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.     

三个时期糖尿病视网膜病变多焦视网膜电图的差异

目的研究三个时期糖尿病视网膜病变的多焦视网膜电图特征及其临床意义。方法采用VERISⅣ视觉诱发反应图像系统测量和分析了34例非增殖期、15例增殖前期和15例增殖期糖尿病视网膜病变的多焦视网膜电图的差异。结果与正常对照眼比较,增殖期糖尿病视网膜病变,多焦视网膜电图的N     

52例糖尿病患者图形视诱发电位检测

作者检测了30例(60眼)正常人和52例(104眼)糖尿病患者(无视网膜病者52眼，非增殖型糖尿病视网膜病变52眼)的图形视诱发电位(PVEP)。结果显示，糖尿病患者PVEP与正常组PVEP之间的差异有显著性(P<0.01)，表现为P₁₀₀潜伏期延长和P₁₀₀波幅值降低。P₁₀₀潜伏期延长与糖尿病病程呈显著正相关。在糖尿病组，PVEP的异常检出率为58.7%，略高于眼底荧光血管造影术异常检出率(54.5%)。因此，PVEP对糖尿病患者在尚无视网膜病变以及只有非增殖期视网膜损害者的检测，具有一定的临床应用价值。 （中华眼底病杂志，1995，11：162-164）     

Pulsatile ocular blood flow in diabetic retinopathy.

PURPOSE: To assess circulatory properties of eyes with progressive stages of diabetic retinopathy. METHODS: The intraocular pressure, pulse amplitude (PA) and pulsatile ocular blood flow (POBF) were measured with a pneumatonometer (OBF Labs UK Ltd). The eyes were grouped: (a) normal control, n = 26, (b) diabetes with no observable diabetic retinopathy (NDR), n = 18, (c) mild to moderate non-proliferative diabetic retinopathy (NPDR), n = 20, and (d) very severe pre-proliferative and proliferative diabetic retinopathy (PPDR/PDR), n = 12. RESULTS: The PA and POBF values were lower than normal values in the earliest stage (NDR). The POBF increased but was still below normal levels at the NPDR stage, and then increased to an above normal level in the PPDR/PDR stage of diabetic retinopathy. The PA was at normal levels in these later two stages. CONCLUSION: An initial decrease in pulsatile ocular blood flow is present with the onset of diabetes where no diabetic retinopathy has yet occurred. Subsequently, the pulsatile ocular blood flow increases with the severity of the retinopathy.     

糖尿病性视乳头病变

目的:探讨糖尿病视乳头病变与糖尿病视网膜病变分期、糖尿病病程之间的关系。方法:回顾分析302例荧光素眼底血管造影、眼底镜、视野计检查确诊的糖尿病视网膜病变患者。根据我国现行的DR诊断分期标准对DR进行分期。统计分析糖尿病视乳头病变的发生率以及糖尿病视乳头病变与糖尿病病程、糖尿病视网膜病变分期之间的关系。结果:DR98例135眼有PD(32.4%),包括76眼发生缺血性视乳头病变,54眼发生视乳头水肿,5眼发生视神经萎缩。Ⅰ期DR糖尿病视乳头病变的发生率为8.3%,Ⅱ期DR糖尿病视乳头病变的发生率为21.1%,Ⅲ期DR糖尿病视乳头病变的发生率为32.4%,Ⅳ期DR糖尿病视乳头病变的发生率为44.8%,Ⅴ期DR糖尿病视乳头病变的发生率为76.2%。结论:糖尿病视乳头病变是糖尿病视网膜病变患者视力损害的常见原因,糖尿病视乳头病变发生率随糖尿病病程延长以及糖尿病视网膜病变的加重而增加.     

Preretinopathic changes in the oscillatory potential in diabetic retina: interpretation and significance

