不同类型糖尿病黄斑水肿患者视力与黄斑形态的相关性分析

摘要

Abstract•AIM:To observe the correlation of visual acuity and central macular morphology in patients with different types of diabetic macular edema ( DME) .• METHODS: Presented study was single -center, uncontrolled retrospective clinical study. Sixty -two patients ( 103 eyes ) with DME were included. Best corrected visual acuity ( BCVA) was evaluated using early treatment diabetic retinopathy study ( ETDRS) vision test chart. All patients were examined by non -contact tonometer, slit lamp, indirect ophthalmoscope, and fundus fluorescein angiography ( FFA ) .Central subfield mean thickness ( CSMT) in the macular area of diameter 1mm was measured by optical coherence tomography ( OCT ) .And in the same time the integrity of inner segments/outer segments ( IS/OS) and external limiting membrane ( ELM ) reflecting light strip of 350μm center horizontal scanning line was investigated by OCT.BCVA and CSMT in different types of DME patients were analyzed using Kruskal-Wallis test. BCVA and CSMT between the two-two groups in different types of DME patients were analyzed using Nemenyi test, and multiple regression analysis was used to analyze the relative factors of BCVA.•RESULTS:In the 103 eyes, 47 eyes (45.6%) were focal DME, 35 eyes (34.0%) were diffuse DME, 6 eyes (5.8%) were ischemic DME and 15 eyes ( 14.6%) were proliferative DME. The difference of mean BCVA ( H =69.167, P0.05) .• CONCLUSION: There are statistically significant differences on macular morphology and vision function among different types of DME patients.%目的：探讨不同类型糖尿病黄斑水肿（ diabetic macular edema，DME）患者最佳矫正视力与黄斑中心凹形态之间的相关性。方法：采用单中心非随机对照临床回顾性研究。选择2008－07／2014－01在我院眼科门诊就诊和内分泌科要求会诊诊断为DME的62例103眼患者的临床资料。采用糖尿病早期治疗研究（ ETDRS ）视力表检查患者的最佳矫正视力（best corrected visual acuity，BCVA），所有患者行非接触眼压、裂隙灯、间接检眼镜、荧光素眼底血管造影（fundus fluorescein angiography，FFA）检查，并利用光学相干断层扫描（ optical coherence tomography，OCT）确定黄斑中心1mm直径范围即中心子域平均厚度（ central subfield mean thickness，CSMT）及中心350μm内光感受器内节／外节（ IS／OS）及外界膜（ external limiting membrane，ELM）反射光带的完整性。不同类型临床有意义的糖尿病性黄斑水肿（ clinical significant diabetic macular edema，CSME）的BCVA及CSMT分析采用Kruskal－Wallis秩和检验；DME的4种分型的 BCVA 及 CSMT 组间差异两两比较采用Nemenyi检验；与 BCVA 相关因素分析采用多元回归分析。结果：患者103眼中，局限型DME者47眼（45．6％），弥漫型DME者35眼（34．0％），缺血型DME者6眼（5．8％），增生型DME者15眼（14．6％）。不同类型DME患者的BCVA（H＝69．167，P＜0．01）、CSMT（H＝57．113，P＜0．01）差异均有显著统计学意义。不同类型组间两两比较：局限性和弥漫性（ BCVA：χ2＝14．982， P＜0．01；CSMT：χ2＝14．537，P＜0．01）、局限型与缺血型（ BCVA：χ2＝15．596，P＜0．01；CSMT：χ2＝15．393， P＜0．01）、局限型与增生型（BCVA：χ2＝16．567，P＜0．01；CSMT：χ2＝15．687，P＜0．01）及弥漫型与缺血型之间（ BCVA：χ2＝12．974， P＝0．008；CSMT：χ2＝13．999，P＜0．01），BCVA和CSMT的差异有统计学意义。多元回归分析患者的 BCVA与 CSMT（ r＝－0．064）、IS／OS及ELM反射光带的完整性（r＝－0．207）、病程（r＝－0．082）、DME水肿类型（r＝－0．160）相关（P＜0．05）；与患者的糖化血红蛋白（r＝－0．885）、眼压（r＝－2．522）、年龄（r＝－1．504）、性别（r＝－0．595）无相关性（P＞0．05）。结论：不同类型DME在形态学和功能学上具有差异。