不同类型糖尿病黄斑水肿患者视网膜敏感度和视力与黄斑厚度相关性分析

Correlation of retinal sensitivity, visual acuity and central macular thickness in different types of diabetic macular edema

目的探讨不同类型糖尿病黄斑水肿（DME）患者黄斑部视网膜敏感度、固视情况、最佳矫正视力与黄斑中心凹视网膜厚度之间的相关性。方法回顾性系列病例研究。选择2011年1月至2012年1月上海交通大学附属第一人民医院眼科门诊及内分泌科会诊诊断为DME的52例（83只眼）患者的临床资料，记录患者的全身情况和疾病史，采用国际标准化视力表检查所有患者的最佳矫正视力，相干光断层扫描（OCT）测量黄斑中心凹视网膜厚度，微视野机检测视网膜敏感度、固视稳定性和固视位置。不同类型DME患者的最佳矫正视力、黄斑中心凹视网膜厚度、视网膜敏感度的分析采用单因素方差分析或Kruskal．Wallis秩和检验；对固视情况的分析采用Fisher确切概率检验；各因素间的相关性分析采用Pearson相关分析，等级资料采用Spearman相关分析；与视网膜敏感度相关因素的分析采用多元回归分析。结果83只眼中，局限型DME47只眼（56．63％），弥漫型DME20只眼（24．10％），缺血型DME5只眼（6．02％），增生型DME11只眼（13．25％）。不同类型DME患者的最佳矫正视力（F=12．737，P〈0．01）、黄斑中心凹视网膜厚度（H=31．504，P〈0．01）、视网膜敏感度（F=14．760，P〈0．01）、固视稳定性（）（z=23．47，P〈0．01）和固视位置（x。=21．01，P〈0．01）的差异均有统计学意义。除增生型外（r=0．43，P=0．19），其他各型DME患者的LogMAR视力与黄斑中心凹视网膜厚度均呈正相关（r=0．56～0．62，P值均〈0．01）；视网膜敏感度与黄斑中心凹视网膜厚度和LogMAR视力之间亦存在负相关性（r=-0．62、-0．68，P值均〈0．叭）。多元回归分析结果发现，LogMAR视力值、黄斑中心凹视网膜厚度是与视网膜敏感度相关的独立因素（t=-5．52、-4．24，P值均〈0．01）。结论不同类型DME在形态学和功能学上具有差异。从局限型、弥漫型到缺血型逐步加重，体现了DME病变的进展过程。联合视力、OCT、微视野检查结果能够对黄斑水肿病变程度进行全面的评估。

Objective To detect the correlation of retinal sensitivity, visual acuity and central macular thickness in patients with different types of diabetic maeular edema （ DME ）, macular function were evaluated by measuring the sensitivity, fixation pattern of the macular was examined by fundus-related microperimetry, then analyzed and compared the results with best-corrected visual acuity （BCVA）and foveal retinal thickness measured by optical coherence tomography（OCT）. Methods A restrospeetive ease-series study. In a prospective, observational case series study, 52 consecutive patients （83 eyes ）with diabetic macular edema were included. Sex, age, BMI, education, type of DM, duration, treatment, laboratory examinations, history of cardiovascular disease, hypertension, hyperlipidemia, diabetic nephropathy, and cigarette use were documented. Logarithm of the minimum angle of resolution（logMAR） BCVA was evaluated using the international vision test chart. Foveal thickness was measured by OCT. Mean retinal sensitivities, fixation stability and position was investigated with microperimetry. Variables related with BCVA, foveal thickness and mean retinal sensitivities were analyzed in different types of DME patients using one-way ANOVA or Kruskal-Wallis test. As for fixation, Fisher exact test was chosen. Pearson Correlation analysis was performed to evaluate the association between these variables. Spearman correlation analysis was used for ordinal data. The correlation between retinal sensitivities and all the variables examined were analyzed under multiple regression analysis. Results Eighty-three eyes were included in this study. Forty-seven eyes （56.63%） were graded as focal DME, 20 eyes （24. 10% ） as diffuse DME, 5 eyes （6.02%） as ischemic DME and 11 eyes（ 13.25% ） as proliferative DME. Comparison between different types of DME patients showed statistically significant difference in mean logMAR BCVA（ F = 12. 737 ,P 〈0.01 ） ,mean OCT foveal thickness （ H = 31. 504, P 〈 0. 01 ）, mean central retinal sensitivities （ F = 14. 760, P 〈 0. 01 ）, and patterns of fixation, which were also statistically correlated （ X2 = 23.47,21.01 ;P 〈 0. 01 ）. It was a positive correlation between OCT foveal thickness and logMAR BCVA in patients with focal, diffuse and ischemic DME （r = 0. 56, - 0. 62 ; P 〈 0. 01 ）, but not with proliferative DME （ r = 0. 43, P = 0. 19 ）. While central retinal sensitivities were also negative correlation between OCT foveal thickness and logMAR BCVA （ r = - 0. 62, -0. 68;P 〈 0.01 ）. Multiple regression analysis showed that central retinal sensitivity was inversely correlated with LogMAR and retinal thickness （ t = - 5.52, - 4. 24 ; P 〈 0.01 ）. Conclusions There are statistically significant difference in macular morphology and vision function between different types of DME patients. The progression of DME are expressed gradually from focal, diffuse to ischemic type. DME could be fully evaluated by measuring macular sensitivity, fixation pattern with microperimetry as well as macular thickness measurement with OCT and visual acuity determination comprehensively.