糖尿病视网膜病变患者光学相干断层扫描图像特征的临床研究

目的探讨光学相干断层扫描(OCT)检查糖尿病视网膜病变(DR)的图像特征。 方法收集2015年1月至2017年12月内蒙古自治区中医医院眼科就诊的DR患者104例(208只眼)的病例资料；并收集同期首都医科大学附属北京同仁医院同仁眼科中心就诊的DR患者289例(578只眼)的病例资料。两个收集地点共计收录DR患者393例(786只眼)。其中，男性181例(356只眼)，女性212例(430只眼)。年龄22～88岁，平均(47.30±5.42)岁。记录全部患者的姓名、性别、年龄、地址、糖尿病病史、临床诊断、眼底彩色照像及OCT检查报告图片。归纳并提炼各期OCT检查图像中的特征。 结果按照2002年我国DR临床分期标准进行分期，全部393例(786只眼)患者中，分为DRⅠ期者51例(102只眼)、DRⅡ期者83例(166只眼)、DRⅢ期者124例(248只眼)、DRⅣ期有46例(92只眼)、DRⅤ期者57例(114只眼)及DRⅥ期者32例(64只眼)。DRⅠ期者的OCT特征为视网膜神经上皮层间出现微血管瘤、偶见或少量出血点；DRⅡ期者的OCT特征为视网膜神经上皮层间出现硬性渗出及出血斑；DRⅢ期者的OCT特征为除出现硬性渗出及出血斑外，还伴有棉絮斑；DRⅣ期者的OCT特征为除出现硬性渗出、出血、棉絮斑外，还伴有水肿或囊样水肿和(或)玻璃体积血；DRⅤ期者的OCT特征为除出现硬性渗出、出血斑、棉絮斑、水肿及玻璃体积血外，还出现机化膜；DRⅥ期者的OCT特征为除出现硬性渗出、出血斑、棉絮斑、水肿、玻璃体积血及机化膜外，还出现牵拉性视网膜脱离。此外，根据DR分期的不同，血流OCT成像(OCTA)可以明确显示微血管瘤、硬性渗出、出血、囊样水肿、无灌注区及新生血管等特征。 结论DR在OCT的检查结果中，根据分期不同可出现特征性的图像表现。掌握和使用OCT检查患者，可以确定患者DR的临床分期，从而指导临床的诊断与治疗。

Clinical study of the characteristics of diabetic retinopathy by optical coherence tomography

ObjectiveTo investigate the imaging features of optical coherence tomography (OCT) in diabetic retinopathy (DR). MethodsFrom January 2015 to December 2017, 104 cases (208 eyes) with DR in the Ophthalmology Department of Inner Mongolia Hospital of Traditional Chinese Medicine were collected, and 289 cases (578 eyes) with DR in Tongren Ophthalmology Center of Beijing Tongren Hospital affiliated to Capital Medical University were collected. A total of 393 cases (786 eyes) were included in the two sites. Among them, there were 181 cases (356 eyes) and 212 cases (430 eyes). The age was 22~88 years, with an average age of (47.30 + 5.42) years. Name, sex, age, address, diabetes history, clinical diagnosis, fundus color photography and OCT report were recorded. Summarize and extract features in each phase of OCT inspection. ResultsAccording to the clinical staging standard of DR in 2002, 393 cases (786 eyes) were divided into three groups: 51 cases (102 eyes), 83 cases (166 eyes), 124 cases (248 eyes), 46 cases (92 eyes), 57 cases (114 eyes) and 32 cases (64 eyes) of DR stage VI. Eye only. The OCT of DR stage I was characterized by microangioma, occasional or minor bleeding spots between the retinal neuroepithelial layers; the OCT of DR stage II was characterized by rigid exudation and bleeding spots between the retinal neuroepithelial layers; the OCT of DR stage III was characterized by cotton flocculent plaques in addition to hard exudation and bleeding spots; and the OCT of DR stage IV was characterized by cotton flocculent plaques. In addition to hard exudation, bleeding spots and cotton wadding spots, there are also edema or cystoid edema and/or vitreous hemorrhage; in DRV stage, the OCT features are not only hard exudation, bleeding spots, cotton wadding spots, edema and vitreous hemorrhage, but also organic film; in DRVI stage, the OCT features are hard exudation, bleeding spots and vitreous hemorrhage. There were also traction retinal detachment outside cotton spots, edema, vitreous hemorrhage and organic membrane. In addition, according to the different stages of DR, blood flow OCT imaging (OCTA) can clearly show the characteristics of microangioma, hard exudation, hemorrhage, cystic edema, no perfusion area and neovascularization. ConclusionIn the examination results of OCT, DR can appear characteristic image according to different stages. Mastering and using OCT can determine the clinical stages of DR and guide the clinical diagnosis and treatment.