糖尿病患者有临床意义黄斑水肿的OCT临床分型

目的 用光学相干断层扫描(OCT)研究糖尿病患者有临床意义的黄斑水肿(CSME)的临床分型.方法 对75例患者104只眼,经裂隙灯三面镜检查诊断为糖尿病性视网膜病变Ⅰ-Ⅳ期(包括Ⅳ期)者,行眼底荧光血管造影(FFA)及黄斑区光学相干断层扫描(OCT)检查,根据1985年CSME诊断标准诊断为CSME,对其OCT图像进行分型.结果 糖尿病患者CSME的OCT分型分为五型:弥漫性黄斑水肿占37.5%(39/104),黄斑囊样水肿占20.2%(211104),弥漫性黄斑水肿伴浆液性神经上皮层脱离占18.3%(191104),黄斑前膜伴神经上皮层水肿占13.5%(14/104),后玻璃体牵引伴黄斑水肿10.6%(11/104);另有黄斑前膜伴裂孔形成1例.结论 OCT对CSME的诊断以及治疗后的随访有重要的价值,是临床观察CSME必不可少的检查手段.     

Ranibizumab治疗糖尿病性黄斑水肿短期疗效观察

目的 观察玻璃体内注射Ranibizumab治疗糖尿病性黄斑水肿的短期疗效.方法 在我院诊断为糖尿病性黄斑水肿患者34例(46眼),应用药物治疗、激光治疗或手术治疗,黄斑水肿无改善或持续加重,应用Ranibizumab 0.5 mg(0.05 mL)玻璃体内注射,术后随访12个月,根据眼底、视力及OCT检查决定是否再次注射.结果 所有患者玻璃体内注射Ranibizumab无局部和全身并发症.每眼注射次数为1～4次,平均2.39次,重复注射时间为注射后1.0～1.5个月.46眼注射后12个月视力不同程度提高者44眼,2眼保持不变,注射后7d、1个月、6个月、12个月最佳矫正视力分别提高2.32个、3.47个、5.34个和6.25个字母.OCT检查结果显示注射Ranibizumab后黄斑区视网膜水肿明显减轻,首次注射后7d、1个月、6个月、12个月黄斑中心视网膜厚度值分别为(425±38) μm、(372±41) μm、(294±32) μm和(276±25) μm,与注射前(647±42) μm相比差异均有统计学意义(均为P ＜0.05).结论 对于糖尿病性黄斑水肿患者,玻璃体内注射Ranibizumab具有很好的安全性和有效性,可明显促进黄斑水肿吸收,提高视力,OCT检查可作为评价是否需要再次注射的标准.     

糖尿病性黄斑水肿的FFA与OCT的应用对比

目的:探讨糖尿病性黄斑水肿FFA与OCT的应用及其相互关系。方法:对70例135眼糖尿病性黄斑水肿患者行中心视力、最佳矫正视力、眼压、直接检眼镜、裂隙灯显微镜联合+90D前置镜散瞳眼底检查、散瞳眼底彩色照相、相干光断层扫描(OCT)、荧光素眼底血管造影(FFA)检查,并将相干光断层扫描和荧光素眼底血管造影结果比较分析。结果:轻度水肿时,FFA表现异常56眼,OCT表现异常68眼(P=0.0009);FFA表现正常12眼中,其OCT检查有10眼为海绵样改变;FFA表现为囊样型的,其OCT表现为囊样型占46.7%。结论:FFA,OCT联合应用于诊断糖尿病性黄斑水肿,而OCT作为临床随访DME是必不可少的检查手段,早期应用有优势。     

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。     

光学相干断层扫描在糖尿病性黄斑水肿的诊断

目的阐明糖尿病性黄斑水肿的光学相干断层扫描(Optical coherence tomography,OCT)特征.方法对37例61眼糖尿病合并黄斑区水肿患者进行OCT检查及资料分析.结果 (1)黄斑区局限性水肿者OCT图像:①11眼表现为局限性视网膜层间海绵样增厚;②2眼为单纯性小范围神经上皮层浆液性脱离.(2)黄斑区及其周围弥漫性水肿者OCT图像:①12眼表现弥漫性视网膜层间海绵样膨胀增厚;②7眼可见包括中心凹的视网膜层间海绵样膨胀在内的神经上皮层脱离;③29眼表现为黄斑囊样水肿.(3)61跟中发现有22眼伴玻璃体部分后脱离,5眼伴玻璃体完全性后脱离.结论糖尿病性视网膜黄斑水肿的OCT图像为临床提供类似病理学的直观资料,尤其对治疗的随诊及判定预后具有重要参考价值.     

