不伴明显视力下降的糖尿病视网膜病变患者黄斑部形态和功能检测

目的:探讨不伴明显视力下降的糖尿病视网膜病变(Diabetic retinopathy,DR)患者黄斑部形态和功能的改变.方法:对DR 0期组(未发现DR改变)、Ⅰ～Ⅱ期组及Ⅲ～Ⅳ期组患者进行光学相干断层扫描(Optical coherence tomography,OCT)及多焦视网膜电图(Multifocal electroreti-nography,mfERG)检查,并与同年龄组正常人相比较.结果:OCT检查确定DR Ⅰ～Ⅱ期组有3眼(10.0%)及DRⅢ～Ⅳ期组有6眼(23.1%)存在黄斑水肿.DRⅢ～Ⅳ期组各方位神经上皮层厚度比相应方位的正常组及DR 0期组增加(P＜0.05).同正常对照组相比,mfERG检查发现DR0期组、DR Ⅰ～Ⅱ期、DR Ⅲ～Ⅳ期组P1、N1波振幅下降,反应密度下降,差异有显著性(P＜0.05);但P1、N1波潜伏期未见延迟(P＞0.05).同DR Ⅰ～Ⅱ期组相比,DRⅢ～Ⅳ期组P1波及N1波潜伏期轻度延长、振幅下降、平均反应密度降低(P＜0.05).结论:视力无明显下降的DR患者中,随病情的加重,无论形态和功能上均已有异常,功能异常早于形态异常.

Macular morphology and function in patients with diabetic retinopathy without apparent visual loss

PURPOSE: To investigate the macular morphology and function in patients with diabetic retinopathy(DR) without apparent visual loss. METHODS: Multifocal electroretinograms(mfERG) and optical coherence tomography(OCT) examination were performed in the DR patients on phase 0, 1 to 2, 3 to 4 as well as the normal control non-diabetes subjects. RESULTS: Macular edema was detected in DR phase 1 and 2 (3 eyes,10%) and DR phase 3 and 4 group (6 eyes,23.1%). In comparison with the normal control and DR phase 0 group,the thickness of retinal neuroepithelium increased in DR phase 3 and 4 group(P>0.05). The amplitude and the average density of P1 wave and N1 wave decreased in all DR groups in comparison with normal controls although the latency of P1 wave and N1 wave was not statistically significant (P>0.05).However,comparing with the DR phase 1 and 2 group,the latency of P1 wave and N1 waves were longer whereas the amplitude and the average density decreased in DR phase 3 and 4 group. CONCLUSION: In the patients with DR but without apparent visual loss,abnormalities of the macular morphology and function already develop. The changes of function appear to develop earlier than that of morphology.