不同类型视网膜病变患者视网膜外层厚度变化研究

Changes in outer retinal thickness in patients with different types of retinopathy

目的探讨不同类型视网膜病变(diabetic retinitis,DR)患者视网膜外层厚度的变化特点。方法选择糖尿病(diabetes mellitus,DM)患者194例(194眼),其中无糖尿病视网膜病变(non-diabetic retinopathy,NDR)患者75例为NDR组,增殖型糖尿病视网膜病变组(proliferative diabetic retinitis,PDR)组患者64例为PDR组,糖尿病视网膜病变黄斑水肿(diabetic macular edema,DME)组患者55例为DME组,并选择50名50眼正常健康人作为对照组,均进行光学相干断层扫描成像检查,测定黄斑中心凹及距黄斑中心凹750μm处鼻上、颞上等方位视网膜光感受器外节厚度(photoreceptor retinal photoreceptor outer segmen,PROS)、视网膜光感受器厚度(total length of the photoreceptors,TLP)、视网膜神经纤维层厚度(retinal nerve fiber layer,RNFL),并分析上述指标与患者视力变化的关系。结果四组患者黄斑中心凹PROS、TLP、RNFL比较差异均有统计学意义(均为P<0.05),PDR组、DME组黄斑中心凹PROS[(35.61±4.41)μm,(32.58±6.74)μm]、TLP[(48.14±3.26)μm,(44.11±2.71)μm]、RNFL[(53.02±5.44)μm,(49.85±4.36)μm]均低于对照组与NDR组(均为P<0.05),DME组均低于PDR组,其旁黄斑中心凹鼻上、颞上RNFL又低于PDR组,差异均有统计学意义(均为P<0.05);四组患者最佳矫正视力比较差异均有统计学意义(均为P<0.05),PDR、DME组最佳矫正视力(0.81±2.24,0.55±0.23)低于对照组与NDR组(均为P<0.05),DME组低于PDR组(P<0.05);DR患者黄斑中心凹PROS、TLP及RNFL均与患者最佳矫正视力呈正相关(均为P<0.05)。结论 PDR、DME患者PROS、RNFL、TLP均较正常健康人与非DR患者变薄或缩短,且其变化与患者视力变化存在紧密关联。

Objective To investigate the changes in outer retinal thickness in patients with different types of retinopathy.Methods A total of 194 patients(194 eyes) with diabetes mellitus(DM) were selected and divided into non diabetic retinopathy group(NDR group,75 patients),proliferative diabetic retinopathy group(PDR group,64 patients) and diabetic macular edema group(DME group,55 patients).Another 50 normal healthy people(50 eyes) were selected as the control group.All the patients were examined by optical coherence tomography(OCT) to measure the thickness of retinal photoreceptor outer segment(PROS),the total length of the photoreceptor(TLP) and the thickness of retinal nerve fiber layer(RNFL) at macula central fovea,superior nasal and superior temporal sites at 750μm far from the macula central fovea.The relationship between the above indexes and changes in the visual acuity of patients was analyzed.Results There were statistically significant differences among the four groups in foveal PROS,TLP and RNFL(all P<0.05).The central foveal PROS [(35.61±4.41)μm,(32.58±6.74)μm],TLP [(48.14±3.26)μm,(44.11±2.71)μm] and RNFL [(53.02±5.44)μm,(49.85±4.36)μm] of PDR group and DME group were smaller than those of the control group or NDR group(all P<0.05).The PROS,TLP and RNFL of DME group were significantly smaller than those of PDR group(all P<0.05).The superior nasal and superior temporal RNFL of DME group were smaller than those of PDR group(both P<0.05).There were statistically significant differences among the four groups in the best corrected visual acuity(all P<0.05).The best corrected visual acuities of DME group and PDR group(0.55±0.23,0.81±2.24) were lower than those of the control group or NDR group(all P<0.05),and that of DME group was lower than that of PDR group(P<0.05).The central foveal PROS,TLP and RNFL of patients with diabetic retinopathy were positively correlated with the best corrected visual acuity(all P<0.05).Conclusion PROS,RNFL and TLP in patients with PDR and DME are thinner or shorter than those of normals and non DR patients,and their changes are closely related to the changes in visual acuity of patients.