Lobo C L, Bernardes R C, Cunha-Vaz J G
Center of Ophthalmology, University Hospital and Institute of Biomedical Research on Light and Image, Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal.
Arch Ophthalmol. 2000 Oct;118(10):1364-9. doi: 10.1001/archopht.118.10.1364.
To identify alterations of the blood-retinal barrier by mapping retinal fluorescein leakage into the vitreous and changes in retinal thickness occurring in the macular region in preclinical diabetic retinopathy.
Ten eyes from 10 patients with type 2 diabetes and no lesions visible on fundus photography (level 10 of Wisconsin grading) were examined with the retinal leakage analyzer (RLA) (Confocal Scanning Laser Ophthalmoscope [modified]; Carl Zeiss Inc, Thornwood, NY) and the retinal thickness analyzer (RTA) (Talia Technology, Mevaseret Zion, Israel). The maps of retinal leakage and retinal thickness were aligned and integrated in the same image to correlate leakage with thickness. Data from the group of individuals with diabetes were compared with those of a healthy control population (N = 14; mean age, 48 years; range, 42-55 years) and used to establish reference maps for the RLA and RTA.
Areas of abnormally increased fluorescein leakage were detected in 9 of 10 eyes examined. The increased leakage in 6 (67%) of 9 eyes reached values higher than 40% more than the mean +2 SD RLA control value. Areas of abnormally increased thickness were found in 7 of 10 eyes examined. For the most part, the increases in retinal thickness were not severe (ie, <15% increase in 5 eyes and an 18% increase in 1 eye). The eyes with the most extensive leakage (cases 1, 3, and 9) showed relatively good coincidence between the location of the areas of increased leakage and the location of the areas of increased thickness. In 4 eyes (cases 2, 5, 7, and 8), no such correlation was apparent. The 3 remaining eyes showed little coincidence between these locations. Characteristically, the latter 3 eyes had areas of abnormally increased thickness that were much larger than the areas of increased fluorescein leakage, which were relatively moderate or absent of any leakage.
Localized sites of increased fluorescein leakage and zones of increased retinal thickness were found in most eyes in a series of 10 eyes in the preretinopathy stage from 10 patients with type 2 diabetes. Increases in retinal thickness may be observed that do not coincide with sites of retinal leakage. Two types of increased retinal thickness may, therefore, be present in the preretinopathy stage of diabetic retinopathy, one directly associated with an alteration of the blood-retinal barrier, and another occurring without apparent breakdown of blood-retinal barrier.
通过绘制视网膜荧光素渗漏至玻璃体的情况以及临床前期糖尿病视网膜病变黄斑区视网膜厚度的变化，来确定血视网膜屏障的改变。
使用视网膜渗漏分析仪（RLA）（共焦扫描激光眼底镜[改良型]；卡尔·蔡司公司，纽约州索恩伍德）和视网膜厚度分析仪（RTA）（Talia Technology公司，以色列梅瓦塞雷锡安）对10例2型糖尿病患者且眼底照相未见病变（威斯康星分级10级）的10只眼进行检查。将视网膜渗漏图和视网膜厚度图对齐并整合到同一图像中，以关联渗漏与厚度。将糖尿病患者组的数据与健康对照人群（N = 14；平均年龄48岁；范围42 - 55岁）的数据进行比较，并用于建立RLA和RTA的参考图。
在检查的10只眼中，9只眼检测到荧光素渗漏异常增加的区域。9只眼中6只（67%）渗漏增加的值比RLA对照均值 +2标准差高出40%以上。在检查的10只眼中，7只眼发现视网膜厚度异常增加的区域。在大多数情况下，视网膜厚度增加并不严重（即5只眼增加<15%，1只眼增加18%）。渗漏最广泛的眼（病例1、3和9）显示渗漏增加区域的位置与厚度增加区域的位置之间有较好的一致性。在4只眼（病例2、5、7和8）中，没有明显的这种相关性。其余3只眼在这些位置之间几乎没有一致性。典型的是，后3只眼视网膜厚度异常增加的区域比荧光素渗漏增加的区域大得多，后者相对中等或无任何渗漏。
在10例2型糖尿病患者处于视网膜病变前期的一系列10只眼中，大多数眼发现了荧光素渗漏增加的局部部位和视网膜厚度增加的区域。可能会观察到视网膜厚度增加与视网膜渗漏部位不一致。因此，在糖尿病视网膜病变的视网膜病变前期可能存在两种类型的视网膜厚度增加，一种与血视网膜屏障改变直接相关，另一种在血视网膜屏障无明显破坏的情况下发生。
