非增生型糖尿病视网膜病变黄斑水肿伴发浆液性黄斑脱离的脉络膜微结构改变

Choroidal changes of macular edema with serous macular detachment in non-proliferative diabetic retinopathy patients

目的 观察非增生型糖尿病视网膜病变（NPDR）黄斑水肿（DME）伴发浆液性黄斑脱离（SMD）的脉络膜微结构改变的光相干断层扫描图像（OCT）特征。方法 NPDR单眼发生DME伴SMD （SMD组）的9只眼以及对侧只有DME而无SMD（无SMD组）的9只眼纳入研究。患者中，既往行全视网膜激光光凝（PRP）治疗6只眼，按是否行PRP治疗分为PRP治疗组和非PRP治疗组，分别为6、12只眼。均行增强深部成像技术（EDI）频域光相干断层扫描（EDI-OCT）和眼底彩色照相检查。测量中心凹处脉络膜厚度，应用Image Plus Pro 6.0 软件计算以中心凹为中心的EDI-OCT水平扫描所提示的脉络膜模拟面积。采用配对t检验对比分析有无SMD眼检测结果的差异；F检验对比分析PRP治疗组与非PRP治疗组间差异。结果 SMD组视网膜神经上皮脱离区域呈梭型或圆顶状的低信号暗区，外界膜均保持完整，光感受器内外节连接层与视网膜色素上皮-Bruch膜之间发生分离。SMD组中心凹脉络膜平均厚度和脉络膜平均模拟面积均高于无SMD组，差异有统计学意义（t=2.306、2.306，P＜0.05）。PRP治疗组脉络膜平均模拟面积大于非PRP治疗组脉络膜平均模拟面积，差异有统计学意义（F=5.227，P＜0.05）；两组间中心凹脉络膜平均厚度比较，差异无统计学意义（F=3.276，P＞0.05）。结论 NPDR中DME伴发SMD眼脉络膜微结构改变的OCT图像特征是视网膜神经上皮脱离区域呈梭型或圆顶状的弱信号暗区。

Objective To observe the choroidal changes of diabetic macular edema （DME） with serous macular detachment （SMD） in non-proliferative diabetic retinopathy （NPDR） patients by optical coherence tomography （OCT）.Methods Nine NPDR patients including DME with SMD in one eye （SMD group） and only DME in the other eye （DME group） were enrolled. These 18 eyes were also divided into PRP group （six eyes, received panretinal photocoagulation before） and non-PRP group （12 eyes）. Spectral domain EDI （enhance depth imaging） OCT and fundus photograph were performed in all the eyes. The subfoveal choroidal thickness was measured. The choroidal simulation area acquired by horizontal EDI-OCT scan through the center of the fovea was calculated by Image Plus Pro 6.0 software. The difference between DME and SMD group was compared and analyzed with matched t- test; the difference between PRP and non-PRP group was compared and analyzed with F test.Results In SMD group, spindle-like or domelike low signal of detachment areas with intact external limiting membrane were found in the retinal detachment region, and the inner and outer segments （IS/OS） were separated from the retinal pigment epithelium （RPE） Bruch membrane. Both subfoveal choroidal thickness and choroidal simulation area in SMD group were significant greater than those in DME group （t=2.306, 2.306;P〈0.05）. Choroidal simulation area in PRP group was larger than that in nonPRP group （F=5.227,P〈0.05）. But there was no significant difference of subfoveal choroidal thickness between PRP and non-PRP group （F=3.276,P〉0.05）. Conclusion EDI-OCT detects spindlelike or domelike low signal areas in detachment region of SMD with DME in NPDR patients.