机构地区:[1]中山大学附属第三医院眼科,广州510630 [2]中山大学中山眼科中心眼科学国家重点实验室
出 处:《中华眼底病杂志》2012年第3期215-218,共4页Chinese Journal of Ocular Fundus Diseases
摘 要:目的观察非增生期糖尿病视网膜病变(NPDR)合并糖尿病视神经病变(DON)的临床分类及表现。方法经荧光素眼底血管造影(FFA)检查确诊为NPDR的224例患者440只眼纳入研究。采用光相干断层扫描(OCT)检查观察视盘形态,测量视盘周围视网膜神经纤维层(RNFI。)厚度。同时检测糖化血红蛋白(HbAlc)、血脂水平等全身相关指标。根据检查结果将合并DON的患者作为DON组,其余未合并DON的患者作为对照组。DON组患者进一步分为糖尿病视盘病变(DP)、缺血性视神经病变(AION)及视神经萎缩等3个亚组。观察DP、AION、视神经萎缩的发病率。分析各组间平均RNFL厚度及全身相关指标的差异。结果224例440只眼中,合并DON者14例19只眼,占患眼的4.3%;未合并DON者210例421只眼,占患眼的95.7%。DON组14例19只眼中,DP2例2只眼,占患眼的10.5%;AION8例12只眼,占患眼的63.2%;视神经萎缩4例5只眼,占患眼的26.3%。DP组患眼均无明显视网膜病变。AION在无明显视网膜病变、轻度、中度、重度NPDR期的发病率比较,差异无统计学意义(x2=0.019,P〉0.05)。与对照组比较,AION组视盘垂直径、水平径及视盘杯盘比(C/D)比值均较小,差异均有统计学意义(t=-2.425,-3.432,-3.871;P〈0.05);糖尿病病程明显延长,差异也有统计学意义(t-2.320;P〈0.05)。结论NPDR可发生DP、AION、视神经萎缩3种病变。AION患者视盘垂直径、水平径及视盘C/D比值均较小,糖尿病病程明显延长。Objective To observe the clinical classification and manifestation of diabetic optic neuropathy (DON) in patients with non-proliferative diabetic retinopathy (NPDR). Methods Two hundreds and twenty four patients (440 eyes) with NPDR diagnosed by fundus fluorescein angiography (FFA) were included in this study. All patients were examined including visual acuity, intraocular pressure, slit-lamp microscopy, color fundus photography and visual field. The morphology of optic disc and peripapillary retinal nerve fiber layer (RNFL) thickness were observed and measured by optical coherence tomography (OCT). The levels of HbA1C and lipid were detected. According to the examination results, the patients were divided into DON group and control group. DON groups were further subdivided into diabetic papillopathy (DP), anterior ischemic optic neuropathy (AION) and optic atrophy subgroups. The incidence of DP, AION and optic atrophy were observed. And the differences of RNFL thickness and systemic related indexes among groups were statistically analyzed. Results Among the 440 eyes, DON was found in 19 eyes (4.3%), without DON was found in 421 eyes (95.7%). There were two eyes (10.5%) with DP, 12 eyes (63.2%) with AION and five eyes (26.3%) with optic atrophy in the DON group. Both of the DP eyes were without obvious DR. There was no statistical significance between the incidence of AIONin without obvious DR, mild, in moderate and severe NPDR stage (X2 = 0.019, P〉0.05). Compared with control group, the horizontal disc diameter, vertical disc diameter and C/D ratio were smaller in eyes with AION (t=-2.425, -3.432, -3.871; P〈0.05); the duration of diabetes was significantly prolonged (t=2. 320, P〈0.05). Conclusions There are three kinds of DON in patients with NPDR, which include DP, AION and optic atrophy. Optic disk and C/D ratio are small, and the duration of diabetes course is long in AION patients.
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