非增殖期糖尿病视网膜病变黄斑区硬性渗出的临床观察

Clinical Observation on Hard Exudates in the Macular Area in Nonproliferative Diabetic Retinopathy

目的观察非增殖期糖尿病视网膜病变黄斑区硬性渗出的特点。方法回顾性分析自2008年1月~2009年5月接受荧光血管造影检查（fundus fluorescein angiography,FFA）,并确诊为单眼或双眼非增殖期糖尿病视网膜病变者共261人,440只眼,观察黄斑区硬性渗出累及的范围、程度,并分析其与视力的关系。结果FFA检查诊断为背景型糖尿病视网膜病变（background diabeticretinopathy,BDR）Ⅱ期及Ⅲ期的440只眼中,黄斑区未见硬性渗出者152只眼（34.6%）,可辨认出硬性渗出者272只眼（61.8%）,16只眼因屈光间质不清而无法辨认（3.6%）。硬性渗出多累及黄斑区1~2个象限（约占40.4%）,以颞侧受累多见。中心凹500μm以内无硬性渗出者约为63.9%,其视力〉0.5者占50.6%,少量硬性渗出者约为27.6%,视力〉0.5者占42.6%,大量硬性渗出者约为4%,视力〉0.5者仅占22.9%（P=0.02）。在单眼发生了较严重的硬性渗出的患者中,88%的患者对侧眼硬性渗出程度较轻,双眼硬性渗出程度的差异有统计学意义（P〈0.0001）。结论硬性渗出是非增殖期糖尿病视网膜病变的常见眼底表现,具有中心凹颞侧多见,双眼严重程度不完全对称,严重硬性渗出发生率低等特点,其发生位置及严重程度与视力损害密切相关。

Objective To characterize the clinical features of the hard exudates within the macular area in nonproliferative diabetic retinopathy.Methods A retrospective hospital-based cross-section study was conducted.261 patients（440 eyes） who were diagnosed as nonproliferative diabetic retinopathy in one or both eyes by fundus fluorescein angiography（FFA） were enrolled in this study.The extension and severity of hard exudate within the macular area were graded from the fundus photograph and collected.The relationship between hard exudates and visual acuity were also analyzed.Results There were 440 eyes diagnosed as background diabetic retinopathy（BDR） Ⅱ and Ⅲ.Among them,152 eyes（34.6%） had no macular involvement by hard exudates,but 272 eyes（61.8%） had hard exudates involving macular area.sixteen eyes（3.6%） could not be graded because of media haze.Hard exudates were mainly situated in the temporal side of the macula and often involved one or two quadrants of macular area.Eyes without hard exudates involving 500 μm of the center of the macula were 63.9% out of 440 and 50.6% had visual acuity beyond 0.5.Eye with mild macular involvment were 27.6% out of 440 and 42.6% had visual acuity beyond 0.5.Eyes with heavily involved macula were 4% out of 440 and 22.9% had visual acuity beyond 0.5（P=0.02）.88% patients had severe hard exudates in one eye and mild hard exudates in the other.There was significant difference in severity of hard exudates between two eyes（P0.0001）.Conclusion Retinal hard exudate is a common retinal lesion of the nonproliferative diabetic retinopathy.The hard exudates is often located at the temporal side of macula.The extention asymmetry of hard exudates is common while severe hard exudates is rare.The location and severity of retinal hard exudates are directly related to the decrease of visual acuity.