2型糖尿病患者黄斑水肿的短期自然病程与玻璃体黄斑关系的相关性

Association between the short-term natural history of diabetic macular edema and the vitreomacular relationship in type II diabetes mellitus.

作者信息

Hikichi T, Fujio N, Akiba J, Azuma Y, Takahashi M, Yoshida A

机构信息

Department of Ophthalmology, Sapporo Kosei General Hospital, Japan.

出版信息

Ophthalmology. 1997 Mar;104(3):473-8. doi: 10.1016/s0161-6420(97)30289-9.

DOI:10.1016/s0161-6420(97)30289-9

PMID:9082275

Abstract

PURPOSE

The authors ascertain the association between the short-term natural history of untreated diabetic macular edema and the vitreomacular relationship.

METHODS

The authors prospectively studied 82 type II diabetic patients with clinically significant macular edema over a six-month period. They used multiple linear regression analysis to evaluate the effect of ten variables on the short-term natural history of macular edema 6 months after diagnosis: age; gender; diabetes duration at diagnosis of macular edema; hemoglobin A1; insulin use; presence of proteinuria; presence of systemic hypertension, cardiac disorders, or both; degree of diabetic retinopathy; history of panretinal photocoagulation; and vitreomacular relationships, as determined by present lens biomicroscopy.

RESULTS

At study entry, 22 (27%) eyes had vitreomacular separation and 60 (73%) eyes did not. Macular edema spontaneously resolved in 27 (33%) eyes 6 months after diagnosis. Of the 22 eyes with vitreomacular separation at study entry, 12 (55%) had spontaneous resolution of macular edema after 6 months, whereas only 15 of 60 (25%) of the eyes with vitreomacular adhesion at study entry had spontaneous resolution (P = 0.01). Stepwise regression analysis indicated that vitreomacular separation (P = 0.01) and diabetes duration (P = 0.03) contribute to resolution of macular edema. Of the 27 eyes with resolved macular edema, 17 (63%) had improved visual acuity of more than two lines, whereas no eyes had improved visual acuity if macular edema persisted. The prevalence of improved visual acuity of more than two lines was significantly higher in eyes with vitreomacular separation at study entry (36%, 8/22) than in eyes without (15%, 9/60; P = 0.04).

CONCLUSION

Our findings suggest that vitreomacular separation may promote the spontaneous resolution of diabetic macular edema and consequently improve visual acuity.

摘要

目的

作者确定未经治疗的糖尿病性黄斑水肿的短期自然病程与玻璃体黄斑关系之间的关联。

方法

作者对82例患有具有临床意义的黄斑水肿的II型糖尿病患者进行了为期6个月的前瞻性研究。他们使用多元线性回归分析来评估10个变量对诊断后6个月黄斑水肿短期自然病程的影响：年龄；性别；黄斑水肿诊断时的糖尿病病程；糖化血红蛋白；胰岛素使用情况；蛋白尿的存在；全身性高血压、心脏疾病或两者皆有的存在；糖尿病视网膜病变的程度；全视网膜光凝病史；以及通过当前晶状体生物显微镜检查确定的玻璃体黄斑关系。

结果

在研究开始时，22只（27%）眼存在玻璃体黄斑分离，60只（73%）眼不存在。诊断后6个月，27只（33%）眼的黄斑水肿自发消退。在研究开始时存在玻璃体黄斑分离的22只眼中，12只（55%）在6个月后黄斑水肿自发消退，而在研究开始时存在玻璃体黄斑粘连的60只眼中，只有15只（25%）自发消退（P = 0.01）。逐步回归分析表明，玻璃体黄斑分离（P = 0.01）和糖尿病病程（P = 0.03）有助于黄斑水肿的消退。在27只黄斑水肿消退的眼中，17只（63%）视力提高超过两行，而如果黄斑水肿持续存在，则没有眼的视力得到改善。在研究开始时存在玻璃体黄斑分离的眼中，视力提高超过两行的患病率显著高于不存在的眼（36%，8/22比15%，；P = 0.04）。