糖尿病黄斑水肿患者黄斑中心凹下脉络膜厚度观察

目的 观察糖尿病黄斑水肿（DME）患者中心凹下脉络膜厚度（SFCT）的变化。方法 横断面观察研究。20例DME患者32只眼纳入研究。男性12例,女性8例。平均年龄（57.6±9.3）岁。均行最佳矫正视力（BCVA）、频域（SD）光相干断层扫描（OCT）、验光检查。根据OCT黄斑水肿形态,分为弥漫水肿型、囊样水肿型、浆液性神经上皮脱离型、硬性渗出为主型。应用Cirrus HD-OCT对患眼黄斑区行加强深度扫描（EDI）,测量SFCT。与国内同年龄段正常人群平均SFCT值（286.84±28.80） μm进行比较。患者年龄、屈光度、糖尿病病程、空腹血糖、BCVA、中央视网膜厚度与SFCT的相关性应用Pearson相关分析;不同类型黄斑水肿间SFCT差异比较行单因素变量分析。结果 患眼SFCT 120.50～361.50 μm,平均SFCT（223.81±43.74） μm,与正常人群平均SFCT值比较,厚度下降63.03 μm,差异有统计学意义（95%可信区间-78.80～-47.26 μm,P＜0.01）;相关性分析结果显示,SFCT与患者年龄（r=0.124）、屈光度（r=0.277）、糖尿病病程（r=0.286）、空腹血糖水平（r=0.408）、BCVA（r=0.087）、中央视网膜厚度（r=0.036）无相关性（P＞0.05）;不同类型黄斑水肿之间SFCT值比较,差异无统计学意义（F=0.042,P＞0.05）。结论 DME患者SFCT较同年龄段正常人群明显变薄。     

非增生型糖尿病视网膜病变患者黄斑中心凹下脉络膜厚度变化

目的 观察非增生型糖尿病视网膜病变（NPDR）患者黄斑中心凹下脉络膜厚度（SFCT）变化及其与视网膜病变严重程度的关系。方法 内分泌科检查确诊的2型糖尿病（DM）患者93例164只眼（DM组）纳入研究。其中,男性34例,女性59例;平均年龄（59.3±5.6）岁。平均糖尿病病程（5.11±4.64）年。所有患者均行视力、眼压、裂隙灯显微镜、间接检眼镜、A/B型超声、光相干断层扫描（OCT）检查,以及空腹血糖、平均动脉压检查。患者平均眼轴长度（23.04±0.78） mm;平均空腹血糖（8.88±2.59） mmol/L;平均动脉压（100.44±9.63） mmHg。按糖尿病视网膜病变（DR）国际分期标准将DM组分为无DR（NDR）组、轻度NPDR组、中度NPDR组、重度NPDR组,分别为64、33、37、30只眼。选取同期正常受试者25例42只眼作为对照组。应用Topcom 3D-OCT仪测量受检者黄斑SFCT。采用完全随机设计资料的方差分析法分析SFCT变化及其与DR严重程度的关系以及糖尿病病程、空腹血糖、平均动脉压、眼轴长度与SFCT的相关性。结果 DM组SFCT为130.5～340.0 μm,平均SFCT为（224.24±42.10） μm。正常对照组SFCT为141.5～415.0 μm,平均SFCT为（276.77±48.07） μm 。DM组SFCT与正常对照组SFCT比较,差异有统计学意义（F=23.86,P＜0.05）。NDR组、轻度NPDR组、中度NPDR组、重度NPDR组间SFCT比较,差异有统计学意义（P＜0.05）。NDR组SFCT较轻度NPDR组SFCT厚,但差异无统计学意义（P＜0.05）;中度NPDR组SFCT与重度NPDR组SFCT比较,中度NPDR组SFCT较厚,但差异也无统计学意义（P＞0.05）。SFCT与DR严重程度呈负直线相关关系（r=-0.555,P=0.000）;糖尿病病程与SFCT呈负相关（r=-0.332,P=0.001）;而空腹血糖（r=－0.123）、平均动脉压（r=－0.116）、眼轴长度（r=－0.018）与SFCT无相关性（P＞0.05）。结论 DM患者较正常对照者SFCT变薄;不同分期DR患者间SFCT也存在差异,随DR严重程度增加SFCT逐渐变薄。     

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.     

