超广角荧光素眼底血管造影检查在糖尿病黄斑水肿与视网膜缺血相关性研究中的应用

Application of ultra-wide-angle fluorescein angiography in diabetic macular edema and retinal ischemia

目的观察超广角FFA(UWFA)在糖尿病黄斑水肿(DME)与视网膜缺血相关性研究中的应用。方法回顾性临床研究。2018年1~8月于西安市人民医院(西安市第四医院)眼科经眼底及FFA检查确诊的糖尿病视网膜病变(DR)患者145例220只眼纳入研究。其中,男性85例132只眼;女性60例88只眼。平均年龄(54.87±10.89)岁;非增生型DR171只眼,其中轻度、中度、重度分别为27、32、112只眼;增生型DR 49只眼。伴视网膜缺血灶141只眼。均未接受过视网膜激光光凝、玻璃体腔注射药物及其他眼部手术治疗。采用英国Optomap200Tx成像系统行UWFA检查。根据黄斑中心2个视盘面积范围内视网膜是否受累将患眼分为DME组、非DME组,分别为183、37只眼。根据不同黄斑水肿类型,将DME组再分为局灶渗漏型(FL)组、弥漫渗漏型(DL)组、弥漫囊样渗漏型(DCL)组,分别为94、73、16只眼。比较DME组、非DME组患眼视网膜缺血、视网膜新生血管(RNV)和(或)视盘新生血管(NVD)发生情况的差异;进一步比较不同黄斑水肿类型组患眼间视网膜缺血指数的差异。DME组与非DME组患眼视网膜缺血、RNV和(或)NVD发生情况差异行χ^2检验或Fisher确切概率法比较;不同黄斑水肿类型组患眼间视网膜缺血指数比较行单因素方差分析。结果DME组183只眼中,伴视网膜缺血灶132只眼(72.13%,132/183);非DME组37只眼,伴视网膜缺血灶9只眼(24.32%,9/37)。两组患眼间视网膜缺血发生率比较,差异有统计学意义(χ^2=30.56,P<0.05)。FL组、DL组、DCL组患眼中,伴视网膜缺血灶分别为51(54.26%,51/94)、70(95.89%,70/73)、11(68.75%,11/16)只眼;伴NVD和(或)RNV分别为11(11.70%,11/94)、30(41.10%,30/73)、4(25.00%,4/16)只眼;视网膜缺血指数分别为0.0516±0.0961、0.2192±0.2166、0.1244±0.1460。三组患眼间视网膜缺血灶(χ^2=35.53)、NVD和(或)RNV(χ^2=18.50)发生率和视网膜缺血指数(F=22.80)比较,差异均有统计学意义(P=0.0000、<0.0500、<0.0001)。结论UWFA可动态评估DME患眼视网膜缺血情况;视网膜缺血区面积增大及RNV的形成更容易形成DL型黄斑水肿。

Objective To observe the application of ultra wide angle FFA(UWFA)in the study of the correlation between diabetic macular edema(DME)and retinal ischemia.Methods One hundred and forty-five patients(220 eyes)with diabetic retinopathy(DR)diagnosed by fundus and FFA in Shaanxi Eye Hospital from January to August in 2018 were enrolled in the study.There were 132 eyes from 85 males and 88 eyes from 60 females.The average age was 54.87±10.89 years old,171 eyes were non proliferative DR(mild 27 eyes,moderate 32 eyes,severe 112 eyes),49 eyes were proliferative DR.There were 141 eyes with retinal ischemia.None of them received retinal laser photocoagulation,intravitreal injection of drugs and other eye surgery.UK Optomap200Tx imaging system was used for UWFA examination.According to whether the central macular retina of 2 disc diameter area was involved,the eyes were divided into DME group(183 eyes)and non DME group(37 eyes).According to different appearance of fluorescein leakage in macular zone,DME group was further divided into focal leakage(FL)group,diffuse leakage(DL)group and diffuse cystic leakage(DCL)group,with 94,73 and 16 eyes,respectively.The incidence of retinal ischemia,retinal neovascularization(RNV)and/or NVD were compared between DME group and non DME group,and the difference of retinal ischemia index(IIS)of three macular edema subgroups was further compared.The differences of retinal ischemia,RNV and/or NVD between DME group and non DME group were compared by chi square test or Fisher exact probability method.The different retinal IIS of three macular edema subgroups was compared by one-way ANOVA.Results Among 183 eyes in DME group,132 eyes(72.13%,132/183)were accompanied with retinal ischemia,and 9 eyes(24.32%,9/37)were accompanied with retinal ischemia in non DME group.There was significant difference in the incidence of retinal ischemia between the two groups(χ2=30.56,P<0.05).In FL group,DL group and DCL group,there were 51(54.26%,51/94),70(95.89%,70/73)and 11(68.75%,11/16)eyes with retinal ischemia,and 11(11.70%,11/94),30(41.10%,30/73)and 4(25.00%,4/16)eyes with NVD and/or RNV,respectively,The retinal ischemia indexes of these three groups were 0.0516±0.0961,0.2192±0.2166,0.1244±0.1460.There were statistically significant differences in the incidences of retinal ischemia(χ2=35.53),NVD and/or RNV(χ2=18.50)and retinal ischemia indexes(F=22.80)among the three groups(P=0.0000,<0.0500,<0.0001).Conclusions UWFA can dynamically evaluate the retinal ischemia in DME patients,and the enlargement of ischemic area.The formation of RNV are more likely to form DL macular edema.