2型糖尿病患者120只眼黄斑区应用光学相干断层扫描观察的分析

Clinical investigation of macular in 120 diabetic eyes using stratus-OCT analysis

目的:应用光学相干断层扫描(optical coherence tomography,OCT)观察2型糖尿病(DM)患者黄斑区厚度与形态的改变。方法:正常对照组23例30眼,DM患者75例120只眼分无糖尿病视网膜病变(non-diabetic retinopathy,NDR)、非增殖期(non-proliferative diabetic retinopathy,NPDR)及增殖期(PDR)病变3组。采用OCT观察DM患者黄斑区图像特征,同一时间点应用黄斑地形图分析软件测量黄斑部9个分区视网膜厚度,并做最佳矫正视力与糖尿病视网膜病变(diabetic retinopathy,DR)患者黄斑中心凹厚度的相关性分析。结果:正常人、NDR、NPDR、PDR组黄斑各区平均厚度与国内外报道相符,NDR与正常人黄斑各区厚度相比差异无显著性(P>0.05),其余各组差异均有显著性(P<0.01);DR患者的黄斑中心凹厚度与视力呈负相关(r=-0.69,P<0.01);同时发现DM患者黄斑区有囊样水肿、黄斑前膜等多种表现,多以两种及两种以上形态出现。结论:OCT能定性、定量地观察糖尿病黄斑区的表现,为其组织形态的评价、指导治疗及随访提供可靠的检测手段。

Objective：To quantitatively assess macular retinal thickness and display the features of macular morphology using stratus optical coherence tomography （OCT） in patients with type 2 diabetes megitus. Methods：In a prospective study,OCT was performed in 120 eyes of 75 diabetic patients and 30 healthy eyes of normal control subjects. The diabetic patients were divided into three groups：non-diabetic retinopathy （NDR）, non-proliferative diabetic retinopathy （NPDR） and proliferative diabetic retinopathy （PDR）. We observed the different tomographic features of diabetic macula and measured macular thickness with the fast macular thickness mapping protocol of the stratus OCT at the same time a day. For each eye,nine different sectors were analyzed （a foveal sector,four parafoveal sectors,and four extrafoveal sectors）. Results：There were statistically significant differences in foveal thickness and each of the nine areas among the control eyes,NPDR and PDR groups （P 〈 0.01）. But it had no significant differences between control eyes and NDR group. Visual acuity correlated with retinal thickness at the central fovea in diabetic retinopathy（r =-0.69;P 〈 0.01）. Furthermore,OCT can identify sponge-like retinal swelling, cystoid macular edema （CME）, serous retinal detachment,hard exudates,epiretinal membranes （ERM） and other features in diabetic patients. Most eyes had more than one pathologic change in these diabetes OCT demonstrated diabetic macular edema （DME） in 60.8% of eyes,hard exudates in 22.3% of eyes,ERM in 17.5% of eyes and normal foveal structure in 35.8% of eyes. Conclusion：OCT is a useful tool for observating macular thickening and structural changes in eyes with diabetic. OCT can facilitate the diagnosis, treatment and prognosis of diabetic patients,which is especially important in the early stages of diabetic maculopathy.