早产儿视网膜病变合并黄斑囊样水肿四例

早产儿视网膜病变(ROP)是目前儿童盲的首位原因。既往对ROP的研究主要关注于周边视网膜血管的发育停滞及病理性增生过程,而对黄斑区视网膜的结构特征研究较少;并且,由于坐位OCT检查对体位及眼位配合的要求,新生儿行OCT检测较为困难。因此,关于合并黄斑囊样水肿(CME)的ROP患儿鲜有报道。OCT应用于早产儿视网膜眼底检查,有助于对婴幼儿黄斑区发育进行观察,更易发现黄斑区异常病变。我们回顾分析了4例ROP合并CME患儿的临床资料。现将结果报道如下。     

不同程度糖尿病性黄斑水肿的多焦视网膜电图特征

目的 研究不同程度糖尿病性黄斑水肿(DME)患者的光学相干断层扫描(OCT)和多焦视网膜电图(mfERG)的特征.方法 对正常人35例(35只眼)及确诊糖尿病视网膜病变(DR)合并临床显著黄斑水肿(CSME)的患者40例(57只眼)进行多焦视网膜电图和光学相干断层扫描检查.根据OCT检查结果,将患者按黄斑中心凹厚度检查结果分为轻、中、重3组.用独立样本t检验将糖尿病性黄斑水肿组与正常对照组的mfERG各反应值进行比较,运用一元相关性分析研究糖尿病性黄斑水肿组mfERG各反应值与黄斑中心凹厚度之间是否存在相关关系.结果 与正常组比较,轻度DME的N1波振幅密度在环4[(14.67±4.91)nV·deg-2]、环5[(11.65±3.89)nV·deg-2]显著下降(t=2.179,2.529;P＜0.05),P1波潜伏期在环3[(40.61±4.10)ms]有明显延迟(t=-2.133,P＜0.05);中度DME的患者的P1波振幅密度在环1[(149.50±29.01)nV·deg-2]、环2[(59.33±25.96)nV·deg-2]、环3[(41.83±9.78)nV·deg-2]、环5[(22.00±5.52)nV·deg-2]显著下降(t=3.610,2.168,2.627,3.445;P＜0.05),N1波振幅密度在环3[(18.10±4.21)nV·deg-2]、环4[(13.22±4.89)nV·deg-2]、环5[(10.37±2.33)nV·deg-2]显著下降(t=2.397,2.489,2.783;P＜0.05),P1波潜伏期在环3[(42.86±4.72)ms]、环4[(44.33±5.56)ms]、环5[(46.31±4.72)ms]有明显延迟(t=-3.150,-3.210,-3.968;P＜0.05),N1波潜伏期在环3[(23.05±3.06)ms]、环4[(22.41±3.36)ms]有明显延迟(t=-2.845,-2.098;P＜0.05);重度DME的患者的P1波振幅密度在环1[(110.00±20.68)nV·deg-2]、环2[(62.40±27.90)nV·deg-2]、环3[(39.20±19.65)nV·deg-2]、环5[(21.60±11.12)nV·deg-2]显著下降(t=7.135,1.782,2.214,2.609;P＜0.05),N1波振幅密度在环1[(41.63±39.17)nV·deg-2]、环3[(16.63±5.81)nV·deg-2]、环4[(11.20±7.42)nV·deg-2]、环5[(9.05±4.63)nV·deg-2]显著下降(t=2.714,2.282,2.736,2.858;P＜0.05),P1波潜伏期在环1[(35.12±8.44)ms]、环3[(40.44±2.10)ms]、环4[(42.80±3.74)ms]有明显延迟(t=3.426,-2.710,-3.120;P＜0.05),N1波潜伏期在环4[(23.36±4.05)ms]有明显延迟(t=-2.572;P＜0.05).结论 随着DME的加重,中度和重度DME患者的黄斑中心凹厚度与mfERG反应值有显著相关性,mfERG联合OCT检查可客观、定量的反映黄斑区形态结构及功能的改变.

