糖尿病黄斑水肿眼底自身荧光和光相干断层扫描图像分型以及与视力的相关性分析

Patterns of fundus autofluorescence and optical coherence tomography in diabetic macular edema and functional correlations

目的 观察糖尿病黄斑水肿（DME）患眼不同眼底自身荧光（FAF）和光相干断层扫描（OCT）图像分型以及黄斑中心凹视网膜厚度（CRT）、黄斑体积与最佳矫正视力（BCVA）的关系.方法 临床检查确诊的DME患者47例84只眼纳入研究.所有患眼均行BCVA、眼底彩色照相、FAF、OCT检查.根据FAF检查结果,将患眼分为正常组、单囊样增强组、多囊样增强组;OCT检查结果,将患眼分为弥漫水肿型、囊样水肿型、浆液视网膜脱离型.其中,正常组、单囊样增强组、多囊样增强组分别为30、20、34只眼;OCT检查所见的弥漫水肿、囊样水肿、浆液视网膜脱离分别为44、18、22只眼.统计FAF各组中不同OCT分型者的比例;不同FAF分型患眼BCVA、平均CRT、平均黄斑体积的关系;不同OCT分型患眼平均CRT、平均黄斑体积与BCVA的关系.结果 患眼平均BCVA 0.38±0.26;平均CRT（360.23±139.40） μm;平均黄斑体积（9.59±1.97） mm3.正常组、单囊样增强组中,弥漫水肿型患眼分别占本组患眼的83.3％、60.0％;多囊样增强组中浆液视网膜脱离型患眼占本组患眼的50.0％.正常组、单囊样增强组、多囊样增强组患眼平均BCVA分别为0.47±0.26、0.43±0.30、0.28±0.19;平均CRT分别为（275.50±58.22）、（315.50±100.55）、（461.29±147.68） μm;平均黄斑体积分别为（8.67±1.03）、（8.94±1.63）、（10.79±2.20） mm^3.3组间平均BCVA（χ^2 =11.34）、CRT（χ^2 =30.25）、黄斑体积（χ^2=20.14）比较,差异有统计学意义（P＜0.05）.弥漫水肿型、囊样水肿型、浆液脱离型患眼平均BVCA分别为0.43±0.25、0.45±0.30、0.22±0.14;平均CRT分别为（272.41±48.62）、（402.84±134.89）、（505.67±135.20） μm;平均黄斑体积分别为（8.58±0.95）、（9.22±1.33）、（12.03±2.01）mm^3.不同类型黄斑水肿患眼平均BCVA（χ^2=11.79）、CRT（χ^2 =42.38）、黄斑体积（χ^2=39.00）比较,差异有统计学意义（P＜0.05）.相关性分析结果显示,CRT与黄斑体积呈显著相关（r=0.85,P＜0.05）;BCVA与CRT、黄斑体积呈负相关（r=-0.31、-0.34,P＞0.05）.结论 正常组、单囊样增强组弥漫水肿型患眼最多,多囊样增强组浆液脱离型患眼最多.FAF分型较OCT分型,与视力的关系更加密切.

Objective To assess and classify the features of fundus autofluorescence （FAF） with optical coherence tomography （OCT） in clinically significant diabetic macular edema according to the criteria reported by ETDRS.Methods Eighty-four eyes of 47 diabetic patients with untreated clinically significant macular edema （CSME） diagnosed by OCT/FAF examination were enrolled in this study.The mean BCVA was 0.38±0.26,CRT was （360.23±139.40） μm and volume was （9.59±1.97） mm3.According to the FAF patterns,the CSME patients were divided into normal group （30 eyes）,single-spot group （20 eyes）,and multiple-spot group （22 eyes）.There were 44,18 and 22 eyes with diffuse edema,cystoid edema and serous retinal detachment,respectively.The correlation of visual acuity with central retinal thickness and total volume of macular was analyzed between different groups.Results In the normal group and the singlespot group,the prevalence of the diffuse type was highest in the OCT （83.3%,60.0%）.In the multiplespot group,the prevalence of the SRD type was highest in the OCT （50.0%）.In the three FAF pattern groups,the BCVA were 0.47±0.26,0.43±0.30,0.28±0.19; the CRT were （272.41±48.62）,（402.84±134.89）,（505.67±135.20） μm ; the total volume was （8.67± 1.03）,（8.94± 1.63）,（10.79±2.20） mm^3.The BCVA were 0.43±0.25,0.45±0.30,0.22±0.14; the CRT were （272.41± 48.62）,（402.84±134.89）,（505.67± 135.20） μm ; the total volume was （8.58±0.95）、（9.22± 1.33）、（12.03±2.01） mm^3 in eyes with diffuse edema,cystoid edema and serous retinal detachment,respectively （r=-0.31,-0.34; P〉 0.05）.Correlation analysis showed CRT positively correlated to volume （r=0.85,P〈 0.05）,BCVA negatively correlated to CRT and volume （r=-0.31,-0.34; P〉 0.05）.Conclusion There are more diffuse edema eyes in normal group and single-spot group,while serous retinal detachmen in multiple-spot group.FAF correlates better with visual acuity than OCT patterns.