非增生型糖尿病视网膜病变超广角眼底彩色照相与眼底自发荧光图像特征分析

目的　分析非增生型糖尿病视网膜病变（non-proliferative diabetic retinopathy，NPDR）超广角眼底彩色照相与眼底自发荧光（fudus autofluorescence，FAF）的图像特征。方法　使用欧堡全景200激光扫描检眼镜对40例（80眼）NPDR患者进行免散瞳模式下的超广角眼底彩色照相及FAF检查，对所有图像进行分析，得出两种模式下NPDR眼底改变的图像特征及阳性率。结果　超广角眼底彩色照相和FAF的图像质量基本一致，均能反映周边部视网膜的情况。在各种典型的眼底病变中，极其微小的血管瘤以及点片状视网膜出血的显影在FAF上有增强，有助于细微病变的诊断。渗出在FAF上的显影并不明显，分辨率不够。视网膜新鲜性光凝斑在两种模式检查上均显影清晰，陈旧性光凝斑在FAF上易与出血混淆，应谨慎诊断。结论　超广角眼底彩色照相图像清晰，周边部显示好，可以提供直观的视网膜图像；FAF可以观察到组织结构的细微改变及视网膜色素上皮细胞的代谢情况。两种模式相辅相成，能为NPDR的诊断、分期和治疗提供更好的帮助。     

中心视网膜厚度对非增生型糖尿病视网膜病变眼底血管充盈状态的影响

目的 观察中心视网膜厚度对非增生型糖尿病视网膜病变(NPDR)眼底血管充盈状态的影响.方法 眼科及内分泌科住院治疗的无眼底病变的糖尿病患者及NPDR患者248例248只右眼纳入研究.所有患者均行光相干断层扫描(OCT)、荧光素眼底血管造影(FFA)、眼部彩色多普勒血液成像(CDFI)检查.排除中心视网膜有明显水肿、出血、渗出的其它眼底病变者.OCT测量距黄斑中心注视点1、1～3、3～6 mm处中心视网膜厚度,将患者按中心视网膜厚度分人视网膜厚度正常、变薄、增厚组.确定中心视网膜厚度正常范围为216.4～304.9 μm.中心视网膜厚度介于216.4～304.9 μm者纳入视网膜厚度正常组,＜216.4 μm者纳入视网膜厚度变薄组,＞304.9 μm者纳入视网膜厚度增厚组.FFA检查时,观察并记录臂-视网膜循环时间、视网膜动脉期-静脉期(A-V)荧光充盈时间.CDFI检查时,检测各组患者眼动脉(OA)、视网膜中央动脉(CRA)及睫状后短动脉(PCA)的收缩峰值速度(PSV)、搏动指数(PI)及阻力指数(RI).对比观察不同视网膜厚度组眼底血管充盈状态及眼部血流动力学指标异同.结果 视网膜厚度正常、变薄、增厚组患者的臂-视网膜循环时间分别为(10.42±0.51)、(10.36±0.64)、(12.94±0.46)s;视网膜A-V荧光充盈时间分别为(9.15±1.36)、(6.36±1.15)、(13.56±2.04)s.视网膜厚度增厚组与视网膜厚度正常组间(t=1.93,P=0.04)、视网膜厚度增厚组与视网膜厚度变薄组间(t=4.49,P=0.00)臂-视网膜循环时间比较,差异有统计学意义;视网膜厚度变薄组与视网膜厚度正常组间(t=2.13,P=0.03)、视网膜厚度增厚组与视网膜厚度正常组间(t=2.49,P=0.02)、视网膜厚度增厚组与视网膜厚度变薄组间(f=5.38,P=0.00)视网膜A-V荧光充盈时间比较,差异有统计学意义.视网膜厚度增厚组与视网膜厚度变薄组间OA、CRA、PCA的PSV(t=3.290、-5.520、-4.900)、PI(t=-4.310、-5.230、-4.390)、RI(t=4.970、6.160、5.990)比较,差异均有统计学意义(P＜0.05).结论 中心视网膜厚度对无眼底病变的糖尿病患者及NPDR患者眼底血管充盈状态有明显影响.     

