微视野计对糖尿病性黄斑水肿患者的视功能评估

Evalution of the macular function by microperimetry in dabetic macular edema

目的采用微视野检测对糖尿病性黄斑水肿(DME)患者视功能进行评估,并探讨微视野检测指标与视力之间的相关性。设计回顾性病例系列。研究对象2016年4月至2018年1月在中国人民解放军武汉总医院确诊为DME的患者164例(220眼)。方法患者均行最佳矫正视力(BCVA)检查(统计时结果转换为最小分辨角对数(logMAR)视力记录)、荧光素眼底血管造影(FFA)、相干光断层扫描(OCT)、全视网膜镜、MAIA微视野等检查。按微视野检查结果中的固视率将研究对象分为三组:稳定组、相对不稳定组、不稳定组;并根据视网膜敏感度差异将固视稳定组分三个阶段:A1(正常)、A2(可疑)、A3(非正常),并比较三个不同的阶段视力。主要指标BCVA、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(BCEA63)、BCEA95。结果DME患者中,稳定组、相对不稳定组、不稳定组的AT分别为23.55±3.90 dB、20.87±6.04 dB、19.30±5.41 dB(F=9.824,P=0.000),logMAR BCVA分别为0.38±0.24、0.59±0.29、0.63±0.31(F=9.808,P=0.000)。稳定组中,视网膜敏感度不同的A1、A2、A3三个阶段组的BCVA分别为0.22±0.15、0.36±0.21、0.51±0.24(F=16.14,P<0.001)。在DME患者中,logMAR BCVA与AT(r=-0.712,P=0.000)、P1(r=-0.380,P=0.000)、P2(r=-0.370,P=0.000)呈负相关,与BCEA63、BCEA95呈正相关(r=0.352、0.355,P均=0.000)。多元线性回归分析显示,AT(OR=0.576,P=0.000)、P1(OR=0.800,P=0.000)是影响logMAR BCVA的独立因素。结论MAIA微视野计可对DME患者黄斑区视功能进行评估。AT与P1可作为评价黄斑部视功能的良好指标,可一定程度上反应DME患者的视功能状态。(眼科,2021,30:236-239)

Objective To evaluate the visual function of diabetic macular edema(DME)patients by microperimetry,and evaluate the association of microperimetry measurements and visual acuity.Design Retrospective case series.Participants 220 eyes of 164 patients with DME were enrolled in Wuhan General Hospital of Chinese People's Liberation Army from April 2016 to January 2018.Methods All patients were examined with best corrected visual acuity(BCVA,logMAR),fluorescein fundus angiography(FFA),optical coherence tomography(OCT),full retinoscoppy,MAIA microperimetry.According to the fixation rate,the subjects were divided into 3 groups:stable fixation,relative unstable fixation,and unstable fixation.According to the difference of retinal sensitivity,3 stages of fixation stability were divided:A1(normal),A2(suspicious),and A3(abnormal),and the visual acuity of different retinal sensitivity groups in the fixation group were compared.Main outcome measures BCVA,average threshold(AT),2 degree fixation rate(P1),4 degree fixation rate(P2)and bivariate contour ellipse area for 63%(BCEA63),BCEA95.Results In patients with DME,the AT of stable group,relatively unstable group and unstable group was 23.55±3.90 dB,20.87±6.04 dB,19.30±5.41 dB,respectively(F=9.824,P=0.00).The BCVA(logMAR)of stable group,relatively unstable group and unstable group was 0.38±0.24,0.59±0.29,0.63±0.31,respectively(F=9.808,P=0.000).In the stable group,the BCVA of A1,A2 and A3 groups were 0.22±0.15,0.36±0.21,0.51±0.24,respectively(F=16.14,P<0.001).In the patients of DME,logMAR BCVA was negatively correlated with AT(r=-0.712,P=0.000)、P1(r=-0.380,P=0.000)、P2(r=-0.370,P=0.000),and positively correlated with BCEA 63(r=0.352,P=0.000),and BCEA95(r=0.355,P=0.000).Multiple linear regression analysis showed that logMAR BCVA was independently affected by AT(OR=0.576,P=0.000)and P1(OR=0.800,P=0.000).Conclusion MAIA microperimetry can assess macular visual function in patients with DME.AT and P1 can be used as a good indicator for the evaluation of macular visual function and a predictor of logMAR BCVA.It can reflect the visual function of patients with DME.(Ophthalmol CHN,2021,30:236-239)