超广角眼底荧光血管造影对糖尿病视网膜病变的诊断价值

Diagnostic value of ultra-wide-angle fundus fluorescein angiography for diabetic retinopathy

目的:分析超广角眼底荧光血管造影(UWFA)对糖尿病视网膜病变(DR)的诊断价值。方法:对2016-10/2018-06在西安市第三医院就诊的DR患者45例90眼进行回顾性分析。其中男25例,女20例,年龄45~76(平均59.52±15.78)岁。所有患者均经直接或间接检眼镜以及UWFA检查。结果:依据检眼镜检查,在12眼内未见DR,42眼诊断为非增殖性糖尿病视网膜病变(NPDR),36眼诊断为增殖性糖尿病视网膜病变(PDR)。在90眼中,22眼接受视网膜激光光凝治疗,其中8眼接受过广泛视网膜激光光凝(PRP)。依据UWFA检查,12只无DR的眼中有8眼(67%)存在视网膜微动脉瘤,42只诊断为NPDR眼中有4眼(10%)被发现视网膜新生血管(RNV)及血管渗漏,36只诊断为PDR的眼中仍有12眼(33%)存在周边RNV。在诊断为NPDR和PDR的眼中,分别有28眼(67%)和26眼(72%)存在周边视网膜无灌注区。另外,在8只已接受广泛视网膜激光光凝的眼中有4眼(50%)仍有周边RNV及无灌注区。结论:UWFA能够更全面地对糖尿病患者的周边视网膜进行检查,有助于发现常规影像学检查难于察觉的周边部糖尿病视网膜病变,尤其利于对视网膜激光光凝后的DR患者病情的随访观察。

·AIM:To investigate the advantages of ultra-wide-field fluorescein angiography(UWFA)over the standard fundus examination in the evaluation of diabetic retinopathy(DR).·METHODS:Forty-five cases(90 eyes)with DR in Xi'an No.3 Hospital from October 2016 to June 2018 were analyzed retrospectively,including 25 males and 20 females,aged from 45-76(59.52±15.78)years.There were 25 males and 20 females.Average age were 59.5 years.All patients were examined with ophthalmoscope and UWFA.·RESULTS:Depending on ophthalmoscope,12 eyes with no DR,42 eyes with nonproliferative diabetic retinopathy(NPDR),and 36 eyes with proliferative diabetic retinopathy(PDR),diagnosed by the standard method.22 eyes of 90 eyes received retinal photocoagulation,including 8 eyes received panretinal photocoagulation(PRP).Depending on UWFA images,peripheral microaneurysms were demonstrated in 8(67%)of 12 eyes with no DR.Peripheral retinal neovascularizations were detected in 4(10%)of 42 eyes with NPDR and in 12(33%)of 36 eyes with PDR.Peripheral vascular nonperfusions were found in 28(67%)of 42 eyes with NPDR and in 26(72%)of 36 eyes with PDR.Peripheral vascular nonperfusions and peripheral retinal neovascularizations also were found in 4(50%)of 8 eyes,which treated by PRP.·CONCLUSION:UWFA demonstrates peripheral lesions beyond standard fields,which can allow early detection of DR,and a close evaluation of eyes with retinal photocoagulation.