视网膜光凝术后糖尿病性黄斑水肿的临床特征

Clinical Features of Diabetic Macula Edema after Photocoagulation in Proliferative Diabetic Retinopathy

目的：分析经视网膜光凝治疗后仍合并黄斑水肿的增殖性糖尿病视网膜病变患者黄斑水肿特点及其视功能低下的原因。方法：回顾性系列病例研究。收集2015 年1 月至2016 年12 月在绵阳万江眼科医院治疗的30 例（43 眼）患者临床资料。通过光学相干断层扫描、眼底荧光素血管造影观察影像学特征，归纳其黄斑水肿的特点。根据是否存在某一个临床特征将患眼分为几个亚组，每一临床特征亚组之间最佳矫正视力（BCVA）的差异比较采用独立样本t检验或单因素方差分析。结果：30例（43眼）患者平均BCVA为3.98 ± 0.58。影像学特征：中、重度黄斑水肿比例大30 眼（70%），其中直径大于350 μm的大囊腔22 眼（51%）；水肿或囊腔位于中心凹比例大（63%），对视网膜外层结构（椭圆体带及外界膜）破坏严重（81%），合并黄斑下微小浆液性视网膜脱离（16%）、黄斑前膜（21%）和糖尿病视神经病（14%）。椭圆体带是否破坏（t=3.62，P=0.001）、水肿是否位于黄斑中心（t=-1.23，P=0.029）、黄斑区是否有大囊腔（t=5.49，P 〈 0.001）、水肿的程度（F=17.54，P 〈 0.001）以及是否合并糖尿病视神经病变（t=-5.56，P 〈 0.001），各亚组间对应的BCVA比较差异有统计学意义。结论：黄斑水肿广泛存在于视网膜光凝治疗后的糖尿病患者中，以中、重度的黄斑水肿为主，椭圆体带破坏，水肿位于黄斑中心、黄斑区有大囊腔、水肿的程度以及合并糖尿病视神经病变对视力影响较大。

Objective： To analyze the clinical features of diabetic macular edema （DME） after photocoagulation in proliferative diabetic retinopathy （PDR）, and to provide the foundation for further research on the treatment of DME. Methods： This retrospective cross-sectional, observational study included 30 patients （43 eyes） who conformed to the inclusion criteria of Mianyang Wanjiang Hospital from January 2015 to December 2016. The features of DME that occurred after photocoagulation for PDR were assessed by optical coherence tomography （OCT） and fundus fluorescein angiography （FFA）. Eyes were divided to subgroups according to with some clinical features or not. The causes of poor visual function of DME were assessed by comparing differences of best corrected visual acuity （BCVA） between subgroups in each characteristic group by independent samples t-tests or one-way analysis of variance. Results： The mean BCVA was 3.98±0.58. Of the 43 eyes with DME, 30 （70%） were classified as moderate or severe DME. Twenty-two eyes （51%） had a cystoid cavity gap of more than 350 μm, 27 （63%） had DME in the central fovea, and 35 （81%） had destruction of the ellipsoid zone and outer limiting membrane. Seven eyes （16%） had a little serous retinal detachment under the macula, nine eyes （21%） had epiretinal membranes, and six eyes （14%） had diabetic optic neuropathy. Five of these characteristics, i.e., ellipsoid zone destruction （t=3.62, P= 0.001）,DME in central fovea （t=-1.23, P=0.029）, large cystoid cavity gap （t=5.49, P〈0.001）, severity of DME （F=17.54, P〈0.001）, and diabetic optic neuropathy （t=-5.56, P〈0.001）, significanlty affect the BCVA. Conclusions： DME occurred extensively after photocoagulation treatment for PDR. For eyes with DME,loss of BCVA was associated with the severity of the DME, ellipsoid zone destruction, DME in the central fovea, large cystoid cavity gap, and diabetic optic neuropathy.