1) The earliest electroretinographic manifestation of diabetic retina is a selective change in the oscillatory potential (OP), which originates in postsynaptic retinal neuronal circuits. "Diabetic intraretinal neuropathy" precedes angiopathic retinopathy. 2) The peak latency and the amplitude of the OP are significantly correlated with the psychophysical contrast threshold for motion perception (CTMP) measured with our original device. 3) The CTMP is not correlated with the conventional static contrast threshold measured with a commercially available chart (VCTS-6000). 4) The CTMP is beyond the upper limit in nondiabetic control eyes in 135 out of 162 diabetic eyes at stage 0 (no ophthalmoscopic diabetic retinopathy) and all retinopathic eyes at stages AI (11 eyes) and AII (21 eyes). The CTMP test, which is completely non-invasive and easy to perform, could be useful for mass-screening of early diabetic retinal dysfuction. 5) The amplitude of the OP is enhanced by dopamine and nomifensine (a potent dopamine-uptake blocker), and diminished by haloperidol (a potent antagonist to dopamine D1-D2 receptors). Intrinsic dopamine release in the retina would regulate the amplitude of the OP. 6) The intraretinal content of dopamine decreases in streptozotocin (STZ)-induced diabetic rats where the OP amplitude is diminished, and increases in eyes where the OP amplitude is enhanced at the early stage in spontaneously diabetic (OLETF) rats. The changes in the OP amplitude in STZ-induced and OLETF diabetic rats can not be accounted for by the intraretinal content of gamma-aminobutyric acid (GABA), glycine, glutamate, aspartate or taurine. The changes in the OP amplitude in the diabetic retina are at least partly due to dysfunction of dopaminergic retinal neurons. 7) The peak latency prolongation and the amplitude diminution of the OP in STZ-induced diabetic rats are normalized after insulin treatment, while vitreous fluorescein concentration by vitreous fluorophotometry is not restored by insulin. Thus, the OP changes in STZ-induced diabetic rats are not due to STZ toxicity but to diabetes per se, and are not attributable to blood-ocular barrier disruption as revealed by vitreous fluorophotometry. Retinal neuronal dysfunction revealed by the OP changes at the early preretinopathic stage in STZ-induced diabetic rats is reversible after insulin treatment. 8) The OP changes in OLETF rats are prevented by decreasing food intake by 30% to maintain their blood glucose level and body weight normal. Even in highly genetically diabetic animals, diet therapy starting at an early stage of life inhibits the diabetic OP changes. 9) The amplitude of the bicarbonate response from the retinal pigment epithelium diminishes even at the preretinopathic stage, and is significanly correlated with the peak latency and the amplitude of the OP. Diabetic retinal pigment epitheliopathy as well as retinal neuropathy takes place prior to angiopathic retinopathy in the diabetic retina.     

Comparative study of postoperative complications in primary and secondary implantation of posterior chamber intraocular lens in cataract surgery for diabetic patients]

Postoperative complications of diabetic cataract cases with active stage diabetic retinopathy, which underwent simultaneous extracapsular lens extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) implantation in 84 eyes, ECCE only in 38 eyes and secondary implantation of PC-IOL after ECCE in 23 eyes, were studied. In the eyes of the primary PC-IOL implantation group, fibrous response in 35 eyes (42%), posterior iris synechia in 10 eyes (12%), progression of diabetic retinopathy in 13 eyes (16%), after cataract in 11 eyes (13%), pupil capture in 4 eyes (5%) and decentration of lens optics in 3 eyes (4%) were appeared, while in the ECCE only group, fibrous response in 11 eyes (29%), posterior iris synechia in 4 eyes (11%), after cataract in 11 eyes (29%), progression of diabetic retinopathy in 6 eyes (16%) were observed. On the other hand, in the secondary PC-IOL implantation group, only fibrous response was appeared in 1 eye (4%), Although PC-IOL implantation has been so far considered contraindication in cases with cataract combined with active stage retinopathy, the present studies strongly suggest that secondary PC-IOL implantation would be good indication in these cases whose blood sugar was properly controlled and the retinopathy was burned out by panretinal photocoagulation soon after ECCE.     

糖尿病性黄斑病变

本文观察65例有黄斑病变的糖尿病患者。全部患者均作眼科常规检查,详细检查眼底,除8只眼不能窥见眼底外,其余122眼均作彩色眼底照像和眼底血管荧光造影。属单纯型者40眼,占32.80%,增殖型82眼,占67.20%。按Sigelmen’s分期法,糖尿病性黄斑病变Ⅰ期17眼,占13.93%,Ⅱ期41眼,占33.60%,Ⅲ期40眼,占32.80%,Ⅳ期24眼,占19.67%。本组病例视力≥0.3者66眼,占54.00%,<0.3者56眼,占46.00%,<0.05者22眼,占18.00%。近半数患者为低视力和盲目,这些患者主要血糖控制不佳,病程较长,患者来诊时均属较晚期。故此作者认为眼科医师和内科医师有责任对糖尿病患者作有效的指导,以便避免严重的糖尿病视网膜病变和其他并发症的发生。本文还讨论了发病机理和治疗方法。     

Long-term visual outcome in proliferative diabetic retinopathy patients after panretinal photocoagulation.

