Shen Yinchen, Liu Kun, Xu Xun
a Department of Ophthalmology , Shanghai First People's Hospital affiliated with Shanghai Jiao Tong University , Shanghai , People's Republic of China and.
b Shanghai Jiao Tong University School of Medicine , Shanghai , People's Republic of China.
Curr Eye Res. 2016;41(3):391-9. doi: 10.3109/02713683.2015.1019003. Epub 2015 Apr 21.
To evaluate the relationship between visual function and (i) microstructural changes in the fovea of the inner segment-outer segment junction (IS/OS) and (ii) external limiting membrane (ELM) in diabetic macular edema (DME).
We conducted a retrospective, observational, cross-sectional study of 40 DME patients (61 eyes), all of whom had been treated at Shanghai First People's Hospital. Patients were divided into groups based on integrity of the IS/OS or ELM: IS/OS (+, ± and -) and ELM (+, ± and -). We performed best-corrected visual acuity (BCVA), MP1 microperimetry and spectral-domain optical coherence tomography (SD-OCT) on all patients. Several variables, including IS/OS and ELM integrity, central macular thickness (CMT) and central macular volume (CMV), were evaluated by two observers, each masked to patients' BCVA. Main outcome measures included determination of the association of visual function with SD-OCT results.
Significant differences were found between IS/OS (+), IS/OS (±) and IS/OS (-) groups in BCVA (66.88 ± 7.89, 51.60 ± 9.39, 32.64 ± 17.93 letters, p < 0.001); macular sensitivity (MS; 8.21 ± 2.91, 3.55 ± 2.75, 2.72 ± 1.86 dB, p < 0.001); fixation stability within 2° (82.09 ± 12.76, 66.43 ± 29.54, 33.73 ± 29.51%, p < 0.001); and % central fixation (74.87 ± 16.88, 61.39 ± 31.38, 31.64 ± 31.89%, p < 0.001); but no differences were found for CMT (p = 0.069) or CMV (p = 0.069). Results were similar for ELM groups. There were significant differences between ELM (+), ELM (±) and ELM (-) groups in BCVA (64.16 ± 9.49, 50.44 ± 9.83, 32.73 ± 17.98 letters, p < 0.001); MS (7.54 ± 3.22, 3.38 ± 2.38, 2.20 ± 1.72 dB, p < 0.001); fixation stability within 2° (81.48 ± 15.26, 61.12 ± 31.63, 35.00 ± 29.07%, p < 0.001); and % central fixation (75.90 ± 17.33, 55.88 ± 30.94, 30.09 ± 33.00%, p < 0.001); but not for CMT (p = 0.216) or CMV (p = 0.202). There was a strong correlation (r = 0.881, p < 0.001) between ELM and IS/OS integrity for the same patient. Categories of IS/OS showed more severe changes than did those of ELM.
Both IS/OS and ELM integrity correlated positively with visual function in DME patients. Further studies are needed to confirm and validate this relationship.
评估糖尿病性黄斑水肿（DME）患者的视功能与（i）内节-外节连接部（IS/OS）中央凹的微观结构变化及（ii）外界膜（ELM）之间的关系。
我们对40例DME患者（61只眼）进行了一项回顾性、观察性横断面研究，所有患者均在上海第一人民医院接受治疗。根据IS/OS或ELM的完整性将患者分为几组：IS/OS（完整、部分缺失和缺失）和ELM（完整、部分缺失和缺失）。我们对所有患者进行了最佳矫正视力（BCVA）、MP1微视野检查和频域光学相干断层扫描（SD-OCT）。包括IS/OS和ELM完整性、黄斑中心厚度（CMT）和黄斑中心体积（CMV）在内的几个变量由两名观察者进行评估，每位观察者均不知道患者的BCVA。主要结局指标包括确定视功能与SD-OCT结果之间的关联。
在BCVA（66.88±7.89、51.60±9.39、32.64±17.93字母，p<0.001）、黄斑敏感度（MS；8.21±2.91、3.55±2.75、2.72±1.86dB，p<0.001）、2°范围内的注视稳定性（82.09±12.76、66.43±29.54、33.73±29.51%，p<0.001）以及中央注视百分比（74.87±16.88、61.39±31.38、31.64±31.89%，p<0.001）方面，IS/OS完整组、IS/OS部分缺失组和IS/OS缺失组之间存在显著差异；但CMT（p=0.069）或CMV（p=0.069）方面无差异。ELM分组的结果相似。在BCVA（64.16±9.49、50.44±9.83、32.73±17.98字母，p<0.001）、MS（7.54±3.22、3.38±2.38、2.20±1.72dB，p<0.001）、2°范围内的注视稳定性（81.48±15.26、61.12±31.63、35.00±29.07%，p<0.001）以及中央注视百分比（75.90±17.33、55.88±30.94、30.09±33.00%，p<0.001）方面，ELM完整组、ELM部分缺失组和ELM缺失组之间存在显著差异；但CMT（p=0.216）或CMV（p=0.202）方面无差异。同一患者的ELM和IS/OS完整性之间存在强相关性（r=0.881,p<0.001）。IS/OS类别的变化比ELM类别更严重。
DME患者的IS/OS和ELM完整性均与视功能呈正相关。需要进一步研究来证实和验证这种关系。
