糖尿病视网膜病变黄斑拱环形态改变的临床研究

目的客观评价糖尿病视网膜病变（DR）患者黄斑拱环结构改变的形态特征，总结黄斑拱环形态变化、荧光渗漏及黄斑区视网膜厚度对视力的影响因素。方法患者按有无眼底改变分为3组，糖尿病视网膜病变组（DR组）38例65只眼，2型糖尿病无DR眼底改变组（非DR组）16例29只眼，正常组17例33眼。三组病例均先行眼底荧光素血管造影（FFA）检查，后行光学相干断层扫描（OCT）眼底黄斑部放射状扫描检查。结果三组之间黄斑拱环形态变化比较，有显著差异（P=0．0003），黄斑中心1mm直径视网膜厚度有显著差异（P=0．0007）。DR组患者拱环形态与荧光渗漏程度显著相关（P=0．0003），黄斑拱环形态与黄斑中心1mm直径视网膜厚度显著相关（P=0．0063），荧光渗漏程度与黄斑中心1mm直径视网膜厚度显著相关（P=0．0046）。DR组患者黄斑拱环形态、荧光渗漏和黄斑中心1mm直径视网膜厚度变化与最佳矫正视力无相关性（P=0．076，P=0．067，P=0．128）。结论DR患者黄斑拱环形态改变、渗漏程度及黄斑中心视网膜厚度是相互影响和互为因果，黄斑拱环形态变化特征为进一步选择和调整治疗手段提供了准确依据。

Clinical research on morphologic characteristics of macula in diabetic retinopathy patients

Objective To observe the changes of morphologic characteristics of foveal avascular zone and evaluate the influence of macula morphologic changes,fluorescence leakage and macula lutea thickness on visual acuity in the patient with diabetic retinopathy （DR）. Methods The patients were divided into 3 groups. DR group： 65 eyes of 38 patients with diabetic retinopathy. Non-insulin dependent diabetes without DR group： 29 eyes of 16 patients of non-insulin dependent diabetes with normal fundus patients. Normal group： 33 eyes of 17 patients without diabetes and DR. All the patients were prospectively examined by fundus fluorescein angiography（FFA） and optic coherence tomography（OCT）. Results There are significant differences of macular morphologic changes between the three groups （ P = 0. 000 3）. There are significant differences in retinal thickening at 1 mm of the center of the macula between the three groups （ P = 0.000 7 ）. In DR group, there are significant correlations between macular morphologic changes and fluorescence leakage extent （P = 0.000 3 ）, between mac- ular morphologic changes and retinal thickening at 1 mm of the center of the macula（ P = 0. 006 3 ） , and between fluorescence leakage extent and retinal thickening at 1 mm of the center of the macula（P = 0.004 6）. The macular morphologic changes, fluorescence leakage, retinal thickening at 1 mm of the center of the macula are no correlations with best corrected visual acuity （ P = 0.076, P = 0.067, P = 0.128）. Conclusion The extent of fluorescence leakage, retinal thickening at 1 mm of the center of the macula and macular morphologic changes are interactive, which may help make management decisions in diabetes by offering an exact parameter in addition to visual acuity.