BACKGROUND: There is the need for a long-term study on the visual outcome of panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) patients. CASES: We retrospectively reviewed the clinical course and visual results in 66 eyes of 59 patients with PDR who were followed-up for at least 10 years after argon or krypton laser PRP. OBSERVATIONS: Thirty-nine eyes had stage B-II, whereas 8 eyes had stage B-III retinopathy. Stage B-IV and B-V retinopathy were seen in 15 and 4 eyes, respectively. Although active stages of diabetic retinopathy were encountered after 5 years, complete regression could be successfully attained after 10 years. Long-term visual prospects were promising for eyes with stage B-II DR; 28.2% still enjoyed 20/40 or better visual acuity by 5 years. Most cases had maintained the same visual acuity at 10 years. Eyes with stage B-III DR did not attain 20/40 vision by 10 years. Panretinal photocoagulation in cases with neovascularization of the optic nerve head was seen to be beneficial but limited, suggesting that such cases might benefit from maximal initial and supplemental PRP followed by vitrectomy and intraoperative endophotocoagulation when necessary. Although 20% of the eyes with stage B-IV and 25% of the eyes with stage B-V DR had 20/40 or better visual acuity, analyses of the visual change revealed that about half the eyes with stage B-IV and all eyes with stage B-V DR experienced a visual loss of two lines or more. CONCLUSIONS: Progression of lens opacities, chronic macular edema, vitreous hemorrhage, macular traction, and neovascular glaucoma were the main causes of visual loss in this series. Panretinal photocoagulation for PDR provides good anatomical and visual outcome for 10 years or longer.     

Personal experience in the treatment of proliferative diabetic retinopathy using an argon laser]

The authors evaluate a group of 44 eyes treated by panretinal photocoagulation by means of an argon laser on account of proliferative diabetic retinopathy. Complete regression of neovascularizations was achieved in 64%, partial regression in 23%, treatment failed in 13%. The resulting visual acuity of 6/12 or better was achieved in 57%, at least stabilization of visual acuity was achieved in 80%, the mean follow-up period being 2.3 years. The results of treatment with an argon laser was analyzed also separately for proliferative diabetic retinopathies of different grades. The authors confirm that advanced stages of proliferative diabetic retinopathy respond more poorly to panphotocoagulation and explain this by an assumed certain grade of autonomy in very advanced proliferative diabetic retinopathy. Therapeutic failure was observed only in a group of eyes with very advanced proliferative retinopathy. The authors also confirm the observation, that if a positive response to laser therapy develops within 3-6 weeks, this is a favourable prognostic sign. In neovascularizations of the retina they observed a more favourable response to panphotocoagulation than in neovascularizations on the disc of the optic nerve.     

Cystoid macular oedema following cataract extraction in patients with diabetes.

The course of cystoid macular oedema (CMO) following extracapsular cataract extraction with posterior chamber intraocular lens implantation was prospectively studied in 44 eyes of 44 consecutive diabetic patients without preoperative CMO. In 50% of eyes CMO was observed 6 weeks after surgery and in 25% was still present at 1 year. The preoperative presence of diabetic retinopathy significantly affected the postoperative onset and persistence of CMO. CMO occurred postoperatively in only 32% of eyes without pre-existing diabetic retinopathy and in 81% of eyes with pre-existing diabetic retinopathy (p < 0.05). CMO persisted at 1 year after surgery in only 7% of eyes without pre-existing diabetic retinopathy and in 56% of eyes in which diabetic retinopathy persisted (p < 0.01). Angiographic CMO (that is, detectable only on fluorescein angiography) was more common than clinical CMO (detectable on ophthalmoscopic examination as well) in eyes with no pre-existing diabetic retinopathy, whereas clinical CMO was seen more often than angiographic CMO when diabetic retinopathy was present preoperatively (p < 0.01). The course and final visual outcome of angiographic CMO were more favourable than in clinical CMO. Final visual acuity of at least 6/12 was achieved in 86% of eyes with angiographic CMO and in only 33% of eyes with clinical CMO. On the basis of the above findings we believe that cataract extraction should not be recommended for eyes with pre-existing diabetic retinopathy until the vision has deteriorated to at least 6/30-6/60.     

多焦视网膜电图及彩色多普勒在糖尿病视网膜病变早期诊断中的应用比较

目的 比较多焦视网膜电图（mfERG）与彩色多普勒在糖尿病视网膜病变（DR）早期诊断中的应用.方法 采用横断面研究,运用mfERLG检测正常对照组22例（22眼）、糖尿病无DR组52例（52眼）及DR单纯期组32例（32眼）.在上述患者中运用彩色多普勒测量视网膜中央动脉（CRA）的血流.采用单因素方差分析方法以及S-N-K法进行统计学分析.结果 糖尿病患者中,无DR组mfERG环1至环3中P1波反应密度低于正常对照组（P＜0.05）;CRA的血流则无异常变化（P＞0.05）.在DR单纯期组,mfERG除上述指标异常以外,Pt波潜伏期也出现延长（P＜0.05）.CRA的流速比正常对照组及无DR组降低（P＜0.05）.结论 在DR的临床早期诊断中,mfERG比彩色多普勒检测CRA血流的方法更敏感.     

