糖尿病黄斑水肿患者视网膜敏感度和最佳矫正视力与黄斑中心凹视网膜厚度的相关性分析

Correlation analysis of visual sensitivity, best corrected visual acuity and central retinal thickness in diabetic macular edema

目的观察糖尿病黄斑水肿（DME）患者视网膜敏感度、最佳矫正视力（BCVA）与黄斑中心凹视网膜厚度（CRT）的相关性。方法回顾性病例分析。临床检查确诊的DME患者30例45只眼纳入研究。其中，男性16例20只眼，女性14例25只眼；平均年龄（54.49±7.45）岁。均为2型糖尿病，病程≥10年。采用国际标准视力表行BCVA检查，统计时换算为最小分辨角对数（logMAR）视力。采用MAIA微视野计检测黄斑10°的黄斑完整性指数（MI）、平均视网膜敏感度（AT）、2°固视率（P1）、4°固视率（P2）、由注视点组成的63%二元轮廓椭圆面积（BCEA）及95%BCEA、63%BCEA及95%BCEA中垂直与水平方向的位移H63、V63、H95、V95。光相干断层扫描（OCT）测量CRT，同时观察椭圆体带的完整性。将椭圆体带完整性分为光带连续光滑（A组）：完全可见；光带部分中断（B组）：不完全可见；光带缺失（C组）：完全不可见。各影响因素之间相关性采用Pearson相关性分析；不同椭圆体带完整性组之间logMAR BCVA、AT、CRT比较采用非参数检验；与AT相关因素分析采用多元线性回归分析。结果Pearson相关性分析结果显示，logMAR BCVA与MI（r=0.303，P=0.04）、CRT（r=0.342，P=0.02）呈正相关；与AT（r=？0.59，P=0.00）、P1（r=？0.38，P=0.01）呈负相关。AT与MI（r=？0.55，P=0.00）呈负相关。多元线性回归分析结果显示，logMAR BCVA是影响AT的独立因素（t=？3.53，P=0.001）。45只患眼中，A、B、C组分别为23、17、5只眼。三组患眼之间logMAR BCVA、AT、CRT比较，差异均有统计学意义（P=0.045，0.049，0.018）。结论DME患者logMAR BCVA与CRT呈正相关，与AT、P1呈负相关。logMAR BCVA是影响AT的独立因素。微视野、OCT及视力三者联合可对DME患者的视功能进行全面评估。

ObjectiveTo investigate the correlation of visual sensitivity, best corrected visual acuity （BCVA） and central retinal thickness （CRT） in diabetic macular edema （DME）.MethodsA retrospectives study. Forty-five eyes of 30 patients in DME were included. There were 20 eyes of 16 males, 25 eyes of 14 females, with an average age of 54.49±7.45 years. All the patients had type 2 diabetes; the average duration of diabetes was over 10 years. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logarithmic logarithm （logMAR） visual acuity. The following parameters provided by the MAIA microperimetric device were evaluated, including average threshold （AT）, macular integrity index （MI）, fixation indexes （P1 and P2）, bivariate contour ellipse area （BCEA） for 63% and 95% of points, and horizontal and vertical axes of the ellipse of fixation （H63, H95, V63, V95）. The CRT was measured and the integrity of the ellipsoidal band was observed by optical coherence tomography （OCT）. The integrity of the ellipsoid band was divided into continuous smooth （group A）： fully visible; part of the light band was interrupted （B group）： not completely visible; missing light band （C group）： completely invisible. Pearson correlation analysis was used to analyze the correlation between the factors; non-parametric tests were used to compare the logMAR BCVA, AT, and CRT between the different ellipsoid zone integrity groups; multiple linear regression analysis was used to analyze factors related to AT.ResultsPearson correlation analysis showed that the logMAR BCVA was positively correlated with MI （r=0.303, P=0.04） and CRT （r=0.342, P=0.02）, negatively correlated with AT （r=？0.59, P=0.00） and P1 （r=？0.38, P=0.01）. There was negative correlation between AT and MI （r=？0.55, P=0.00）. The result of multivariate linear regression analysis showed that the logMAR BCVA is inversely correlated with AT （t=？3.53, P=0.001）. Group A, B and C were 23, 17 and 5 eyes in the 45 eyes, respectively. There were significant differences in logMAR BCVA, AT, and CRT between the three groups of eyes （P=0.045, 0.049, 0.018）.ConclusionsIn DME patients, the logMAR BCVA was positively correlated with CRT, negatively correlated with AT and P1. The logMAR BCVA is inversely correlated with AT. Microperimetry combined with OCT and visual acuity can be used to assess the visual function of patients with DME.