Cunha-Vaz J, Lobo C, Sousa J C, Oliveiros B, Leite E, de Abreu J R
Department of Ophthalmology, University Hospital and Institute for Biomedical Research in Light and Image, Coimbra, Portugal.
Graefes Arch Clin Exp Ophthalmol. 1998 Apr;236(4):264-8. doi: 10.1007/s004170050075.
The study was carried out to evaluate the correlation between blood-retinal barrier (BRB) permeability and the progression of diabetic retinopathy (DR), defined by development of "need for photocoagulation", over a 7-year period by means of vitreous fluorometry (VF).
Forty type 2 diabetic patients with minimal or no retinopathy, aged 40-65 years (mean 53.9 + 7.3 years), were followed up prospectively for 7 years. Investigations including standard ophthalmological examination, fundus photography, fluorescein angiography and VF were performed at entry and 1, 4, 5 and 7 years later. Only one eye per patient was included in the study. Need for photocoagulation was based on Early Treatment Diabetic Retinopathy Study protocols and decided by the attending ophthalmologist.
After 7 years of follow-up a total of 22 of the 40 eyes had received photocoagulation. The eyes that needed photocoagulation were those that had higher VF values at the entry of the study and showed higher rates of deterioration (initial values 5.1 + 1.9 vs 2.8 + 1.5 x 10(-6) min-1, P < 0.001; annual increase in leakage for the first year, 1.5 + 0.8 vs 0.5 + 1.0 x 10(-6) min-1, P < 0.001,). The eyes that did not need photocoagulation during the 7 years of follow-up showed stable VF readings (-0.1 + 1.2 x 10(-6) min-1, difference between initial values and 7 years later).
Abnormally high VF values and their rapid increase over time are good indicators of progression and worsening of the retinopathy in diabetes type 2.
本研究旨在通过玻璃体荧光测定法（VF）评估血视网膜屏障（BRB）通透性与糖尿病视网膜病变（DR）进展之间的相关性，DR的进展定义为在7年期间出现“需要进行光凝治疗”的情况。
对40例年龄在40 - 65岁（平均53.9±7.3岁）、患有轻度或无视网膜病变的2型糖尿病患者进行了为期7年的前瞻性随访。在入组时以及1年、4年、5年和7年后进行了包括标准眼科检查、眼底照相、荧光素血管造影和VF在内的检查。每位患者仅一只眼睛纳入研究。是否需要光凝治疗依据糖尿病视网膜病变早期治疗研究方案确定，并由主治眼科医生决定。
经过7年随访，40只眼中共有22只接受了光凝治疗。需要光凝治疗的眼睛在研究入组时具有较高的VF值，且显示出较高的恶化率（初始值5.1±1.9 vs 2.8±1.5×10⁻⁶ min⁻¹，P < 0.001；第一年渗漏的年增加量，1.5±0.8 vs 0.5±1.0×10⁻⁶ min⁻¹，P < 0.001）。在7年随访期间不需要光凝治疗的眼睛显示VF读数稳定（-0.1±1.2×10⁻⁶ min⁻¹，初始值与7年后的差值）。
异常高的VF值及其随时间的快速增加是2型糖尿病视网膜病变进展和恶化的良好指标。
