methods Twenty-one eyes of 12 patients (4 males and 8 females) with tilted disc were studied with OCT3 and mfERG and compared with 40 eyes of 20 age and sex-matched control subjects. The thickness of the fovea and the thickness of retinal nerve fibre layer (RNFL) along a 3.4-mm-diameter circle centred on the optic nerve head were evaluated using OCT3. The macular cone function was tested by mfERG. Results The OCT-derived RNFL thickness was significantly decreased in the superior area of eyes with tilted disc with a mean value equal to 106.47 μm (SD 24.1). The mean response amplitude density of the fovea (11.75 nV/deg2) and parafovea (8.22 nV/deg2) was significantly lower in eyes with tilted disc than in normal eyes. Conclusion OCT and mfERG can be objective tools for assessing anatomical and functional damage of the macula. Our results suggest that in tilted disc syndrome even without visual impairment the optic nerve and the macula show dysfunction not visible by other means.