Bek T, Lund-Andersen H
Department of Ophthalmology, University of Copenhagen, Gentofte Hospital, Hellerup, Denmark.
Br J Ophthalmol. 1990 Jul;74(7):388-92. doi: 10.1136/bjo.74.7.388.
Twenty patients with insulin dependent diabetes mellitus were selected on the basis of morphological signs of blood-retinal barrier leakage--namely, hard exudates seen on fundus photographs and/or localised leakage of fluorescein seen on fluorescein angiograms. Computerised perimetry was carried out in visual field areas that corresponded to the morphological lesions, and the visual field data were accurately correlated with the morphology as seen on fundus photographs and fluorescein angiograms. In addition, in seven of the patients who represented the range of leakage among the patients studied, the blood-retinal barrier leakage was quantitated by vitreous fluorophotometry. In 16 cases normal light sensitivity was found in retinal areas showing localised leakage as studied on fluorescein angiograms. In four cases with pronounced maculopathy, where scotomata occurred, there was no topographical correlation between the scotomata and barrier leakage. Furthermore hard exudates often, but not consistently, caused localised scotomata when arranged in dense conglomerates. The permeability values correlated with angiographically observed hyperfluorescence in the macular area. On the basis of the techniques employed in the present study it seems that breakdown of the blood-retinal barrier is an earlier event than disturbance of neurosensory function in the development of diabetic retinopathy. However, the findings give no evidence of a causal relationship between barrier leakage and damage to sensory cell function.
根据血视网膜屏障渗漏的形态学体征，即眼底照片上可见的硬性渗出物和/或荧光素血管造影上可见的荧光素局部渗漏，选取了20例胰岛素依赖型糖尿病患者。在与形态学病变相对应的视野区域进行计算机视野检查，并将视野数据与眼底照片和荧光素血管造影上所见的形态学准确关联。此外，在代表所研究患者渗漏范围的7例患者中，通过玻璃体荧光光度法对血视网膜屏障渗漏进行了定量。在16例病例中，荧光素血管造影研究显示，视网膜局部渗漏区域的光敏感度正常。在4例有明显黄斑病变且出现暗点的病例中，暗点与屏障渗漏之间不存在地形学相关性。此外，硬性渗出物在密集聚集时，常但并非总是会导致局部暗点。通透性值与黄斑区血管造影观察到的高荧光相关。根据本研究采用的技术，在糖尿病视网膜病变的发展过程中，血视网膜屏障的破坏似乎比神经感觉功能障碍更早发生。然而，这些发现没有证据表明屏障渗漏与感觉细胞功能损害之间存在因果关系。
