光学相干断层成像在糖尿病视网膜病变临床前期观察中的应用

The Application of Optical Coherence Tomography in Observation of Preclinical Diabetic Retinopathy

目的 采用光学相干断层扫描（OCT）观察尚处于临床前期的糖尿病视网膜病变（DR）患者的眼底视盘周围视网膜神经纤维层（RNFL）厚度变化,试图发现更早期DR.方法 以沧州市中心医院2011年6月-2012年6月有糖尿病病史10～15年,尚未出现视网膜病变的2型糖尿病患者76例（152只眼）为观察组,另选择同时期体检健康者40例（80只眼）为对照组,进行OCT检查,分析视盘周围RNFL厚度变化情况.RNFL厚度明显变薄者,9个月后复查OCT及眼底荧光血管造影（FFA）.结果 观察组较对照组360°平均值[（101.26±10.23）μm与（105.45±8.82）μm]、上1/4象限[（118.83±14.90）μm与（129.65±13.12）μm]和下1/4象限[（132.46±15.37）μm与（136.63±13.78）μm]的RNFL厚度均变薄（P＜0.05）.21例OCT检查RNFL厚度明显变薄者,9个月后复查,RNFL厚度继续变薄[（94.03±11.35）μm与（95.35±11.23）μm,P＜0.05],其中14例FFA出现异常荧光.结论 处于临床前期的DR患者已经有眼底视盘周围RNFL厚度变薄,此可能是由DR临床前期至DR1期的＂窗口期＂,OCT为检测RNFL厚度变薄的有效手段.

Objective To analyze retinal peripapillary retinal nerve fiber layer （RNFL） thickness variation in patients with preclinical diabetic retinopathy （ DR）, and try to discover early DR. Methods We reviewed the retinal peripapillary RNFL thickness variation a total of 76 patients （ 152 eyes） with preclinical DR and type 2 diabetes for 10 to 15 years who were treated in Cangzhou Central Hospital, were selected as observation group, and at the same time 40 healthy persons （80 eyes） were selected as control group, all cases in both groups were examined by optical coherence tomography （OCT） , retinal peripapillary RNFL thickness variations of these cases were analysed. Patients with significantly thinner RNFL were reexamined by OCT and fundus fluorescein angiography （FFA） 9 months later. Results The average 360° RNFL thickness of patients with preclinieal DR was significantly thinner than that of healthy people [ （ 101.26 ± 10. 23 ）μm and （ 105.45 ±-8.82 ） μm, P 〈 0.05 ] . Particularly, the ootic disc up 1/4 quadrant and the optic disc down 1/4 quadrant RNFL thickness of patients with preclinical DR were signifi-cantly thinner than those of healthy persons [ （ 118. 83 ± 14. 90） μm and （ 129. 65 ± 13. 12） μm, （ 132. 46 ± 15.37）μm and （ 136. 63 ± 13.78） μm, P 〈0. 05, respectively] . 21 patients with significantly thinner RNFL thickness thinning were reexamined 9 months later, RNFL thickness was significantly thinner than before [ （94. 03 ± 11.35 ） μm and （ 95.35 ± 11.23 ） μm, P 〈 0. 05 ±, and 14 patients of them were abnormal in FFA. Conclusion The RNFL thickness of patients with preclinical DR is probably thinner than normal, this may be a ＂ window phase＂ between DR preclinical phase and DR first phase. The results suggest that OCT is a sort of effective measure for RNFL thickness.