Abstract：

Objective To investigate the characters of multifocal electroretinogram (mfERG) in different grades of diabetic macular edema defined by optical coherence tomography ( OCT). Methods MfERG and OCT were performed in 57 eyes of diabetic macular edema (DME) patients and 35 eyes of the control group. According to the macular thickness measured by OCT, eyes with DME were divided into three groups: mild, moderate and severe DMEs. Results In mild DME, the response densities of N1 were attenuated in ring 4[ ( 14. 67 ±4. 91 )nV · deg-2 ] to ring 5[ ( 11.65 ±3. 89)nV · deg-2 ] respectively (t=2. 179,2. 529; P ＜ 0. 05 ). The latencies of P1 was prolonged significantly in ring 3 [ (40. 61 ± 4. 10 ) ms ](t = -2. 133 ,P＜0. 05). In moderate DME , the response densities of P1 and N1 were attenuated in ring 1[ (149.50 ±29.01)nV · deg-2], ring 2[ (59.33 ±25.96) nV · deg-2], ring 3[(41.83 ±9.78) nV ·deg-2 ], and ring 5 [ ( 22. 00 ± 5. 52 ) nV · deg-2 ] respectively ( t = 3. 610,2. 168,2. 627,3. 445; P ＜0. 05). The latencies of P1 and N1 were prolonged significantly in ring 3 [ (42. 86 ± 4. 72 ) ms ], ring 4[ (44. 33 ±5.56)ms], ring 5[ (46. 31 ±4.72)ms] (t= -3. 150, -3.210, -3.968;P＜0.05) and ring 3[(23.05 ±3.06)ms], ring 4[ (22.41 ±3.36)ms] (t= -2.845, -2.098;P＜0.05) respectively. In severe DME. The response densities of P1 and N1 were attenuated in ring 1 [ ( 110. 00 ± 20. 68 ) nV ·deg-2 ], ring 2 [ (62. 40 ± 27.90) nV · deg-2 ], ring 3 [ ( 39. 20 ± 19.65 ) nV · deg- 2 ], ring 5 [ (21.60 ±11. 12)nV · deg-2] (t =7.135,1.782,2.214,2.609;P ＜0.05) and ring 1[(41.63 ±39. 17) nV ·deg-2], ring 3[ (16.63 ±5.81)nV · deg-2], ring 4[(11.20 ±7.42)nV · deg-2], ring 5[(9.05 ±4.63 ) nV · deg-2 ] ( t = 2. 714,2. 282,2. 736,2. 858; P ＜ 0. 05 ) respectively. The latencies of P1 and N1 were prolonged significantly in ring 1 [ (35. 12 ±8.44)ms], ring 3[ (40. 44 ±2. 10)ms], ring 4[ (42. 80 ±3.74)ms] (t=3.426,-2.710,-3.120;P＜0.05) and ring 4 [ ( 23. 36 ± 4. 05 ) ms ] (t= -2.572;P＜0. 05) respectively. Conclusion As the progress of DME, the thickness of macular fovea had significant correlation with responses of multifocal electroretinogram in patients with moderate or severe DME. MfERG combined with OCT can evaluate the changes of morphology and local retinal function in macula area objectively and quantitatively.     

