Haj Najeeb Bilal, Simader Christian, Deak Gabor, Vass Clemens, Gamper Jutta, Montuoro Alessio, Gerendas Bianca S, Schmidt-Erfurth Ursula
Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
Glaucoma Clinic, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
Invest Ophthalmol Vis Sci. 2017 Aug 1;58(10):3986-3990. doi: 10.1167/iovs.17-21510.
To determine the distribution of leakage on fluorescein angiography (FA) and explore the clinically protective role of astrocytes against damage to the inner blood retinal barrier (iBRB) in diabetic macular edema (DME).
A consecutive case series of 87 eyes of 87 patients with DME was included. We measured the leakage area in each field of the Early Treatment Diabetic Retinopathy Study (ETDRS) grid on late-phase FA images. The normative thickness of the nerve fiber layer (NFL), in which the astrocytes are confined, was derived from a previous work using spectral-domain optical coherence tomography. We explored the difference in leakage areas in every two fields. Moreover, we investigated the correlation between the mean of the leakage area and the mean of thickness of the NFL in each ETDRS field.
The leakage areas in the nasal, inferior, superior, and temporal fields were 2.34 mm2, 2.84 mm2, 3.03 mm2, and 3.96 mm2. The difference in leakage area between each two fields was significant in all cases (P < 0.05) except between the inferior and superior fields (P = 0.65). The temporal field was the only field that showed leakage in all 87 cases. The correlation between the leakage area and the thickness of the NFL in the ETDRS fields was negative and highly significant: r = -0.96 (95% confidence interval -0.99 to -0.02).
The distribution of leakage correlates inversely and statistically significantly with the thickness of the NFL, suggesting astrocytes in the NFL play a pivotal role in preventing damage to the iBRB and subsequent evolution of microaneurysms in DME. Moreover, fluid extravasation due to damage to the iBRB is expressed earlier in the temporal than in the other three fields.
确定糖尿病性黄斑水肿（DME）患者荧光素血管造影（FA）渗漏的分布情况，并探讨星形胶质细胞对糖尿病性黄斑水肿患者内血视网膜屏障（iBRB）损伤的临床保护作用。
纳入87例DME患者的87只眼的连续病例系列。我们在晚期FA图像上测量了糖尿病视网膜病变早期治疗研究（ETDRS）网格每个区域的渗漏面积。神经纤维层（NFL）的正常厚度来自先前使用光谱域光学相干断层扫描的研究，星形胶质细胞局限于该层。我们探讨了每两个区域渗漏面积的差异。此外，我们研究了每个ETDRS区域渗漏面积的平均值与NFL厚度平均值之间的相关性。
鼻侧、下方、上方和颞侧区域的渗漏面积分别为2.34平方毫米、2.84平方毫米、3.03平方毫米和3.96平方毫米。除下方和上方区域之间差异无统计学意义（P = 0.65）外，所有病例中每两个区域之间的渗漏面积差异均有统计学意义（P < 0.05）。颞侧区域是所有87例病例中唯一均出现渗漏的区域。ETDRS区域中渗漏面积与NFL厚度之间的相关性为负且高度显著：r = -0.96（95%置信区间为-0.99至-0.02）。
渗漏分布与NFL厚度呈负相关且具有统计学意义，提示NFL中的星形胶质细胞在预防DME中iBRB损伤及随后微动脉瘤的演变中起关键作用。此外，iBRB损伤导致的液体外渗在颞侧区域比在其他三个区域出现得更早。