糖尿病黄斑水肿患者病变程度与脉络膜厚度的关系

目的　利用频域光学相干断层扫描深度增强（enhanced depth imaging spectral domain optical coherence tomography，EDI SD-OCT）观察糖尿病黄斑水肿（diabetic macular edema，DME）患者脉络膜厚度（choroidal thickness，CT）的变化及结构特点，探讨DME病变程度与CT的关系。方法　纳入2型糖尿病患者共123例204眼，其中69眼诊断为DME（DME组），135眼无黄斑水肿为对照组。DME眼依据OCT形态学特点进一步分为视网膜弥漫性增厚（diffuse retinal thickness，DRT）型（34眼）、黄斑囊样水肿（cystoid macular edema，CME）型（19眼）和浆液性视网膜脱离（serous retinal detachment，SRD）型（16眼），利用EDI-OCT分别测量黄斑中心凹下CT和以黄斑为中心上、下、鼻、颞500 μm、1000 μm、1500 μm、2000 μm处CT。结果　DME组黄斑中心凹下CT为（326.72±90.15）μm，对照组为（320.17±106.46）μm，两组之间无统计学差异，但黄斑中心凹下CT与视网膜厚度间具有明显正相关关系（r=0.270，P=0.025）。DME亚型CT分别为:DRT型（303.94±81.47）μm、CME型（304.42±73.98）μm和SRD型（401.63±88.80）μm，SRD型CT明显高于其他亚型（P<0.05），此外，SRD型的周边CT同样呈现均匀一致的增厚；鼻侧CT从500 μm至2000 μm呈距离敏感性降低（P<0.05），但SRD型鼻侧CT降低幅度明显变缓（P=0.195）。结论　SRD型黄斑水肿患者CT在中心凹下及周边部均显著增厚，CT与DME病变程度之间有一定相关性。     

糖尿病黄斑水肿的诊断和治疗进展

糖尿病黄斑水肿(DME)的发病率正逐渐上升,其作为导致糖尿病患者视力不可逆丧失的主要原因,一直受到医学研究者的关注。目前,在应用诸如光学相干断层扫描和抗血管内皮生长因子等针对DME的诊疗方法的同时,多种新兴的解决方案正在被研发。因此,本文将对现有DME的诊断和治疗方案进行总结讨论,以期为未来DME诊疗标准的统一奠定基础。     

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。     

OCT在糖尿病性黄斑水肿激光治疗中的应用

目的:探讨光学相干断层扫描(optical coherence tomography,OCT)在糖尿病性黄斑水肿(diabetic macular edema,DME)激光治疗后临床观察中的应用.方法:回顾性病例研究,选取2015-01/2016-06在秦皇岛市海港医院行黄斑区格栅样光凝治疗的DME患者188例376眼,治疗1 mo后利用OCT检测黄斑区6 mm范围内视网膜厚度,采用SPSS19.0统计软件对所得数据进行分析.结果:格栅样光凝1 mo后,患者黄斑中心凹至1mm、黄斑1~3 mm、黄斑3~6 mm平均视网膜神经上皮层厚度分别为332.02±18.07、393.40±19.71、372.00±20.01μm,与治疗前(404.70±16.37、445.17±18.25、410.87±18.14μm)比较,差异具有统计学意义(P<0.05).三者厚度变化分别为72.68±14.74、51.77±9.48、38.87±17.94μm,组间及两两比较,差异具有统计学意义(P<0.05).结论:DME经格栅样光凝治疗1mo后黄斑区视网膜神经上皮层厚度降低,并且越接近黄斑中心凹处,降低作用越明显.     

