糖尿病黄斑病变分型和视力预后

Classification and visual prognosis of diabetic maculopathy.

目的 分析 317例 5 97只眼糖尿病黄斑病变荧光形态并进行分型 ,探讨类型和分期与视力预后的关系。方法 每例均作双眼荧光素眼底血管造影 ,分析黄斑区荧光素渗漏的来源 ,形态和范围。黄斑拱环的大小及黄斑区是否有无灌注区存在 ,有无增生等。 结果 ① 5 97只眼中无渗漏型 15 4只眼占 2 5 .8,局部水肿型 188只眼占 31.5 % ,弥漫水肿型 2 39只眼占 40 .0 % ,缺血型 12只眼占 2 .0 % ,增生型 4只眼占0 .7% ;②视力预后与分型有密切关系。以视力大于或等于 0 .5计 ,无渗漏型占 99.4% ,局部水肿型占 83 .0 % ,弥漫水肿型占 2 8.4% ,缺血型占 8.4% ,增生型无 1只眼在 0 .5以上。黄斑囊样水肿占 2 0 .3 %。③分期与视力预后 ,随期数愈高视力预后愈差 ,视力大于或等于 0 .5者 ,1期占 96 .2 % ,2期占 84.8% ,3期占 5 3 .2 % ,4期占 37.2 % ,5期占 12 .5 %。结论 糖尿病黄斑病变是导致糖尿病患者视力减退的重要因素 ,不同分型有不同的预后 .黄斑水肿和囊样水肿应作激光治疗以阻止视力下降。

Purpose To analyse the maculopathy in 597 eyes of 317 cases with diabetic retinopathy,and to explore the classification and visual prognosis. Methods Using fluorescein angiography to examine the extend of capillary leakage and foveal avascular zone as well as the extent of the capillary closure in macular area. Results ①Diabetic maculopathy was divided into 5 types,among 597 eyes,no leakage type 154 eyes (25.8%),focal edema type 188 eyes(31.5%),diffuse edema type (including cystoid edema)231 eyes(40.0%),ischemic type 12 eyes(2.0%) and proli ferative type was 4 eyes(0.7%).② There is close relationship between the classification and visual prognosis.such as when visual acuity was ≥0.5,no leakage type was 99.4%, focal edema type was 83.0%,diffuse edema type was 28.4%,ischemic type was 8.4%,and proliferative type was 0.5%. the visual acuity of cystoid edema was worse than diffuse edema only 20.3%. ③The stage and visual prognosis:The higher the stage the worse the visual prognosis.if visual acuity≥ 0.5, 1 stage in 96.2% eyes,2 stage in 84.8%,3 stage in 53.2%,4 stage in 37.2%,5 stage in 12.5%. Conclusion Diabetic maculopathy is the main cause of visual impairment in diabetic retinopathy.Different type has different visual prognosis.macular edema and cystoid edema are the main factors to decrease visual acuity and could be treated by focal and grid laser photocoagulation to prevent visual loss.