通过光学相干断层扫描评估的糖尿病性黄斑水肿类型

Types of diabetic macular edema assessed by optical coherence tomography.

作者信息

Koleva-Georgieva Desislava N, Sivkova Nelly P

机构信息

Department of Ophthalmology, Medical University, Plovdiv, Bulgaria.

出版信息

Folia Med (Plovdiv). 2008 Jul-Sep;50(3):30-8.

PMID:19009748

Abstract

AIM

To assess the types of diabetic macular edema (DME) in patients with type 2 diabetes mellitus by analyzing retinal thickness, morphology and presence of macular traction using optical coherence tomography (OCT).

PATIENTS AND METHODS

This prospective study included 74 diabetics with diabetic retinopathy (DR) (141 eyes), 29 diabetics without DR (57 eyes) and 25 healthy volunteers (39 eyes). The ophthalmic examination included best corrected visual acuity, stereo-ophthalmoscopy, fluorescein angiography and OCT. DME assessment was based on the analysis of several OCT features: macular thickness, retinal morphology and presence of macular traction--vitreomacular and/or from epiretinal membranes. Four OCT types of DME were suggested: type 1--early, type 2--simple, type 3--cystoid (3a--mild, 3b--intermediate, 3c--severe) and type 4--serous macular detachment. The distribution of the DME types and their correlation with retinal thickness and visual acuity were analyzed.

RESULTS

The distribution of eyes with DME was: type 1--14.1%, type 2--30.4%, type 3--45.7% (3a--14.1%, 3b--12%, 3c--19.6%) and type 4--9.8%. Macular traction with retinal distortion was detected in 31.5% of the eyes with DME. Retinal thickness at the fixation point was 176 +/- 16.8 microm (116 microm / 210 microm) in healthy eyes and 182.2 +/- 19.6 microm (138 microm / 212 microm) in eyes without DR. There was no statistically significant difference between the two groups (Independent samples test, P > 0.05). The retina was significantly thicker in eyes with early DME (232.9 +/- 7.9 microm) than in healthy eyes and eyes without DR (Independent samples test, F = 16.274 and F = 13.100, P < 0.0001). Increasing retinal thickness was significantly correlated with worse visual acuity (ANOVA, F = 16.692, P < 0.0001).

CONCLUSION

OCT precisely differentiated 4 types of DME: early, simple, cystoid and serous macular detachment, as well as determined the presence of macular traction. The early diagnosis, high precision in retinal thickness measurement, assessment of the morphologic types and macular traction are of uppermost importance in determining the therapeutic approach, prognosis and the effect of treatment.

摘要

目的

通过光学相干断层扫描（OCT）分析视网膜厚度、形态及黄斑牵拉情况，评估2型糖尿病患者糖尿病性黄斑水肿（DME）的类型。

患者与方法

这项前瞻性研究纳入了74例患有糖尿病视网膜病变（DR）的糖尿病患者（141只眼）、29例无DR的糖尿病患者（57只眼）以及25名健康志愿者（39只眼）。眼科检查包括最佳矫正视力、立体眼底镜检查、荧光素血管造影和OCT。DME评估基于对多个OCT特征的分析：黄斑厚度、视网膜形态以及黄斑牵拉的存在情况——玻璃体黄斑牵拉和/或视网膜前膜牵拉。提出了4种OCT类型的DME：1型——早期，2型——单纯型，3型——囊样型（3a——轻度，3b——中度，3c——重度），4型——浆液性黄斑脱离。分析了DME类型的分布及其与视网膜厚度和视力的相关性。

结果

患有DME的眼睛分布情况为：1型——14.1%，2型——30.4%，3型——45.7%（3a——14.1%，3b——12%，3c——19.6%），4型——9.8%。在31.5%患有DME的眼睛中检测到伴有视网膜变形的黄斑牵拉。健康眼睛在注视点处的视网膜厚度为176±16.8微米（116微米/210微米），无DR的眼睛为182.2±19.6微米（138微米/212微米）。两组之间无统计学显著差异（独立样本检验，P>0.05）。早期DME患者的视网膜明显比健康眼睛和无DR的眼睛厚（232.9±7.9微米）（独立样本检验，F=16.274和F=13.100，P<0.0001）。视网膜厚度增加与视力下降显著相关（方差分析，F=16.692，P<0.0001）。