糖尿病性黄斑水肿与激光治疗

糖尿病性黄斑水肿（diabetic macular edema，DME）是导致糖尿病患者视力损害的常见原因，自1962年激光应用于糖尿病视网膜病变治疗以来，根据资料和研究表明激光治疗黄斑水肿可以稳定和提高患者的视力。本文就DME的病因分型、发病机制、治疗（主要是激光治疗的原理、治疗方法、治疗效果及副作用）相关问题和合理应用进行综述。     

Observational study of subclinical diabetic macular edema

Purpose

To determine the rate of progression of eyes with subclinical diabetic macular edema (DME) to clinically apparent DME or DME necessitating treatment during a 2-year period.

Methods

In all, 43 eyes from 39 study participants with subclinical DME, defined as absence of foveal center edema as determined with slit lamp biomicroscopy but a center point thickness (CPT) between 225 and 299 μm on time domain (Stratus, Carl Zeiss Meditec) optical coherence tomography (OCT) scan, were enrolled from 891 eyes of 582 subjects screened. Eyes were evaluated annually for up to 2 years for the primary outcome, which was an increase in OCT CPT of at least 50 μm from baseline and a CPT of at least 300 μm, or treatment for DME (performed at the discretion of the investigator).

Results

The cumulative probability of meeting an increase in OCT CPT of at least 50 μm from baseline and a CPT of at least 300 μm, or treatment for DME was 27% (95% confidence interval (CI): 14%, 38%) by 1 year and 38% (95% CI: 23%, 50%) by 2 years.

Conclusions

Although subclinical DME may be uncommon, this study suggests that between approximately one-quarter and one-half of eyes with subclinical DME will progress to more definite thickening or be judged to need treatment for DME within 2 years after its identification.     

Impact of COVID-19-related lifestyle changes on diabetic macular edema

AIM: To assess diabetic macular edema (DME) progression during the early phases of the COVID-19 pandemic, when severe societal restrictions raised the concern of possible deterioration of health in patients with systemic conditions, particularly those requiring frequent office visits. METHODS: This is a multicenter retrospective chart review of 370 patients (724 eyes) with an established diagnosis of DME seen on 3 separate visits between January 2019 and July 2021. Period 1 was January 2019 to February 2020 (considered pre-COVID-19), period 2 was March 2020 to December 2020 (considered the height of the pandemic; highest level of pandemic-related clinical and societal regulations) and period 3 was January 2021 to July 2021 (re-adjustment to the new “pandemic norms”). Main outcome measures included visual acuity, body mass index (BMI), blood pressure (BP), hemoglobin A1c (HbA1c), macular thickness, patient adherence to scheduled ophthalmology visits, and DME treatment(s) received at each visit. To facilitate measurement of macular thickness, each macula was divided into 9 Early Treatment Diabetic Retinopathy Study (ETDRS)-defined macular sectors as measured by OCT imaging. RESULTS: There was no change of BMI, systolic BP, and diastolic BP between any of the time periods. HbA1c showed a very small increase from period 1 (7.6%) to period 2 (7.8%, P=0.015) and decreased back to 7.6% at period 3 (P=0.12). Macular thickness decreased for 100% of macular regions. The central macular thickness decreased across all 3 periods from 329.5 to 316.6 μm (P=0.0045). After analysis of multiple variables including HbA1c, BMI, adherence to scheduled appointments, different clinic centers, and treatment interventions, there was no easily identifiable subgroup of patients that experienced the increase in DME. CONCLUSION: DME doesn’t worsen during the COVID-19 pandemic, instead sustaining a very small but statistically significant improvement. While identifying a mechanism behind our findings is beyond the scope of this study, potential explanations may include a delay in retinal changes beyond our study period, an unexpected increase in treatment frequency despite pandemic restrictions, and an unanticipated pandemic-related improvement in some lifestyle factors that may have had a positive impact on DME.     

