Agardh E, Stjernquist H, Heijl A, Bengtsson B
Department of Ophthalmology, Malmö University Hospital, SE 205 02, Malmö, Sweden.
Diabetologia. 2006 Jan;49(1):200-6. doi: 10.1007/s00125-005-0072-8. Epub 2005 Dec 10.
AIMS/HYPOTHESIS: We examined to what extent visual acuity and perimetric sensitivity as measures of central and paracentral visual function would be useful for evaluating the presence and severity of diabetic macular oedema.
We evaluated 59 eyes of 59 diabetic patients by identifying the presence (n=20) or absence (n=39) of macular oedema on stereo fundus photographs. The area of oedema and its distance to the centre of the macula were measured. Ischaemic macular damage was quantified by measuring the foveal avascular zone and adjacent perifoveolar intercapillary areas on fluorescein angiograms. Visual function was assessed by visual acuity charts and by short-wavelength perimetry and standard white-on-white perimetry of the central 10 degrees field.
Visual acuity did not differ between eyes with and without macular oedema. In eyes with oedema, visual acuity was correlated to the distance of the oedema from the centre of the macula (log of minimum angle of resolution {LogMar} score decreased by 0.15/mm; p=0.006) and to the thickness of the retina when the centre was affected (LogMar score decreased by 0.003/mum of thickness; p=0.0002). Multivariate analyses confirmed the results (R (2)=0.46 and 0.77, respectively). Short-wavelength perimetry sensitivity was more depressed in eyes with oedema (p=0.033) but was not significantly associated with the presence of oedema after correction for macular ischaemic damage. There was no correlation between these field defects and the severity of oedema.
CONCLUSIONS/INTERPRETATION: Visual acuity was a useful measure of visual function in diabetic macular oedema involving the centre. Visual field defects were more common in eyes with macular oedema but reflected ischaemic damage of the macula rather than macular oedema itself.
目的/假设：我们研究了作为中心和旁中心视觉功能指标的视力和视野敏感度在评估糖尿病性黄斑水肿的存在及严重程度方面的有用程度。
我们通过在立体眼底照片上识别黄斑水肿的存在（n = 20）或不存在（n = 39），对59例糖尿病患者的59只眼睛进行了评估。测量了水肿面积及其到黄斑中心的距离。通过在荧光血管造影上测量黄斑无血管区和相邻的黄斑旁毛细血管间区域来量化缺血性黄斑损伤。通过视力表以及中心10度视野的短波视野检查和标准白对白视野检查来评估视觉功能。
有黄斑水肿和无黄斑水肿的眼睛之间视力无差异。在有水肿的眼睛中，视力与水肿到黄斑中心的距离相关（最小分辨角对数{LogMar}评分每毫米降低0.15；p = 0.006），并且与中心受影响时视网膜的厚度相关（LogMar评分每微米厚度降低0.003；p = 0.0002）。多变量分析证实了这些结果（R²分别为0.46和0.77）。短波视野检查敏感度在有水肿的眼睛中降低更明显（p = 0.033）但在矫正黄斑缺血性损伤后与水肿的存在无显著相关性。这些视野缺损与水肿的严重程度之间无相关性。
结论/解读：视力是涉及中心的糖尿病性黄斑水肿中视觉功能的有用指标。黄斑水肿的眼睛中视野缺损更常见，但反映的是黄斑的缺血性损伤而非黄斑水肿本身。