糖尿病性黄斑水肿视网膜微结构SD-OCT改变研究进展

糖尿病性黄斑水肿( diabetic macular edema ,DME)是糖尿病患者视功能损害的主要原因,中央视网膜厚度( central retinal thickness,CRT)与DME患者视功能损害及治疗前后视功能变化密切相关,而黄斑部视网膜微结构改变与CRT变化有关。频域 OCT ( spectral-domain OCT, SD-OCT)可以定性、定量的分析黄斑各组织层次的细微结构。我们对DME患者黄斑部视网膜微结构SD-OCT改变的相关研究进展进行综述,对进一步探讨DME的发病机制、观察病情进展、指导临床治疗及判断预后情况有重要意义。     

糖尿病视网膜病变患者黄斑中心凹下脉络膜厚度分析

目的 观察糖尿病视网膜病变（DR）不同分期脉络膜厚度的变化。方法 临床检查确诊的2型糖尿病患者150例227只眼纳入研究。其中,男性67例 89只眼,女性83例 138只眼;平均年龄（65.6±8.0）岁;平均糖尿病病程（12.4±6.5）年。所有患者均行最佳矫正视力（BCVA）、屈光度、裂隙灯显微镜、间接检眼镜、频域光相干断层扫描（SD-OCT）检查。参照早期DR治疗研究组制定的分级诊断标准将患者分为无DR（NDR）组、非增生型DR不伴黄斑水肿（NPDR/ME-）组、非增生型DR伴黄斑水肿（NPDR/ME+）组、增生型DR不伴黄斑水肿（PDR/ME-）组、增生型DR伴黄斑水肿（PDR/ME+）组,分别为99、64、5、25、5只眼。选取既往行全视网膜激光光凝（PRP）治疗的19例29只眼作为PRP治疗（PRP-DR）组。行PRP治疗的时间距离本研究SD-OCT检查时间为0.25～18.00个月。与患者年龄匹配的正常人17例32只眼作为正常对照组。应用SD-OCT深度增强成像技术测量受检者黄斑中心凹下脉络膜厚度（SFCT）。统计分析时,因NPDR/ME+组和PDR/ME+组样本量较小,未行组间比较。结果 正常对照组、NDR组、NPDR/ME-组、PDR/ME-组、PRP-DR组SFCT分别为（310.2±54.8）、（251.1±81.4）、（262.5±83.2）、（286.2±76.8）、（327.4±83.1） μm。与正常对照组SFCT比较,NDR组、NPDR/ME-组SFCT降低,差异有统计学意义（t=2.754、2.140,P＜0.05）。PDR/ME-组SFCT较NDR组增厚,差异有统计学意义（t=-2.114, P＜0.05）。PRP-DR组SFCT较PDR/ME-组增厚,差异有统计学意义（U=271.500, P＜0.05）。结论 早期DR患者SFCT变薄,随病变程度加重,SFCT逐渐增厚;行PRP后早期SFCT增厚。     