糖尿病性黄斑水肿的光学相干断层扫描与荧光血管造影图像的对比分析

目的对比分析糖尿病视网膜病变患者的光学相干断层扫描(optical coherence tomography,OCT)与荧光血管造影(fluorescein angiographic,FA)图像。方法回顾性分析不同阶段糖尿病视网膜病变70例患者95眼的OCT和FA图像。结果OCT图像显示视网膜水肿占70.5%,囊样黄斑水肿(cystoid macular edema,CME)占13.7%,浆液性黄斑脱离并发水肿占4.2%,浆液性黄斑脱离并发水肿和CME占2.1%,正常黄斑结构占9.5%。结论OCT为糖尿病视网膜病变黄斑结构的变化提供了依据,特别是对FA未能发现的早期黄斑结构改变的诊断具有重要意义。     

Changes in diabetic retinopathy and visual acuity in patients with end-stage diabetic nephropathy after the introduction of hemodialysis

PURPOSE: To study the diabetic retinopathy (DR) and visual acuity in patients with end-stage diabetic nephropathy in the predialysis period and the changes after the initiation of hemodialysis at Tokyo Postal Service Agency Hospital (TPSAH). METHODS: We retrospectively analyzed the systemic conditions and the stage of DR and visual acuity in the medical records, of 24 patients 48 eyes (male: female=20 : 4) with diabetic nephropathy, who were started on hemodialysis between June 1994 and August 2003 at TPSAH, and were followed ophthalmologically more than 6 months after the start of hemodialysis. RESULTS: At the start of hemodialysis, 46 of 48 eyes (95.8%) had already been treated by retinal photocoagulation. The DR activity was assessed as "low" in 62.5% of the patients at the start of hemodialysis, but 6 months later, over 95% of the patients were assessed as having "low-activity". At the start of hemodialysis visual acuity was less than 0.1 in 21% of the eyes, and over 0.7 in 42% of the eyes, and the ratio was stable in the follow-up period. In 2 eyes the stage of diabetic retinopathy became worse by more than one grade in Fukuda's grading of diabetic retinopathy, and in 4 eyes more than a 2 grade alteration in visual acuity was observed. CONCLUSIONS: After the start of hemodialysis, DR became less active relatively early, and only a few eyes became worse in visual acuity and DR.     

糖尿病视网膜病变黄斑水肿的临床分析

目的 探讨糖尿病视网膜病变黄斑水肿（diabetic macular edema ,DME）分型与糖尿病视网膜病变(diabetic retinopathy, DR)分期、糖尿病病程以及视力损害之间的关系。 方法 回顾分析1 521例荧光素眼底血管造影(fundus fluorescein angiography，FFA )检查确诊的DR患者的FFA检查结果、病程、视力等临床资料。根据我国现行的DR诊断、分期标准对DR进行分期，按美国糖尿病视网膜病变早期治疗研究小组制定的标准对DME进行分型，分析统计各期DR中DME的发生率以及DME与病程、视力的关系。 结果 1521例患者中，468例791只眼存在DME，占30.77%。DME主要发生在糖尿病病程10年的患者，在此期间，DME 的发生率以及严重程度有逐年上升和加重的趋势。DME中黄斑局限性水肿361只眼，占DME患 者的45.64%；黄斑弥漫性水肿430只眼，占DME患者的54.36%。DME在DR I期中占1.13%；III 期中占7.84%；III期中占41.98%；IV期中占48.93%。V、VI期中，由于视网膜增生、玻璃体积血或者其他并发症的出现使DME的发现率较低。黄斑局限性水肿在DRIII期中居多，占22.51 % ，黄斑弥漫性水肿在DRIV期居多，占31.48%。但有部分患眼在DRI期出现了黄斑弥漫性水肿，而部分患眼在DR IV～V 期仍仅有局限性黄斑水肿。黄斑弥漫性水肿较局限性水肿对视力的损害更重。 结论 DME是DR引起视力损害的重要原因之一，随着糖尿病病程的延长，DME 的发生率增加，程度加重。DME的发生和分型与DR的程度有一定关系，但在时序上与我国现行的DR分期标准之间没有严格对应一致的关系。 （中华眼底病杂志，2003，19：83-86）     

