采用频域OCT观察糖尿病患者早期黄斑区视网膜结构的变化

Evaluation of early diabetic macular morphology changes using SD-OCT

目的探讨糖尿病患者黄斑区视网膜结构变化的频域OCT(Cirrus HD-OCT)特征,将其测量参数与正常人群的测量结果进行比较。方法回顾性分析了由Cirrus HDOCT测量的糖尿病患者黄斑区视网膜的结构参数。将糖尿病患眼分为了存在糖尿病视网膜病变(diabetic retinopathy,DR)组和不存在DR组(NDR组),纳入与糖尿病患者年龄和性别分布相匹配的健康对照者(对照组),并对三组的黄斑区神经纤维层和神经节细胞-内丛状层(ganglion cell-inner plexiform layer,GCIPL)厚度等参数进行比较。结果本研究纳入了42例(42眼)2型糖尿病患者(DR组26眼,NDR组16眼),以及30例健康对照者(30眼;对照组)。DR组的GCIPL为(77.2±8.7)μm,NDR组为(79.4±11.3)μm,均小于对照组的(83.2±7.6)μm(均为P<0.05)。DR组的最小GCIPL为(65.4±9.3)μm,NDR组为(69.7±7.6)μm,均小于对照组的(76.2±9.2)μm(均为P<0.05)。黄斑区各个扇形区域GCIPL厚度中,DR组的上方、鼻侧和下方区域,以及NDR组的鼻下和下方区域明显变薄,与对照组相比差异均有统计学意义(均为P<0.05)。DR组和NDR组之间的GCIPL厚度相近,差异均无统计学意义(均为P>0.05)。DR组、NDR组和对照组的黄斑区神经纤维层厚度相近,差异均无统计学意义(均为P>0.05)。结论糖尿病患者在DR出现之前就已经出现了GCIPL的变薄,频域OCT可被用于监测糖尿病患者早期出现的视网膜神经退行性改变。

Objective To evaluate the macular morphological changes in the neural retina in T2DM patients using a new spectral-domain OCT （ Cirrus HD-OCT） and compare the measurements with those obtained from the age-matched healthy subjects. Methods Retrospective analysis of Cirrus HD-OCT scans of subjects with T2DM was performed. Eyes from diabetic patients were divided into two groups, including diabetic retinopathy （DR） and Non-DR （NDR）. A control group of age-matched healthy volun- teers was included for comparison. Macular retinal nerve fiber layer （mRNFL） and ganglion cell-inner plexiform layer （GCIPL） were collected from these groups and compared. Results The study evaluated 42 T2DM patients （42 eyes, DR group 26 eyes, NDR group 16 eyes）, and 30 healthy controls （30 eyes）. Average GCIPL of DR, NDR and control group were （77.2 ± 8.7 ） μm, （ 79.4 ± 11.3 ） μm and （ 83.2 ± 7.6） μm, respectively, and minimum GCIPL of DR, NDR and control group were （ 65.4 ± 9.3 ） μm, （ 69.7 ± 7.6） μm and （ 76.2 ± 9.2 ） μm, respectively, showed significant thinning in diabetic patients compared with controls （ all P 〈 0. 05 ）, especially involving the papilla-macula bundle. However, the GCIPL thickness was similar between the DR and NDR group. There was no significant difference in average or sectoral mRNFL thickness among groups （ all P 〉 0.05 ）. Conclusion The early thinning of the neural retina is presented in the T2DM patients, even before the visible signs of DR. SD-OCT could help detect early signs of neurodegeneration in diabetic patients.