Fondazione G. B. Bietti, IRCCS, Roma, Italy.
Retina. 2012 Oct;32(9):1781-90. doi: 10.1097/IAE.0b013e31825db73d.
To investigate macular and peripapillary choroidal thickness (CT) in diabetic patients with and without diabetic retinopathy (DR).
One hundred and fifty subjects were enrolled: 102 diabetic patients (102 eyes) and 48 normals, as controls. Exclusion criteria were previously treated DR, refractive error higher than ± 3 diopters, and treated or untreated glaucoma. All patients underwent full ophthalmic examination, stereoscopic color fundus photography, and spectral domain optical coherence tomography (RS-3000; Nidek). Spectral domain optical coherence tomography examination consisted of linear scans, 6 mm in length, centered onto the fovea, and circle scan positioned around the optic disk (3.46 mm in diameter). Choroidal thickness was measured manually at the fovea and at 1, 2, and 3 mm distance along all scans in the macula. Peripapillary CT was measured at eight points along the circle scan. All measurements were performed independently by 2 masked graders.
Mean age was not significantly different between patients with diabetes and controls. In the macular area, CT was significantly lower in the nasal quadrant versus all other quadrants (P < 0.0001), in both groups. In the peripapillary area, CT was significantly lower in the inferior quadrant versus all other quadrants (P < 0.05), in both groups. Mean macular and peripapillary CT progressively and significantly decreased with increasing level of DR (nonproliferative and proliferative DR vs. controls, P < 0.05). No significant CT difference was found between controls and diabetic eyes without detectable DR. Diabetic macular edema did not influence CT. Interobserver coefficient of repeatability was 28.8 (95% confidence interval, 24.8-32.8) for foveal measurements and 13.0 (95% confidence interval, 11.2-14.8) for peripapillary measurements. Pearson correlation coefficient was 0.99, and P <0.0001 for all measurements.
Choroidal thickness is reduced in diabetic eyes and parallels appearance and evolution of DR. Spectral domain optical coherence tomography clearly confirms in vivo previously reported histopathologic observations. The role of choroid in the pathophysiology of DR needs to be adequately investigated.
研究糖尿病患者是否存在糖尿病性视网膜病变（DR）以及存在 DR 时黄斑和视盘周围脉络膜厚度（CT）的变化。
共纳入 150 例受试者：102 例糖尿病患者（102 只眼）和 48 例正常对照。排除标准为：曾接受过 DR 治疗、屈光不正大于±3 屈光度以及患有或未患有青光眼。所有患者均接受全面的眼科检查、立体彩色眼底照相和频域光学相干断层扫描（RS-3000；尼德克）。频域光学相干断层扫描检查包括 6mm 长的线性扫描，以黄斑为中心，以及围绕视盘的圆形扫描（直径 3.46mm）。手动测量黄斑区和所有扫描的 1、2 和 3mm 处的黄斑区 CT。在圆形扫描的 8 个点测量视盘周围 CT。所有测量均由 2 名独立的盲法评分者进行。
糖尿病患者和对照组的平均年龄无显著差异。在黄斑区，与其他象限相比，鼻侧象限的 CT 明显更低（P<0.0001），两组均如此。在视盘周围区域，与其他象限相比，下象限的 CT 明显更低（P<0.05），两组均如此。随着 DR 程度的增加（非增生性和增生性 DR 与对照组相比，P<0.05），黄斑和视盘周围 CT 逐渐且显著降低。在无明显 DR 可检测的糖尿病眼中，与对照组相比，CT 无显著差异。糖尿病性黄斑水肿并不影响 CT。黄斑区重复测量的观察者间可重复性系数为 28.8（95%置信区间，24.8-32.8），视盘周围区域为 13.0（95%置信区间，11.2-14.8）。Pearson 相关系数为 0.99，P<0.0001。
糖尿病患者的脉络膜厚度降低，且与 DR 的出现和进展呈平行关系。频域光学相干断层扫描清楚地证实了先前报道的组织病理学观察结果。脉络膜在 DR 的病理生理中的作用需要进一步研究。