非增殖期糖尿病视网膜病变黄斑水肿对脉络膜横断面面积的影响

目的　通过光学相干断层成像（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）分析非增殖期糖尿病视网膜病变黄斑水肿对脉络膜横断面面积的影响。方法　收集２０１２年３月至２０１４年２月于我院眼科门诊就诊的非增殖期糖尿病视网膜病变患者４７例（５７眼）,分为非增殖期糖尿病视网膜病变不伴临床显著性黄斑水肿组（ＮＰＤＲＣＳＭＥ－组）和伴临床显著性黄斑水肿组（ＮＰＤＲＣＳＭＥ＋组）。采用Ｔｏｐｃｏｎ３ＤＯＣＴ１０００脉络膜模式扫描黄斑区,比较２组之间脉络膜横断面面积差异,分析２组脉络膜横断面面积与黄斑中心凹厚度（ｃｅｎｔｒａｌｍａｃｕｌａｒｔｈｉｃｋｎｅｓｓ,ＣＭＴ）、最佳矫正视力的相关性。结果　ＮＰＤＲＣＳＭＥ－组与ＮＰＤＲＣＳＭＥ＋组性别、年龄和屈光度差异均无统计学意义（Ｐ＝０．５５０、０．７９０、０．０７０）。ＮＰＤＲＣＳＭＥ＋组脉络膜横断面面积（１１４１７５４．４７±３３７７６２．０５）μｍ２较ＮＰＤＲＣＳＭＥ－组（１３７８１２８．４５±３９５７２８．６６）μｍ２变小（Ｐ＝０．０１９）。ＮＰＤＲＣＳＭＥ－组脉络膜横断面面积与ＣＭＴ（中位数２２６．５０μｍ）之间无相关性（ｒ＝－０．１３０,Ｐ＝０．４９４）;ＮＰＤＲＣＳＭＥ＋组脉络膜横断面面积与ＣＭＴ（中位数３１７．００μｍ）之间也无相关性（ｒ＝－０．２１８,Ｐ＝０．２７４）。ＮＰＤＲＣＳＭＥ－组脉络膜横断面面积与最佳矫正最小分辨角对数视力（ＢＣｌｏｇＭＡＲ）（中位数０．０９７）之间无相关性（ｒ＝０．３２１,Ｐ＝０．０８０）;ＮＰＤＲＣＳＭＥ＋组脉络膜横断面面积与ＢＣｌｏｇＭＡＲ（中位数０．６９９）之间亦无相关性（ｒ＝－０．０７０,Ｐ＝０．７００）。结论　非增殖期糖尿病视网膜病变患者发生黄斑水肿者较未发生黄斑水肿者脉络膜横断面面积变小。脉络膜横断面面积与ＣＭＴ、最佳矫正视力均不相关。     

光相干断层扫描及血管成像在糖尿病黄斑水肿诊疗中的应用研究现状

糖尿病黄斑水肿(DME)是糖尿病视网膜病变患者中心视力丧失甚至失明的首要原因。相较于传统的FFA检查,OCT能快速获得高分辨率的三维立体图像,从而便捷地反映眼底组织的细节并实现定量测量。OCT血管成像(OCTA)作为一种新兴的血管成像技术,对观察视网膜及脉络膜不同层面的血管结构形态,量化一定范围内的血流密度及病灶面积有其无可比拟的优势。因此,结合OCT和OCTA的检查结果对DME患者进行形态学、血管及血流定性和定量分析,对DME的诊断及分型、指导治疗、评估预后具有指导性作用。     

