糖尿病视网膜病变振荡电位和荧光血管造影的相关性

Correlation between oscillatory potentials and fundus angiography in diabetic retinopathy

目的 :研究在荧光素钠血管造影 (FA)和吲哚青绿血管造影 (ICGA)下糖尿病视网膜病变 (DR)在不同阶段、形态改变时的振荡电位 (OPs) ,了解DR的功能学与形态学改变的特点及其之间的联系。方法 :选择 4 9名糖尿病患者(89只患眼 ) ,按在FA下DR的不同阶段分 4组 (88眼 ) ,按ICGA分 2组 (6 0眼 ) ,选择 4 3只正常眼为对照组 ,对所有眼按国际标准化方法进行OPs检测。结果 :OPs总和振幅在FA有改变时下降 ,OP2 振幅在FA无改变时下降 ,有改变时进一步下降 ;无灌注期与新生血管期的OPs总和振幅及各子波振幅改变相同 ;ICGA晚期 ,部分眼出现晚期弥散性高荧斑和极晚期高荧伴低荧的“椒盐状”外观 ,与此相应 ,OP3 振幅和OP4潜伏期较对照组下降和延长。结论 :OP2 振幅较OPs总和振幅在DR早期诊断方面敏感 ,无灌注期和新生血管期的视网膜循环状态相似 ,无灌注区可与新生血管一样作为DR进展的质变标志 。

Objective:To investigate the manifestation of oscillatory potentials(OPs) under different morphological changes in fundus angiography in diabetic retinopathy(DR),and to provide functional and morphological information for current DR classification.Methods:49 diabetic patients(89 eyes) were selected and divided into 4 groups by fluorescein angiography(FA),and into 2 groups by indocyanine green angiography(ICGA). The OPs were tested under the protocols of the international society for clinical electrophysiology of vision(ISCEV) in all eyes.Results:The summed amplitudes of OPs were reduced when FA abnormalities could be observed. The amplitudes of OP 2 were reduced when no change could be observed under FA and were further reduced when FA changes could be observed. There was no difference in the summed amplitudes of OPs and the amplitudes of the waves(OP 1,OP 2,OP 3,OP 4) between non perfusion and neovascular formation stages. Some eyes exhibited diffuse hyperfluorescence spots in ICGA late phase,hyper and hypo fluorescence(salt and pepper appearance) in very late phases. With these changes under ICGA,the amplitude of OP 3 and the latency of OP 4 was reduced and prolonged compared with the control group.Conclusion:The amplitude of OP 2 is more sensitive than the summed amplitudes of OPs in DR. The vascular circulation in non perfusion stage is the same as the neovascular formation stage. The non perfusion area may be treated as another vital sign of neovascular formation in the DR process. This can provide functional evidence for photocoagulation at this stage. The morphological changes under late stage ICGA have some relationship with the changes in OPs.