糖尿病性黄斑病变的临床分析

Clinical analysis of the results of maculopathy in diabetic retinopathy

目的 :探讨糖尿病性黄斑病变分型与糖尿病视网膜病变 (diabeticretinopathy ,DR)分期及视力损害的关系。方法 :回顾分析DR患者 4 2 5例 (85 0只眼 )采用眼底血管荧光造影 (fundusfluoresceinangiography ,FFA)确诊及视力等检查手段进行统计的临床资料。根据我国DR诊断、分期标准对DR进行分期 ,参照美国DR早期治疗研究小组制定标准对糖尿病性黄斑水肿 (diabeticmacularedema ,DME)进行细化分型 ,分析统计各期DR中DME发生率以及DME及DR各期及视力损害的关系。结果 :4 2 5例患者中 ,194例 387只眼存在DME ,占 4 5 5 % ;其中局限性黄斑水肿 6 7只眼 ,占 17 3% ,弥漫性黄斑水肿 176只眼 ,占 4 5 5 % ,黄斑囊样水肿 115只眼 ,占 2 9 7% ,缺血样黄斑病变 2 9只眼 ,占 7 5 %。DME在DRI期中占 1 0 3% ,Ⅱ期中占11 11% ,Ⅲ期中占 36 6 4 % ,Ⅳ期中占 4 5 4 7% ,Ⅴ期中占 5 7%。黄斑水肿对视力有不同程度损害 :其中 <0 1者占 13 6 9% ,0 1～ 0 3占 2 8 6 8% ,0 4～ 0 6占 33 85 % ,0 7～ 0 9占 16 %和≥ 1 0占 7 7%。结论 :DME是DR引起视力损害的重要原因之一。随着DR程度加重 ,DME的发生与DR分型有一定平行关系 ,但没有严格的对应关系。

Objective:To explore the relationship between the classification of diabetic macular edema(DME)and stages of the diabetic retinopathy(DR)and visual loss.Methods:The clinical data of fundus fluorescein angiography(FFA)and other related information of 425 patients (850 eyes)with DR were analyzed retrospectively.DR were classified according to national standard of the diagnosis and classification of DR,and DME were classified according to the standard made by the Early Treatment Diabetic Retinopathy Study Research Group of the United States.The occurrence of DME in DR in each stage and the relationships between DME and vision were analyzed.Results:In 425 patients,387 eyes had DME(45.5%),including 67 eyes(17.3%)with focal DME,176 eyes(45.5%)with diffuse DME,115 eyes(29.7%)with cystoid edema and 29 eyes(7.5%)with ischemic maculopathy.The occurrence of DME was 1.03% in I-stage DR,11.11% in Ⅱ-stage DR,36.64% in Ⅲ-stage DR,45.47% in Ⅳ-stage DR and 5.7% in V-stage DR.The visual loss of DME: 13.69% in<0.1,28.68% in 0.1～0.3,33.85% in 0.4～0.6,16% in 0.7～0.9 and 7.7% in≥1.0. Conclusion:DME is the main cause of visual impairment of DR.Along with the development of retinopathy,the incidence of DME increases,and the severity of DME aggravateds,but the development of DME and its classification do not have definite correspondence or unification with the classification of DR,hence the typing of DME in another individual classification in DR,of course,is necessary.