神经上皮层脱离与否DME眼光感受器层完整性与视力的关系

Association between photoreceptor integrity and visual acuity in diabetic macular edema with or without serous retinal detachment

目的:观察伴或不伴神经上皮层脱离的糖尿病黄斑水肿(diabetic macular edema,DME)眼的光感受器层完整性,分别评价其与视力的关系。方法:前瞻性对照研究。通过频域光相干断层扫描(OCT)观察中心子域平均厚度(CSMT)≥300μm,中心500μm范围内无明显硬渗及牵拉的DME眼。根据中心凹有无神经上皮层脱离(SRD)分两组,分别观察中心500μm范围内外界膜(ELM)及视细胞内外节连接线(IS/OS)反射光带完整性。将所有眼ELM的完整性以及SRD眼中IS/OS的完整性均分为存在或完全缺失两级,将SRD眼中IS/OS的完整性分为保存或萎缩两级,分别比较不同完整性时logMAR有无显著差异。结果:患者41例56眼中,不伴SRD者32眼,SRD者24眼。不伴SRD眼中,ELM及IS/OS反射光带存在与完全缺失组间logMAR差异均有统计学意义(t=-7.345,P=0.000;t=-7.938,P=0.000)。SRD眼中,IS/OS保存及萎缩组logMAR差异有统计学意义(t=-4.354,P=0.000);ELM反射光带存在或完全缺失组间logMAR差异无统计学意义(t=-0.895,P=0.381)。结论:DME眼的中心凹IS/OS完整性与视力存在显著联系。伴或不伴SRD,ELM完整性与视力的关系并不一致。

AIM： To observe the photoreceptor integrity by spectral-domain optical coherence tomography （SD-OCT） in diabetic macular edema （DME） with or without serous retinal detachment（SRD）, and assess their association with visual acuity.METHODS： In this prospective study, consecutive patients were observed by SD-OCT with central subfield mean thickness （CSMT） ≥300μm and without definite macular traction or compact hard exudates in central 500μm. They were divided into two groups： with or without SRD. The integrity of photoreceptor was observed in the central 500μm. The integrity of external limiting membrane（ELM） in all eyes and the integrity of inner and outer segments（IS/OS） in eyes without SRD was classified as existent or completely absent. In SRD eyes, the integrity of IS/OS was classified into another two grades： preserved or atrophic. BCVA between different integrity of IS/OS or ELM were compared.RESULTS： In all the 56 eyes of 41 patients, there were 32 eyes detected without SRD and 24 eyes with SRD. In eyes without SRD, BCVA was significantly poorer in eyes with completely absent IS/OS or ELM than those with existent IS/OS or ELM（t=-7.938, P=0.000; t= -7.347, P=0.000）. In eyes with SRD, BCVA was also significantly poorer in eyes with atrophic IS/OS than those with preserved IS/OS（t=-4.354, P=0.000）, but there was no significant difference in BCVA between eyes with or without completely absent ELM （t=-0.895, P=0.381）.CONCLUSION： In patients of diabetic macular edema, the integrity of subfoveal IS/OS was closely related to BCVA. But the associations between the integrity of ELM and BCVA might not consistent in eyes with or without SRD.