海德堡视网膜断层扫描监测糖尿病黄斑水肿的可行性及其临床意义

Feasibility and clinical significance of monitoring diabetic macular edema by Heidelberg retina tomographⅡ

目的：探讨海德堡视网膜断层扫描（HRT）监测糖尿病性黄斑水肿（DME）的可行性及其临床意义。方法：采用HRTⅡ对经裂隙灯显微镜加三面镜检查、荧光素眼底血管造影（FFA）检查确诊的DME、糖尿病无黄斑水肿（NDME）患者和无糖尿病正常对照者共77例120只眼进行黄斑中心凹水肿指数（e值）测定。其中，DME组23例40只眼，男性13例23只眼，女性10例17只眼，年龄44～68岁，平均年龄（55．17±8．26）岁；NDME组32例40只眼，男性18例22只眼，女性14例18只眼，年龄44～68岁，平均年龄（55．17±6．5）岁；正常对照组22例40只眼，男性10例19只眼，女性12例21只眼，年龄42～65岁，平均年龄（53．32±6．04）岁。3组间性别、年龄差异均无统计学意义（P〉O．05）。根据FFA检查黄斑区可疑渗漏或渗漏面积〈25％、渗漏面积在25％～66％、渗漏面积〉66％将DME分为3级。40只DME眼中FFA1、2、3级分别为9、10、21只眼。观察分析DME患眼e值与FFA渗漏面积和视力的关系以及受检组之间不同黄斑直径与e值的相互关系。结果：黄斑直径为1、2、3mm的e值行方差分析，组间差异有统计学意义（P〈0．05）。两两比较，正常对照组与NDME组e值差异无统计学意义（P〉0．05），正常对照组、NDME组分别与DME组比较，e值差异均有统计学意义（P〈O．05）。DME组视力的对数与e值存在相关性（P〈0．05）。DME组FFA1、2、3级之间的e值行方差分析，两两比较，三者之间总体有差异。FFA1级与3级、2级与3级黄斑渗漏面积差异有统计学意义（P〈0．05），1级与2级之间差异无统计学意义（P〉0．05），结果与黄斑区测定的直径大小无关。结论：HRTⅡ黄斑模块中的e值能够量化测量和客观评价DME程度。

Objective To investigate the feasibility and clinical significance of monitoring diabetic macular edema by Heidelberg retina tomograph Ⅱ （HRT）. Methods The diabetic macular edema （DME） was diagnosed by slit lamp microscopy combined with three-mirror contact lens examination and fundus fluorescein angiography （FFA）. The exponential of macular edema （e value） of healthy people and patients with DME or without DME （NDME） （the total number is 77 individuals and 120 eyes） were detected by HRT Ⅱ . All of the 77 people were divided into three groups. In DME group, there were 23 patients （40 eyes）, including 13 males （23 eyes） and 10 females （17 eyes）, at the age of 44-68 （average of 55.17±8.26）. In NDME group, there were 32 patients （40 eyes）, including 18 males （22 eyes） and 14 females （18 eyes）, at the age of 44-68 （average of 55.17±6. 5）. In normal control group, there were 22 patients （40 eyes）, including 10 males （19 eyes） and 12 females （21 eyes）, at the age of 42-65 （average of 53.32±6.04）. According to the results of FFA, the 40 eyes in DME group were divided into： grade 1 of FFA in 9 eyes, with macular suspicious leakage or the area of leakage of 〈25% ; grade 2 of FFA in 10 eyes, with the area of leakage between 25% and 66% ; grade 3 of FFA in 21 eyes, with the area of leakage of〉66%. The differences of sex and age among the 3 groups were not significant （P〉0. 05）. The relationship among e value, leakage area, and visual acuity was observed. Results There was a significant difference of e value （the macular diameter was 1, 2, and 3 mm） among the 3 groups（P〈 0. 05）. The e value in normal control group didn＇t differ much from which in NDME group （P〉0.05）, but was statistically different from which in DME group （P〈0. 05）. Significant difference of e value was also found between NDME group and DME group （〈0.05）. There was a correlation between visual acuity and e value in DME group （P〈0. 05）. In DME group, the difference of e value among FFA grade1, 2, and 3 groups was found according to the variance analysis; the macular leakage area in FFA grade 3 group differed much from which in grade 1 （P〈0. 05） and grade 2 group （P〈0.05）, while no significant difference was found between grade 1 and grade 2 group. The result was not correlated with the macular diameter. Conclusion E value in the macular module of HRT Ⅱ can detect and evaluate the degree of DME.