非诺贝特在糖尿病性黄斑水肿中的临床研究

目的　观察非诺贝特在视网膜光凝后糖尿病性黄斑水肿（ｄｉａｂｅｔｉｃｍａｃ-ｕｌａｒｅｄｅｍａ,ＤＭＥ）中的疗效。方法　观察３８例（６７眼）已完成视网膜光凝的ＤＭＥ患者,其中１５例（２３眼）为增生型糖尿病性视网膜病变,２３例（４４眼）为非增生型糖尿病性视网膜病变;随机分为两组,其中Ａ组２０例（３５眼）口服非诺贝特＋复方血栓通胶囊,Ｂ组１８例（３２眼）单独口服复方血栓通胶囊,两组均连续服药２８ｄ,２８ｄ后采用光学相干断层扫描随诊观察两组黄斑中心凹视网膜平均厚度（ａｖｅｒａｇｅｆｏｖｅａｌｒｅｔｉｎａｌｔｈｉｃｋｎｅｓｓ,ＡＦＲＴ）、平均黄斑容积（ａｖｅｒａｇｅｍａｃｕｌａｒｖｏｌ-ｕｍｅ,ＡＭＶ）、黄斑区视网膜平均厚度（ａｖｅｒａｇｅｍａｃｕｌａｒｔｈｉｃｋｎｅｓｓ,ＡＭＴ）,并观察两组视力情况。结果　用药２８ｄ后,在视力改善方面Ａ组优于Ｂ组,差异有统计学意义（Ｐ＜０．０５）;Ａ组ＡＦＲＴ、ＡＭＶ、ＡＭＴ均较用药前明显减少,差异均有统计学意义（均为Ｐ＜０．０５）;Ｂ组ＡＦＲＴ、ＡＭＶ、ＡＭＴ均较用药前稍有增加,差异均有统计学意义（均为Ｐ＜０．０５）;Ａ组患者用药后黄斑水肿消退各指标（ＡＦＲＴ、ＡＭＶ、ＡＭＴ）较Ｂ组明显减少,差异均有统计学意义（均为Ｐ＜０．０５）。结论　非诺贝特能改善ＤＭＥ患者视力,有效促进视网膜光凝后黄斑水肿的吸收。     

Optical coherence tomography for assessment of diabetic macular edema

Optical coherence tomography (OCT) is a noninvasive objective diagnostic technique that has become a powerful method for the clinical assessment of diabetic macular edema. It is a very useful imaging technique to diagnose and follow-up diabetic macular edema (DME). The present paper aims to present an overview of the principles, progress, and uses of OCT in the diagnosis and management of DME.     

Green-light fundus autofluorescence in diabetic macular edema

AIM:To evaluate the role of central green-light fundus autofluorescence (FAF) in diabetic macular edema (DME).METHODS: A consecutive series of 92 study eyes with diabetic retinopathy were included. Out of those, 51 diabetic eyes had DME and were compared to 41 diabetic eyes without DME. In all subjects, green-light FAF images were obtained, quantified and classified into various FAF patterns. Cross-sectional optical coherence tomography (OCT) scans were obtained for evaluation of Inner/Outer segment (IS/OS) layer integrity, measurements of central RPE-IS/OS layer thickness as well as classification of DME into various subtypes.RESULTS:Mean central green-light FAF intensity of eyes with DME (1.289±0.140)log did not significantly differ from diabetic patients without DME (1.317±0.137)log. Most classifiable FAF patterns were seen in patients with cystoid DME. Mean central retinal thickness (CRT) of all study eyes with DME was (501.9±112.4)µm compared to (328.2±27.0)µm in diabetic patients without DME. Patients with DME had significantly more disrupted photoreceptor IS/OS layers than diabetic patients without DME (28/51 vs 5/41, P<0.001). Mean RPE-IS/OS thickness of patients with DME (60.7±14.1)µm was significantly (P<0.001) lower than in diabetic eyes without DME (73.5±9.4)µm. Correlation analys1s revealed non-significant correlations of green-light FAF intensity and OCT parameters in all subtypes of DME.     

非增生型糖尿病视网膜病变患者黄斑水肿与中心凹下脉络膜厚度的关系

目的 观察非增生型糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)伴临床有意义的黄斑水肿(clinically significant macular edema,CSME)时黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)的情况,探讨糖尿病患者SFCT与糖尿病视网膜病变发生发展的关系.方法 按2014年我国糖尿病视网膜病变临床诊疗指南分期标准将NPDR患者分为伴CSME(NPDR CSME+)组15例(21眼),不伴CSME(NPDR CSME-)组21例(36眼).比较两组之间最佳矫正视力、黄斑中心凹视网膜厚度(central retinal thickness,CRT)及SFCT是否存在差异性.采用SPSS 18.0软件进行统计学分析处理.结果 NPDR CSME+组与NPDR CSME-组间性别、眼别、年龄、眼轴长度、眼压相比差异均无统计学意义(均为P＞0.05),两组间最佳矫正视力相比差异有统计学意义(P =0.001).NPDR CSME+组SFCT为(328.24±101.92) μm,NPDR CSME-组为(235.31±66.98)μm,两组间差异具有统计学意义(t=4.156,P=0.000).NPDR患眼CRT与SFCT呈正相关关系(r=0.473,P=0.000).结论 NPDR伴有CSME时,SFCT显著增厚,并且SFCT的增厚与CSME的发生发展具有一定相关性.     

