Yang Xiao-lu, Zou Hai-dong, Xu Xun
Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200080, China.
Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200080, China. Email:
Zhonghua Yan Ke Za Zhi. 2013 Dec;49(12):1081-8.
To detect the correlation of retinal sensitivity, visual acuity and central macular thickness in patients with different types of diabetic macular edema (DME), macular function were evaluated by measuring the sensitivity, fixation pattern of the macular was examined by fundus-related microperimetry, then analyzed and compared the results with best-corrected visual acuity (BCVA) and foveal retinal thickness measured by optical coherence tomography (OCT).
A retrospective case-series study. In a prospective, observational case series study, 52 consecutive patients (83 eyes) with diabetic macular edema were included.Sex, age,BMI, education, type of DM, duration, treatment, laboratory examinations, history of cardiovascular disease, hypertension, hyperlipidemia, diabetic nephropathy, and cigarette use were documented.Logarithm of the minimum angle of resolution (logMAR) BCVA was evaluated using the international vision test chart.Foveal thickness was measured by OCT. Mean retinal sensitivities, fixation stability and position was investigated with microperimetry. Variables related with BCVA, foveal thickness and mean retinal sensitivities were analyzed in different types of DME patients using one-way ANOVA or Kruskal-Wallis test. As for fixation, Fisher exact test was chosen. Pearson Correlation analysis was performed to evaluate the association between these variables. Spearman correlation analysis was used for ordinal data. The correlation between retinal sensitivities and all the variables examined were analyzed under multiple regression analysis.
Eighty-three eyes were included in this study. Forty-seven eyes (56.63%) were graded as focal DME, 20 eyes (24.10%) as diffuse DME, 5 eyes (6.02%) as ischemic DME and 11 eyes (13.25%) as proliferative DME. Comparison between different types of DME patients showed statistically significant difference in mean logMAR BCVA (F = 12.737, P < 0.01) , mean OCT foveal thickness (H = 31.504, P < 0.01) , mean central retinal sensitivities (F = 14.760, P < 0.01) , and patterns of fixation, which were also statistically correlated (χ(2)= 23.47, 21.01; P < 0.01). It was a positive correlation between OCT foveal thickness and logMAR BCVA in patients with focal, diffuse and ischemic DME (r = 0.56, -0.62; P < 0.01) , but not with proliferative DME (r = 0.43, P = 0.19) .While central retinal sensitivities were also negative correlation between OCT foveal thickness and logMAR BCVA (r = -0.62, -0.68; P < 0.01) . Multiple regression analysis showed that central retinal sensitivity was inversely correlated with LogMAR and retinal thickness (t = -5.52, -4.24; P < 0.01).
There are statistically significant difference in macular morphology and vision function between different types of DME patients. The progression of DME are expressed gradually from focal, diffuse to ischemic type. DME could be fully evaluated by measuring macular sensitivity, fixation pattern with microperimetry as well as macular thickness measurement with OCT and visual acuity determination comprehensively.
检测不同类型糖尿病性黄斑水肿（DME）患者视网膜敏感度、视力及黄斑中心厚度之间的相关性，通过测量视网膜敏感度评估黄斑功能，采用眼底相关微视野计检查黄斑的注视模式，然后将结果与光学相干断层扫描（OCT）测量的最佳矫正视力（BCVA）和黄斑视网膜厚度进行分析比较。
一项回顾性病例系列研究。在一项前瞻性观察性病例系列研究中，纳入了52例连续的糖尿病性黄斑水肿患者（83只眼）。记录患者的性别、年龄、体重指数、教育程度、糖尿病类型、病程、治疗情况、实验室检查结果、心血管疾病史、高血压、高脂血症、糖尿病肾病及吸烟情况。使用国际视力检查表评估最小分辨角对数（logMAR）BCVA。通过OCT测量黄斑厚度。用微视野计研究平均视网膜敏感度、注视稳定性和位置。使用单因素方差分析或Kruskal-Wallis检验分析不同类型DME患者中与BCVA、黄斑厚度和平均视网膜敏感度相关的变量。对于注视情况，选择Fisher精确检验。进行Pearson相关分析以评估这些变量之间的关联。对有序数据使用Spearman相关分析。在多元回归分析下分析视网膜敏感度与所有检查变量之间的相关性。
本研究共纳入83只眼。47只眼（56.63%）为局灶性DME，20只眼（24.10%）为弥漫性DME，5只眼（6.02%）为缺血性DME，11只眼（13.25%）为增殖性DME。不同类型DME患者之间的比较显示，平均logMAR BCVA（F = 12.737，P < 0.01）、平均OCT黄斑厚度（H = 31.504，P < 0.01）、平均中心视网膜敏感度（F = 14.760，P < 0.01）及注视模式存在统计学显著差异，且这些差异也具有统计学相关性（χ(2)= 23.47, 21.01; P < 0.01）。在局灶性弥漫性和缺血性DME患者中，OCT黄斑厚度与logMAR BCVA呈正相关（r = 0.56, -0.62; P < 0.01），但在增殖性DME患者中无相关性（r = 0.43, P = 0.19）。而中心视网膜敏感度与OCT黄斑厚度和logMAR BCVA也呈负相关（r = -0.62, -0.68; P < 0.01）。多元回归分析显示，中心视网膜敏感度与LogMAR和视网膜厚度呈负相关（t = -5.52, -4.24; P < 0.01）。
不同类型DME患者的黄斑形态和视觉功能存在统计学显著差异。DME的进展从局灶性、弥漫性逐渐发展为缺血性类型。通过综合测量黄斑敏感度、用微视野计检查注视模式以及用OCT测量黄斑厚度和测定视力，可以全面评估DME。
