增生型糖尿病视网膜病变合并增生型糖尿病虹膜病变对侧眼糖尿病虹膜病变及视盘新生血管发生率观察

Incidence of diabetic iridopathy and optic disc neovascularization in the contralateral eyes of proliferative diabetic retinopathy with proliferative diabetic iridopathy

目的观察增生型糖尿病视网膜病变(PDR)合并增生型糖尿病虹膜病变(PDI)对侧眼糖尿病虹膜病变及视盘新生血管发生率。方法回顾性病例对照研究。2014年2月至2020年5月于河南省眼科研究所接受虹膜荧光血管造影(IFA)联合荧光素眼底血管造影(FFA)检查的PDR合并PDI患者36例72只眼纳入研究。其中,男性17例34只眼,女性19例38只眼;平均年龄(62.3±4.7)岁。所有患者均行最佳矫正视力(BCVA)、眼压、IFA联合FFA检查。BCVA检查采用国际标准视力表进行,统计分析时换算为最小分辨角对数视力。根据PDI分期,将患者分为早期虹膜红变(RI)组和新生血管性青光眼(NVG)组,分别为28、8例。与NVG组比较,RI组患眼BCVA更优,眼压更低,差异有统计学意义(t=6.433、10.619,P=0.000、0.011)。对比观察两组对侧眼PDI发生率和双眼视盘新生血管发生率,并采用Fisher精确概率法进行比较。结果IFA检查结果显示,RI组患眼瞳孔缘虹膜表面可见新生血管性芽状或斑片状强荧光;NVG组患眼瞳孔缘和虹膜中部可见新生血管性团状强荧光。RI组对侧眼中,PDI(RI期)6只眼(21.4%,6/28),非PDI(NPDI)21只眼(75.0%,21/28),无糖尿病虹膜病变1只眼(1/28,3.6%)。NVG组对侧眼中,PDI5只眼(62.5%,5/8),其中RI期4只眼,NVG期1只眼(12.5%,1/8);NPDI 3只眼。NPDI者IFA影像表现为瞳孔缘虹膜自身局部小血管点状荧光。RI组对侧眼PDI发生率小于NVG组,差异有统计学意义(P=0.040)。FFA检查发现,RI组患眼、对侧眼合并视盘新生血管分别为9(32.1%,9/28)、8(28.6%,8/28)只眼;NVG组患眼、对侧眼合并视盘新生血管均为6只眼(75.0%,6/8)。两组患眼、对侧眼视盘新生血管发生率比较,差异均有统计学意义(P=0.046、0.040)。结论PDR合并PDI者,RI者对侧眼PDI及视盘新生血管发生率均较NVI者低。

Objective To observe the incidence of diabetic iridopathy and optic disc neovascularization in the contralateral eyes of proliferative diabetic retinopathy(PDR)with proliferative diabetic iridopathy(PDI).Methods A retrospective case-control study.From February 2014 to May 2020,72 eyes of 36 patients with PDR and PDI who underwent iris fluorescein angiography(IFA)combined with fluorescein fundus angiography(FFA)at the Henan Eye Institute were enrolled in the study.Among them,there were 34 eyes in 17 males and 38 eyes in 19 females;the average age was 62.3±4.7 years.All patients underwent best corrected visual acuity(BCVA),intraocular pressure,IFA combined with FFA examination.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logarithm of the minimum angle of resolution BCVA for statistic analysis.According to PDI staging,patients were divided into early rubeosis iridis(RI)group and neovascular glaucoma(NVG)group,with 28 and 8 cases respectively.Compared with NVG group,RI group had better BCVA and intraocular pressure,and the difference was statistically significant(t=6.433,10.619;P=0.000,0.011).The incidence of PDI and the incidence of binocular optic disc neovascularization in the two groups were compared,and Fisher's exact probability method was used for comparison.Results The results of the IFA examination showed that in the RI group,the pupil border and the iris surface of the iris of the affected eyes had strong neovascular bud-like or patchy fluorescence;the pupil border and the middle of the iris of the patients in the NVG stage had strong neovascular cluster-like fluorescence.Among the contralateral eyes in the RI group,6 eyes(21.4%,6/28)were with PDI(stage RI),21 eyes(75.0%,21/28)were with non-PDI(NPDI),and 1 eye(1/28,3.6%)were absence of diabetic iris disease.Among the contralateral eyes in the NVG group,there were 5 eyes with PDI(62.5%,5/8),including 4 eyes with RI stage,1 eye with NVG stage(12.5%,1/8);3 eyes with NPDI.The image of IFA in patients with NPDI early showed as punctate fluorescence in the local small blood vessels of the iris itself.The incidence of PDI in the contralateral eye of the RI group was lower than that of the NVG group,and the difference was statistically significant(P=0.040).The results of FFA examination showed that 9(32.1%,9/28)and 8(28.6%,8/28)eyes of the affected eye and the contralateral eye in the RI group were combined with optic disc neovascularization.In NVG group,there were seperately 6 eyes(75.0%,6/8)in the affected eyes and the contralateral eyes with optic disc neovascularization.The differences in the incidence of optic disc neovascularization between the two groups of the affected eyes and the contralateral eye were statistically significant(P=0.046,0.040).Conclusion The incidence of PDI and optic disc neovascularization in the contralateral eye of PDR and PDI,RI is lower than that of NVG.