不同眼轴眼振荡电位与糖尿病视网膜病变眼振荡电位相关性研究

目的比较不同眼轴眼振荡电位与糖尿病视网膜病变（DR）眼振荡电位幅值的相关性,研究不同眼轴患者视网膜微循环功能的变化。方法回顾性收集不同眼轴患者32例（32只眼）进行视网膜电流图检查,同时收集经荧光素眼底血管造影证实的Ⅲ期及Ⅳ期DR患者18例（30只眼）进行视网膜电流图检查,比较不同眼轴眼振荡电位与DR患者振荡电位的相关性。结果正常眼轴眼平均∑O为（143.81±42.47）μv,中等眼轴眼平均∑O为（93.93±28.93）μv,长眼轴眼平均∑O为（68.43±17.99）μv;Ⅲ期DR平均∑O为（108.19±21.21）μv,Ⅳ期DR平均∑O为（69.70±16.63）μv。比较5组之间的差异有统计学意义（F=16.896,P〈0.01）,中等眼轴患者∑O值与Ⅲ、Ⅳ期DR患者∑O值差异无统计学意义,长眼轴患者∑O值与Ⅲ期DR患者∑O值差异有统计学意义,与Ⅳ期DR患者∑O值差异无统计学意义。结论随着眼轴的逐渐增长,视网膜振荡电位逐渐下降。长眼轴患者视网膜的微循环功能低于Ⅲ期DR患者。     

The rhythmic ERG in the diagnosis of diabetic retinopathy in cataract patients

The paper describes a new method for diagnosing initial stages of diabetic retinopathy in the presence of cataract--analysis of amplitude parameters of averaged ERG. The usage of different frequency stimuli allows to separately judge about the state of peripheral (10 Hz) and central (40 Hz) segments of the retina. The stage of diabetic retinopathy can be judged by degree of depression of rhythmical ERG. Ophthalmoscopic and fluorescein angiographic verification of the method conducted in 70 patients (94 eyes) after cataract extraction confirmed its high informativeness.     

Primary color P-VEP in diabetic retinopathy

148 normal eyes and 123 eyes of diabetic retinopathy patients were examined the red, green, blue primary color and black/white P-VEPs, with the conclusion that the latencies of P100 were significantly delayed in the diabetic group, particularly that of the blue color, which was also in positive correlation with the level of blood sugar and the duration of diabetes. The consistency of blue P-VEP with fluorescein angiographic examination in diabetic retinopathy was good, and the abnormality ratio of the former (73.0%) was higher than that of the latter (60.2%). The results indicated that S-wave cones were damaged more readily than were L-wave cones, and the blue P-VEP was sensitive in monitoring the injury to visual function in diabetes.     

糖尿病性黄斑水肿的临床研究

目的探讨糖尿病性黄斑水肿（DME）分型与糖尿病性视网膜病变（DR）分期、视力损害及血糖控制等之间的相关性。方法采用回顾性病例研究的方法,随机选择符合标准的DME患者80例（139只眼）,回顾性分析患者视力、血糖控制情况和眼底等资料,探讨与DME分型的相关性。结果 80例（139只眼）DME患者中,局限性DME者59只眼,占42.4%,弥漫性DME者80只眼,占57.6%。DME在DR的Ⅰ～Ⅳ期中分别占3.6%、11.5%、36.7%和44.6%。弥漫性DME的视力损害比局限性DME的严重。血糖控制不好者,弥漫性DME的发生率高。结论 DME分型与DR分期、视力损害及血糖控制等之间有一定的相关性,随着DR病变严重程度的增加,DME发生的比率也随之增加;与局限型DME相比,弥漫型DME患者视力的损害较为严重;血糖控制不好者,发生弥漫性DME的可能性大。     

The correlation of the results of vitreous fluorophotometry and fluorescein angiography in nonproliferative diabetic retinopathy

The authors examined 103 eyes of 53 patients with insulin-dependent diabetes mellitus simultaneously by fluorescein angiography and vitreous fluorophotometry and correlated the stage of diabetic retinopathy with the posterior vitreous leakage (PVL) level, calculated from the preinjection-, bolus-, and measurement scans. There was a significant correlation between stage of retinopathy and PVL level, but there was a large variation of PVL readings within each group of retinopathy stages. All eyes were reexamined after a mean period of 11.84 months. In 15 of 16 eyes with progressive retinopathy the first PVL readings were within the distribution range of the respective retinopathy level. A progression of retinopathy was not accompanied by a significant change of the PVL. It was concluded that vitreous fluorophotometry alone is not sufficient for the grading of diabetic retinopathy and has only little prognostic value for the course of the disease.