视网膜静脉阻塞黄斑水肿的光相干断层扫描观察

目的 观察视网膜静脉阻塞(RVO)黄斑水肿的光相干断层扫描(OCT)图像特征以及与临床的关联,探讨新型频域OCT在RVO患者黄斑水肿形态和定量分析中的临床价值.方法 回顾分析临床确诊的RVO患者91例92只眼的OCT检查资料.其中,视网膜中央静脉阻塞(CRVO)35例35只眼;视网膜分支静脉阻塞(BRVO)56例57只眼.所有患者接受最佳矫正视力(BCVA)、直接或间接检眼镜、裂隙灯显微镜加前置镜检查.其中60例60只眼还接受了荧光素眼底血管造影(FFA)检查.5线扫描(5 Line Raster)模式下通过中心凹的水平+垂直两条扫描线的分析,对黄斑水肿类型和累及层次以及视网膜外层的细微结构进行观察,用软件自带cliaper功能模块手工测量黄斑中心凹厚度(FT)、浆液性视网膜脱离高度、中心凹囊腔的高度和宽度、中心凹囊腔下光感受器层厚度.在立方体(Cube)扫描模式下,采用软件自带的功能模块对黄斑中心厚度(CFT)、黄斑中心凹体积(V)、平均厚度(AT)进行测量.回顾分析时,重点分析黄斑水肿类型、OCT图像特征以及不同黄斑水肿类型与视力的相互关系.结果 RVO患者黄斑水肿表现为弥漫性水肿、囊样水肿、浆液性视网膜脱离、混合性水肿等多种形态.其中,弥漫性水肿表现为视网膜组织增厚,结构疏松,反射轻度降低;囊样水肿表现为视网膜神经上皮层内有单个或多个低反射囊泡,其间又可见组织柱分隔;浆液性视网膜脱离表现为视网膜神经上皮与色素上皮分离,其间有低反射液性空腔;混合性水肿表现为以上几种水肿形式的混合.92只眼中,弥漫性水肿12例12只眼,占13.0%;囊样水肿21例21只眼,占22.8%;浆液性视网膜脱离37例37只眼,占40.2%;混合性水肿58例59只眼,占64.1%.水肿位于外网状层/外核层91例92只眼.占100.0%;位于内核层67例68只眼,占74.2%;位于神经节细胞层23只眼,占25.0%.光感受器内外节连接(r=3.778 6,P=0.000)、外界膜完整性(r=4.462 2,P=0.000)和FT(r=-0.451 3,P=0.000)与其BCVA有相关性;而CFT(r=0.269 7,P=0.121)、V(r=0.052 8,P=0.054)和AT(r=0.060 8,P=0.075)与视力无相关性.结论 RVO所导致的黄斑水肿其形态和层次可表现为多种不同的类型,频域OCT可以对这些改变进行有效观察,其中有些改变与视力密切相关;定量分析在RVO黄斑水肿患者中的价值有待进一步确定.

Abstract：

Objective To observe the images characteristics of optic coherence tomography (OCT) on macular edema in retinal vein occlusion (RVO), and to explore the application value of Fourier-domain (FD)OCT in RVO macular edema. Methods The clinical data of 91 RVO patients (92 eyes) were retrospectively analyzed. All patients received examinations of best corrected visual acuity (BCVA), direct or indirect ophthalmoscope, slit lamp ophthalmoscope, and 60 patients (60 eyes)also underwent fundus fluorescein angiography. There were 35 patients (35 eyes) with central retinal vein occlusion (CRVO) and 56 patients (57 eyes) with branch retinal vein occlusion (BRVO). The type and involved layer of macular edema, and subtle structure changes of the outer retina were observed through the horizontal and vertical scanning lines through the foveal under the model of 5 Line Raster. The foveal thickness (FT), height of serous retinal detachment, width and height of foveal cystoid spaces and thickness of foveal photoreceptor layer were measure manually. The central fovea thickness (CFT), volume (V) and average thickness (AT) were collected from the OCT readings. Further analysis was focused on different type of the edema, characteristics of OCT images and the relationship between the different type of the edema and vision. Results The manifestation of macular edema was variable by OCT scanning, and can be categorized into diffuse edema (sponge-like thickening of the retina with reduced reflectivity) 12 patients ( 12 eyes, 13.0% ), cystoid edema (multi-cyst-like space in the neuro-retina separated by tissue column) 21 patients (21 eyes, 22.8%) and serous retinal detachment (separation of neuro-retina and retinal pigment epithelium by space with low reflectivity) 37 patients (37 eyes, 40. 2%) and mixed edema(mix of the above several edema form) 58 patients (59 eyes, 64.1 %). The edema can happen at different layers of the neuro-retina, including outer nuclear layer/outer plexiform layer (ONL/OPL) in 92 patients (92 eyes, 100. 0%), inner nuclear layer (INL) in 68 patients (68 eyes, 74.2%) and ganglion cell layer (GCL) in 23 patients (23 eyes, 25.0%).Statistic analysis revealed that BCVA was related to the integrity of IS/OS (r=3. 778 6, P=0. 000), ELM (r=4.462 2, P= 0. 000 ) and FT (r=-0.4513, P=0. 000 ), but not related to CFT (r=0.269 7, P=0.121), V(r=0.0528, P= 0. 054 ) and AT (r=0.0608, P=0.075). Conclusion he manifestation of macular edema associated with RVO is variable. FD-OCT can demonstrate its fine details, and some changes are related to visual acuity. Therefore, the value of quantitative analysis in these patients needs further confirmation.     

