Byeon Suk Ho, Chu Young Kwang, Lee Hun, Lee Sang Yeop, Kwon Oh Woong
The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seodaemun-Gu, Seoul, Korea.
Ophthalmology. 2009 Oct;116(10):1949-59.e8. doi: 10.1016/j.ophtha.2009.06.066. Epub 2009 Aug 21.
To describe the morphologic features of ischemic diabetic maculopathy by high-resolution optical coherence tomography (OCT) and their correlation with the damaged foveal avascular zone (FAZ) on fluorescein angiography (FA).
Observational case series.
One hundred twenty-four eyes of 63 patients with diabetic retinopathy and acceptable FA and OCT images were studied. Twenty-three normal fellow eyes of 23 nondiabetic patients with unilateral acute central serous choroidopathy also were studied.
High-speed Fourier-domain OCT was used with a speckle noise-reduction technique to obtain detailed horizontal and vertical images through the center of the fovea and horizontal raster scans every 100 microm. Foveal ganglion cell layer (GCL) damage was identified on OCT as an evident difference in foveal thickness and contour compared with a normal fovea or as asymmetry within the fovea. Fluorescein angiography was performed by confocal scanning laser ophthalmoscope (HRA 2; Heidelberg Engineering, Heidelberg, Germany), and FAZ damage visible during the FA arterial phase was graded according to the Early Treatment Diabetic Retinopathy Study (ETDRS) FA grading system. Correlations were sought between foveal GCL damage identified on OCT and FA capillary dropout sites.
Foveal GCL damage on OCT, the size of the foveola on OCT (defined as the area of GCL thickness <10 microm), ETDRS grading of FAZ on FA, and visual acuity.
Among the 124 eyes with diabetic retinopathy, 62 (50%) had FA evidence of either FAZ damage higher than grade 1 or FAZ capillary loss. In these eyes, damage to the FAZ seen on FA also could be detected on OCT (positive predictive value, 84.5%; negative predictive value, 72.9%), and locations of FAZ damage seen on FA corresponded well with sites of foveal GCL damage on OCT. In nondiabetic, normal eyes, the size of the foveola on OCT matched the size of the FAZ on FA.
Evidence of foveal GCL damage on OCT is a good indicator of macular ischemic damage in eyes with diabetic retinopathy. Although in this study FA was more sensitive than OCT in detecting vascular damage, OCT provides objective results and seems to be a good noninvasive substitute for FA.
通过高分辨率光学相干断层扫描（OCT）描述缺血性糖尿病性黄斑病变的形态学特征及其与荧光素血管造影（FA）中受损的黄斑无血管区（FAZ）的相关性。
观察性病例系列。
研究了63例糖尿病视网膜病变患者的124只眼，其FA和OCT图像质量合格。还研究了23例单侧急性中心性浆液性脉络膜病变的非糖尿病患者的23只正常对侧眼。
使用高速傅里叶域OCT和散斑降噪技术，通过黄斑中心获取详细的水平和垂直图像，并每隔100微米进行水平光栅扫描。OCT上黄斑神经节细胞层（GCL）损伤表现为与正常黄斑相比黄斑厚度和轮廓有明显差异，或黄斑内不对称。通过共焦扫描激光检眼镜（HRA 2；德国海德堡工程公司，海德堡）进行荧光素血管造影，并根据早期糖尿病视网膜病变研究（ETDRS）FA分级系统对FA动脉期可见的FAZ损伤进行分级。寻找OCT上识别的黄斑GCL损伤与FA毛细血管缺失部位之间的相关性。
OCT上的黄斑GCL损伤、OCT上黄斑小凹的大小（定义为GCL厚度<10微米的区域）、FA上FAZ的ETDRS分级以及视力。
在124只糖尿病视网膜病变眼中，62只（50%）有FA证据显示FAZ损伤高于1级或FAZ毛细血管丢失。在这些眼中，FA上可见的FAZ损伤在OCT上也能检测到（阳性预测值为84.5%；阴性预测值为72.9%），且FA上可见的FAZ损伤位置与OCT上黄斑GCL损伤部位高度吻合。在非糖尿病正常眼中，OCT上黄斑小凹的大小与FA上FAZ的大小相符。
OCT上黄斑GCL损伤的证据是糖尿病视网膜病变患者黄斑缺血损伤的良好指标。尽管在本研究中FA在检测血管损伤方面比OCT更敏感，但OCT能提供客观结果，似乎是FA的良好无创替代方法。