糖尿病视网膜病变中微动脉瘤荧光素渗出与视网膜增厚的关系

目的:观察糖尿病视网膜病变患者血管荧光素造影微动脉瘤处渗出与视网膜增厚的关系。方法:选取糖尿病视网膜病变患者24例38眼,首次及末次血管荧光素造影检查确定是否存在微动脉瘤荧光素渗出。根据毛细血管闭塞区的位置选取微动脉瘤荧光素渗出与未渗出各1眼配对进行对比。在微动脉瘤和直径为1mm区域使用光学相干断层成像术(OCT)测量视网膜厚度。结果:微动脉瘤荧光素渗出眼视网膜厚度明显高于未渗出眼(356±69μmvs318±56μm,P<0.001),渗出眼平均增长厚度高于未渗出眼(95%的可信区间为25～51μm,P<0.001).在直径为1mm区域,渗出眼视网膜厚度和平均增长厚度均明显高于未渗出眼(351±67μmvs319±59μm;最小值311±62μmvs284±60μm;最大值389±78μmvs352±66μm)。结论:血管荧光素造影显示微动脉瘤荧光素渗出可以增加视网膜厚度,并运用高分辨率OCT测量。因此,对糖尿病视网膜病变患者早期诊断微动脉瘤荧光素是否渗出可以抑制视网膜增厚。     

Correlation of leaking microaneurysms with retinal thickening in diabetic retinopathy

AIM: To investigate the contribution of fluorescein angiographic leaking microaneurysms (leak-MA) versus non-leaking microaneurysms (non-leak-MA) to retinal thickening in diabetic retinopathy. METHODS: A consecutive series of 38 eyes from 24 patients with diabetic retinopathy was included. Leak-MA and non-leak-MA in each eye were selected in pairs at corresponding topographic location. Leaking was defined by late phase fluorescein angiograms compared to early phase. Retinal thickness was measured with Heidelberg Spectralis OCT topographically aligned on early phase angiograms at the MA site and within a 1 mm circle. RESULTS: In all eyes, significant retinal thickening at the site of leaking compared to non-leaking microaneurysms was observed (356±69μm vs 318±56μm, P <0.001), showing a mean increase in thickness in the areas of leak-MA vs non-leak-MA of 38±39μm (95% confidence interval 25-51μm, P<0.001). All 1mm area measurements also showed significant (P<0.001) thickening of the leak-MA with average thickness of leak-MA vs non-leak-MA as 351±67μm vs 319±59μm; minimum thickness 311±62μm vs 284±60μm; maximum thickness 389±78μm vs 352±66μm; and retina volume 26.4±6.0mm vs 23.6±3.7mm3, respectively. CONCLUSION: Leaking of microaneurysms on fluorescein angiography appears to cause focal thickening of retina, which can be measured with high-resolution OCT. Therefore, targeting leaking microaneursyms in diabetic retinopathy has the potential to reduce retinal thickening.     

重度非增生性与增生性糖尿病视网膜病变多焦视网膜电图一阶函数核的特征分析

目的对比并分析糖尿病视网膜病变(diabetic reti-nopathy,DR)重度非增生期及增生期的多焦视网膜电图(mul-tifocal electroretinogram,mERG)一阶函数核的变化特征。方法选取DR患者46例72眼分为2组:一组为重度非增生性糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)患者23例38眼,另一组为增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者23例34眼。设立对照组为正常健康人23例34眼。采用罗兰的多焦视觉电生理检查仪进行mERG一阶函数核反应检查,提取数据后分析比较2组患者mERG1~5环的N1波、P1波的振幅密度值及峰时值。结果PDR组的N1波和P1波的振幅密度值比NPDR组下降,第1环的差异均有显著统计学意义,2~5环N1波的差异无统计学意义,P1波的差异有统计学意义;PDR组的N1波和P1波的潜伏期比NPDR组延迟,2种波形第1环的差异均无统计学意义,2~5环的差异有统计学意义(N1波4环除外)。结论DR从非增生期进入增生期,mERG一阶函数的N1和P1波在黄斑中心凹区振幅密度值下降明显,而在黄斑区外视网膜则以潜伏期的延长为明显。N1和P1波的振幅密度值对反映视细胞功能更为敏感,而潜伏期则可能与视网膜缺血的关系相对密切。     