光学相干断层扫描技术在糖尿病黄斑水肿的应用

光学相干断层扫描技术是一种高分辨率,非接触性的生物组织成像技术,能在活体上动态的观察一些眼底疾病发生发展的过程,近年来光学相干断层扫描技术在对糖尿病黄斑水肿的临床诊治和研究工作中发挥了很大的作用。本文就光学相干断层扫描技术对糖尿病黄斑水肿的应用作一综述。     

Intravitreal injection of conbercept for diabetic macular edema complicated with diabetic nephropathy

AIM: To observe the therapeutic effect of conbercept on diabetic macular edema (DME) complicated with diabetic nephropathy (DN). METHODS: In this retrospective study, 54 patients (54 eyes) that diagnosed as DME from January 2017 to October 2021 were collected. The patients were divided into two groups: DME patients with DN (25 eyes), and DME patients without DN (29 eyes). General conditions were collected before treatment, laboratory tests include fasting blood glucose, HbA1c, microalbumin/creatinine, serum creatinine. Optical coherence tomography (OCT) was used to check the ellipsoidal zone (EZ) and external limiting membrane (ELM) integrity. Central macular thickness (CMT), best corrected visual acuity (BCVA), and retinal hyperreflective foci (HF) as well as numbers of injections were recorded. RESULTS: There were significant differences between fasting blood glucose, HbA1c, serum creatinine, urinary microalbumin/creatinine, and estimated glomerular filtration rate (eGFR) between the two groups (all P<0.05). EZ and ELM continuity in the DME+DN group was worse than that in the DME group (P<0.05). BCVA (logMAR) in the DME group was significantly better than that in the DME+DN group at the same time points during treatment (all P<0.05). CMT and HF values were significantly higher in the DME+DN group than that in the DME group at the all time points (all P<0.05) and significantly decreased in both groups with time during treatment. At 6mo after treatment, the mean number of injections in the DME+DN and DME group was 4.84±0.94 and 3.79±0.86, respectively. CONCLUSION: Conbercept has a significant effect in short-term treatment of DME patients with or without DN, and can significantly ameliorate BCVA, CMT and the number of HF, treatment efficacy of DME patients without DN is better than that of DME patients with DN.     

糖尿病黄斑水肿的临床诊断方法比较

目的 对比分析糖尿病黄斑水肿患者光学相干断层扫描(optical coherence tomo-graphy,OCT)、荧光素眼底血管造影(fluorescein fundus angiography,FFA)及裂隙灯显微镜下+90 D前置镜检查所观察到的图像特征,探讨3种检查方法的诊断价值.方法 分析51例(94眼)临床确诊为糖尿病视网膜病变患者的OCT、FFA及裂隙灯显微镜下+90 D前置镜检查结果,将结果进行一致性比较,并观察分析OCT、FFA图像特征,所得结果行单因紊方差分析.结果 OCT与FFA及FFA与+90 D前置镜检查结果有较好的一致性,符合率分别为88.3%、69.1%.OCT、FFA与+90 D前置镜裂隙灯显微镜下检查结果对糖尿病黄斑水肿的检出率分别是86.2%、83.0%及62.8%.OCT所测得的黄斑中心凹平均视网膜厚度值在无渗漏时最低,并随局限性渗漏、弥漫性渗漏、局限合并弥漫性渗漏、黄斑囊样水肿依次增加,经比较它们之间的差异均具有统计学意义(F=40,P均<0.05).结论 OCT能客观的提供糖尿病患者黄斑区结构的变化,尤其对+90D前置镜裂隙灯显微镜下检查及FFA还没有明确变化的早期黄斑水肿诊断敏感.三者的联合应用为揭示糖尿病病理机制、临床诊断糖尿病黄斑水肿、判断糖尿病黄斑水肿的类型及其最佳治疗方案提供参考依据.