糖尿病黄斑水肿的临床诊断方法比较

目的 对比分析糖尿病黄斑水肿患者光学相干断层扫描(optical coherence tomo-graphy,OCT)、荧光素眼底血管造影(fluorescein fundus angiography,FFA)及裂隙灯显微镜下+90 D前置镜检查所观察到的图像特征,探讨3种检查方法的诊断价值.方法 分析51例(94眼)临床确诊为糖尿病视网膜病变患者的OCT、FFA及裂隙灯显微镜下+90 D前置镜检查结果,将结果进行一致性比较,并观察分析OCT、FFA图像特征,所得结果行单因紊方差分析.结果 OCT与FFA及FFA与+90 D前置镜检查结果有较好的一致性,符合率分别为88.3%、69.1%.OCT、FFA与+90 D前置镜裂隙灯显微镜下检查结果对糖尿病黄斑水肿的检出率分别是86.2%、83.0%及62.8%.OCT所测得的黄斑中心凹平均视网膜厚度值在无渗漏时最低,并随局限性渗漏、弥漫性渗漏、局限合并弥漫性渗漏、黄斑囊样水肿依次增加,经比较它们之间的差异均具有统计学意义(F=40,P均<0.05).结论 OCT能客观的提供糖尿病患者黄斑区结构的变化,尤其对+90D前置镜裂隙灯显微镜下检查及FFA还没有明确变化的早期黄斑水肿诊断敏感.三者的联合应用为揭示糖尿病病理机制、临床诊断糖尿病黄斑水肿、判断糖尿病黄斑水肿的类型及其最佳治疗方案提供参考依据.

Comparison among diagnostic methods for diabetic macular edema

Obiective To compare and analyze the features of image of patients with diabetic macular edema by optical coherence tomography(OCT),fluorescence fundns angiography(FFA) and +90 D preset lens examination under slit-lamp microscope, and to evaluate the diagnostic value of these three methods. Methods Ninety-four eyes of 51 patients, who were clinically diagnosed with diabetic retmopathy, were taken OCT,FFA and + 90 D preset lens examination under slit-lamp microscope. The results were analyzed,and comparison of consistency was taken. The features of image by OCT and FFA were observed and analyzed. The results were taken one-factor analysis of variance, Results The high consistency was 88.3% between OCT and FFA,and 69.1% between FFA and + 90 D preset lens examination under slit-lamp microscope. The detection rate for the diabetic macular edema was 86.2% with OCT,83.0% with FFA and 62.8% with + 90 D preset lens examination under slit-lamp microscope,respectively. The mean retinal thickness at central fovea of macula lutea determined with OCT was to the least at the time without leakage, and increased in a order at the time with local leakage, diffuse leakage, local combined with diffuse leakage and cystoid macular edema. There was a significant difference among groups (F = 40, all P <0.05). Conclusions OCT can objectively indicate structural changes at macular area in patients with diabetes meliitus, especially has sensitive diagnosis for macular edema at early stage when the structural changes axe not yet evident at FFA or + 90 D preset lens examination under slit-lamp microscope. The combination of OCT, + 90 D preset lens examination under slit-lamp microscope and FFA can provide reference to disclose the pathomechanisms of diabetes mellitus, diagnose diabetic macular edema, determine the type of diabetic macular edema and provide optimum treatment.