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。     

糖尿病视网膜病变新生血管程度与眼轴长度的关系

目的：评估糖尿病视网膜病变新生血管程度与眼轴长度的相关性。方法：选取我院2012－12／2015－01收治的增殖期糖尿病视网膜病变患者146例189眼作为观察组,对患者行常规眼部检查,经眼底荧光血管造影检测,将患者按眼底情况不同分成Ⅳ期、Ⅴ期与Ⅵ期,同时随机抽取糖尿病无视网膜病变患者146例292眼作为对照组,记录各组眼轴长度。结果：观察组患者眼轴长度为22．03±0．92mm,对照组眼轴长度为24．14±0．78mm,两组相比,差异有统计学意义（t＝7．272,P＝0．024）。在观察组中患眼眼轴越长,糖尿病视网膜病变新生血管程度越轻,且为负相关。结论：较长的眼轴长度对于糖尿病患者有保护作用,在临床工作中,测量糖尿病患者眼轴长度对于预测糖尿病视网膜病变有一定的指导意义。     

糖尿病视网膜病变振荡电位和荧光血管造影的相关性

目的 :研究在荧光素钠血管造影 (FA)和吲哚青绿血管造影 (ICGA)下糖尿病视网膜病变 (DR)在不同阶段、形态改变时的振荡电位 (OPs) ,了解DR的功能学与形态学改变的特点及其之间的联系。方法 :选择 4 9名糖尿病患者(89只患眼 ) ,按在FA下DR的不同阶段分 4组 (88眼 ) ,按ICGA分 2组 (6 0眼 ) ,选择 4 3只正常眼为对照组 ,对所有眼按国际标准化方法进行OPs检测。结果 :OPs总和振幅在FA有改变时下降 ,OP2 振幅在FA无改变时下降 ,有改变时进一步下降 ;无灌注期与新生血管期的OPs总和振幅及各子波振幅改变相同 ;ICGA晚期 ,部分眼出现晚期弥散性高荧斑和极晚期高荧伴低荧的“椒盐状”外观 ,与此相应 ,OP3 振幅和OP4潜伏期较对照组下降和延长。结论 :OP2 振幅较OPs总和振幅在DR早期诊断方面敏感 ,无灌注期和新生血管期的视网膜循环状态相似 ,无灌注区可与新生血管一样作为DR进展的质变标志 ,ICGA后期改变与OPs的指标有一定联系     

非增殖性糖尿病视网膜病变患者中血生化指标与脉络膜厚度的关系

目的:研究初治非增殖性糖尿病视网膜病变(NPDR)患者中血生化指标与脉络膜厚度(CT)的关系。方法:前瞻性横断面研究。选取2021-07/2022-07在南昌大学附属眼科医院就诊且初次治疗的NPDR患者92例92眼。所有纳入本研究的患者均行深度增强光学相干断层扫描(EDI-OCT)、最佳矫正视力(BCVA)、眼底荧光血管造影、眼压、裂隙灯、散瞳眼底等眼科检查及血糖、糖化血红蛋白、血肌酐、尿酸、尿素、β2微球蛋白、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、血清钙及血清钾等血液学检查。根据患者的肾小球滤过率(eGFR)及CT将纳入研究的患者分为肾功能正常、轻度异常及中重度异常三组和厚脉络膜及薄脉络膜两组。分析初治NPDR患者的血生化指标、CT的差异以及血生化指标与CT的相关性。结果:共92例92眼纳入本研究,其中男51例51眼,女41例41眼,右眼45眼,左眼47眼。三组年龄、眼轴、病程比较均无差异(均P>0.05)。三组鼻侧0.5、1.5mm、中心凹下、颞侧0.5、1.5mm的CT均具有显著差异(均P<0.05)。厚脉络膜组与薄脉络膜组年龄、病程及眼轴比较均无差异(均P...     

Midperipheral fundus involvement in diabetic retinopathy

We evaluated the topologic distribution of vaso-occlusive and vasoformative lesions in 119 eyes with diabetic retinopathy using our newly developed super-wide (130 degrees) fluorescein angiographic montage technique. A numeric coding system was applied to assess the vaso-occlusive lesions by dividing each fundus maximally into 418 blocks. We demonstrated that the midperipheral retina was far more prone to undergo capillary nonperfusion than the posterior retina. The extent of capillary nonperfusion was more pronounced in eyes with neovascularization from (in ascending order): the retina, the optic disc, and in the chamber angle.     

