中心凹囊腔与糖尿病性黄斑水肿中增大的中心凹无血管区和微动脉瘤有关。

Foveal cystoid spaces are associated with enlarged foveal avascular zone and microaneurysms in diabetic macular edema.

机构信息

Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, Japan.

出版信息

Ophthalmology. 2011 Feb;118(2):359-67. doi: 10.1016/j.ophtha.2010.03.035. Epub 2010 Jul 24.

DOI:10.1016/j.ophtha.2010.03.035

PMID:20656355

Abstract

OBJECTIVE

To study the association between pathomorphology at the foveal center delineated by spectral domain optical coherence tomography (SD-OCT) and vascular changes around the fovea in fluorescein angiography (FA) in patients with diabetic macular edema (DME).

DESIGN

Retrospective, observational, cross-sectional study.

PARTICIPANTS

Consecutive series of 86 eyes from 72 patients with clinically significant macular edema (CSME) on which SD-OCT and FA were performed on the same day.

METHODS

Fluorescein angiography using HRA2 (Heidelberg Engineering, Heidelberg, Germany) and SD-OCT images using Spectralis OCT (Heidelberg Engineering) were obtained for all patients. Microaneurysms (MAs) in the perifoveal capillary network (PCN) and foveal avascular zone (FAZ) in the FA images were quantified. The pathomorphology at the foveal center was evaluated in OCT images. We then investigated the association between pathologic perifoveal capillaries in FA and the neuroglial morphology in OCT.

MAIN OUTCOME MEASURES

The relationship between pathologic changes in perifoveal capillaries in FA and foveal pathomorphology in OCT.

RESULTS

According to the foveal morphology in OCT images, 44 eyes presented foveal cystoid spaces (cystoid macular edema [CME]), 25 eyes had serous retinal detachment (SRD) at the foveal center, and 17 eyes had foveal thickening without cystoid spaces or retinal detachment (retinal swelling). After 3 eyes with ischemic maculopathy were excluded, the relationship was evaluated. The number of MAs in the PCN was significantly greater in eyes with CME (3.20 ± 1.76) than in eyes with SRD (0.40 ± 1.04; P < 0.01) or retinal swelling (0.47 ± 0.72; P < 0.01). In addition, the FAZ in the eyes with CME (0.553 ± 0.323 mm(2)) was significantly larger than that of the eyes with SRD (0.302 ± 0.245 mm(2); P < 0.01) or retinal swelling (0.268 ± 0.142 mm(2); P < 0.01). These associations were found in eyes with thickened posterior hyaloid membranes.

CONCLUSIONS

The eyes with cystoid spaces at the foveal center delineated by OCT had more MAs in the PCN and larger FAZ in FA images.

摘要

目的

研究在糖尿病黄斑水肿（DME）患者中，频域光学相干断层扫描（SD-OCT）所描绘的黄斑中心区的病理形态与荧光素血管造影（FA）中黄斑周围血管变化之间的关系。

设计

回顾性、观察性、横断面研究。

参与者

连续系列的 72 例患者 86 只眼，这些患者均患有临床上明显的黄斑水肿（CSME），并在同一天进行了 SD-OCT 和 FA。

方法

对所有患者均进行 HRA2（Heidelberg Engineering，Heidelberg，德国）荧光素血管造影和 Spectralis OCT（Heidelberg Engineering）SD-OCT 成像。在 FA 图像中量化了周边毛细血管网（PCN）中的微动脉瘤（MA）和黄斑中心无血管区（FAZ）。在 OCT 图像中评估黄斑中心的病理形态。然后我们研究了 FA 中病理性周边毛细血管与 OCT 中的神经胶质形态之间的关系。

主要观察指标

FA 中周边毛细血管病变与 OCT 中黄斑中心形态之间的关系。

结果

根据 OCT 图像中的黄斑形态，44 只眼出现黄斑囊样空间（囊样黄斑水肿[CME]），25 只眼在黄斑中心出现浆液性视网膜脱离（SRD），17 只眼出现黄斑增厚但无囊样空间或视网膜脱离（视网膜肿胀）。排除 3 只存在缺血性黄斑病变的眼后，对该关系进行了评估。CME 眼中的 MA 数量（3.20±1.76）明显多于 SRD 眼（0.40±1.04；P<0.01）或视网膜肿胀眼（0.47±0.72；P<0.01）。此外，CME 眼中的 FAZ（0.553±0.323mm2）明显大于 SRD 眼中的 FAZ（0.302±0.245mm2；P<0.01）或视网膜肿胀眼中的 FAZ（0.268±0.142mm2；P<0.01）。这些关联存在于后玻璃体膜增厚的眼中。