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.     

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）     

糖尿病性黄斑水肿的治疗进展

糖尿病性黄斑水肿（DME）是糖尿病视网膜病变（DR）患者视力下降的重要原因,除有效控制血糖、血压、血脂,以及保持全身的良好健康状态外,激光光凝依然是最基本的治疗手段,新的Pascal激光器展现了比原本激光器更强大的技术优势。用于治疗DME的激素类玻璃体植入缓释系统虽展示了良好的应用前景,但还处于临床验证阶段。难治性的弥漫性黄斑水肿可考虑光凝与玻璃体注射曲安奈德、抗血管内皮生长因子类药物,甚至玻璃体手术联合治疗以提高疗效。各种新疗法以及联合疗法已经体现了较好的治疗效果,但依然没有充足的证据证明任何一种疗法或联合疗法比单一的光凝治疗要好,尚需要大规模的随机对照实验来证明其长期应用的安全性和有效性。     

Evaluation of changes of macular thickness in diabetic retinopathy after cataract surgery

Purpose

To assess the macular thickness changes after cataract surgery in diabetic patients using optical coherence tomography (OCT).

Methods

We retrospectively reviewed the records of 104 diabetic patients who underwent cataract surgery. We examined the changes of macular thickness using OCT before cataract surgery and 1 week, 1-, 2- and 6-months after surgery. The central subfield mean thickness (CSMT) was used to evaluate macular edema which was defined as an increase of CSMT (ΔCSMT) > 30% from the baseline. The association between prior laser treatment or severity of diabetic retinopathy and macular thickness were also analyzed.

Results

Macular edema occurred in 19 eyes (18%) from the diabetic group and 63% of macular edema developed at 1 month after surgery. Thirteen (68%) out of 19 eyes with macular edema showed the resolution of macular edema by 6 months after surgery without treatment. ΔCSMT of eyes without a history of laser treatment was statistically greater compared to eyes with a history of laser treatment in at 1- and 2-months after surgery, but was not different than eyes who had laser treatment at 6-months after surgery. The severity of diabetic retinopathy was not significantly correlated to macular edema, but there was statistical difference when patients who had a history of prior laser treatment were excluded.

Conclusions

The incidence of macular edema after cataract surgery in diabetic patients was 18%. Its peak incidence was at 1 month post surgery and it resolved spontaneously in 68% of patients by 6 months post surgery. Prior laser treatment might prevent postoperative macular edema until 2 months after cataract surgery in diabetic patients. However, macular edema did not affect the severity of diabetic retinopathy.     

糖尿病性黄斑水肿眼玻璃体状况的观察

目的观察糖尿病性黄斑水肿(diabetic macular edema, DME)眼玻璃体状况，探讨玻璃体后脱离(posterior vitreous detachment, PVD)与DME之间的关系。方法回顾分析经裂隙灯显微镜、双目间接检眼镜、荧光素眼底血管造影(fundus fluorescein angiography FFA)、光相干断层扫描(optical coherence tomography， OCT)检查确诊的无明显牵引的DME 169只眼的临床资料，对比裂隙灯显微镜、双目间接检眼镜和OCT检查结果，分析患眼玻璃体状态与黄斑中心凹平均厚度的关系。结果169只眼中无玻璃体脱离者156只眼，占92.3%,中心凹平均厚度为297 μm；玻璃体脱离者11只眼，占6.5%,中心凹平均厚度为229 μm；部分玻璃体后脱离者2只眼，占1.2%，中心凹平均厚度为347 μm。结论无明显牵引的DME患眼中大多数眼未发生PVD和浅分离，玻璃体与视网膜分离时所产生的牵引力不是DME发生的主要原因。(中华眼底病杂志,2003,19:341-343)