糖尿病并发视网膜病变与伴发周围神经病变的关系探讨

目的探讨糖尿病并发视网膜病变(DR)与伴发周围神经病变(DPN)的相关关系。方法设实验组和对照组,实验组分为有视网膜病变组(DR组)和无视网膜病变组(NDR组)。三组均进行体感诱发电位检查,测定感觉神经传导速度(SCV)。实验组患者根据荧光眼底血管造影(FFA)结果进行分期。结果DR组与对照组间SCV值差异非常显著(P<0.01)。DR组与NDR组比较,SCV值亦有非常显著性差异(P<0.01)。随着视网膜病变的发展由Ⅰ期至Ⅵ期,周围神经病变的发生率逐期递增。结论DR与DPN的发生二者间具有平行关系,DPN的发生率高于DR,所有增殖期DR患者均伴有DPN改变。了解DR与DPN的伴发规律,可能有助于临床对二者病情演变的估计。     

Vascular basement membrane thickening in diabetic retinopathy

Vascular basement membrane (BM) thickening is a fundamental structural alteration of small blood vessels in diabetes. Over two decades of research has established hyperglycemia as the primary causal factor mediating this alteration. Various high glucose-induced mechanisms have been investigated and excess synthesis of BM components has been identified as a major contributing factor to BM thickening. Although BM thickening has been long hailed as the histological hallmark of diabetic microangiopathy, the consequences of BM thickening on the functionality of target organs of diabetes remain elusive even today. This review presents an overview of our current understanding of the BM structure and function, and focuses on how capillary BM thickening develops, its effect on retinal vascular function, and potential strategies for preventing the development of BM thickening in diabetic retinopathy.     

视网膜电图PhNR和OPs在非增生型DR中的变化特点

目的观察非增生型糖尿病视网膜病变（DR）中视网膜电图PhNR和OPs的变化特点,比较OPs、PhNR指标在早期诊断及评估视网膜功能的敏感性和特异性。方法选取经间接检眼镜、荧光素眼底血管造影（FFA）确诊的DR患者30例（30眼）,同时选取与其性别、年龄相匹配的正常对照25例（25眼）作为对照组。2组均进行视力、闪光视网膜电图（F-ERG）、FFA检查。比较2组PhNR振幅、OPs振幅及ERG其他参数指标,并探讨不同DR分级与PhNR振幅、OPs振幅的变化关系。结果在OPs指标中,DRⅠ~Ⅳ级OPs振幅与正常值比较差异均有统计学意义（P〈0.05）,PhNR指标显示,DRⅠ级PhNR振幅与正常值比较,差异无统计学意义（P〉0.05）,DRⅡ~Ⅳ级与正常组比较,差异均有统计学意义（P〈0.05）。在比较各参数ROC下面积（AUC）中,OPs指标的AUC最高,为0.866;其次是PhNR指标,AUC为0.754。OPs诊断NPDR的敏感性和特异性分别为63.6%和80%,而PhNR的敏感性和特异性分别为54.5%和73.3%。结论DR在病变初期即出现血液循环性改变、神经细胞功能障碍,表现为PhNR振幅和OPs振幅均明显降低。OPs指标在DR的早期诊断及评估视网膜功能方面敏感性和特异性更高。     

Comparison between ophthalmoscopy and fundus photography in determining severity of diabetic retinopathy

Diabetic retinopathy was assessed in a population-based study of 2708 diabetic persons in southern Wisconsin. The retinopathy levels as determined by ophthalmoscopy and by the grading of stereoscopic fundus photographs were compared in the eyes of 1949 persons. Ophthalmoscopy was performed by an ophthalmologist and a specially trained optometrist and ophthalmic technician. Consultation among the three examiners was permitted. There was exact agreement between ophthalmoscopy and grading for detecting retinopathy (none, nonproliferative, proliferative) 85.7% of the time. The kappa statistic, which corrects for chance agreement, was 0.749. There were no significant differences among the three ophthalmoscopists. Ophthalmoscopy was more likely to disagree with fundus photography grading in eyes with less severe forms of retinopathy and in patients examined early in the study. Other factors found to influence the degree of agreement were age, visual acuity, and duration of diabetes. It is concluded that with proper training ophthalmoscopy can be an acceptable alternative to fundus photography in certain situations.