糖尿病性黄斑水肿患者黄斑中心凹无血管区形态与视网膜光感受器层完整性的关系  

Association between morphology of macular foveal avascular zone and integrity of retinal photoreceptor layer in patients with diabetic macular edema

作　　者：刁莉莉 史雪辉 张丛 姚宁 DIAO Lili;SHI Xuehui;ZHANG Cong;YAO Ning(Department of Ophthalmology,the Affiliated Beijing Tongren Hospital of Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心

出　　处：《眼科新进展》2020年第1期38-41,共4页Recent Advances in Ophthalmology

摘　　要：目的探究糖尿病性黄斑水肿(diabetic macular edema,DME)患者黄斑中心凹无血管区(foveal avascular zone,FAZ)形态与光感受器层(外界膜及椭圆体带)完整性的关系。方法回顾性病例研究。纳入DME患者65例(100眼)作为研究对象,行最佳矫正视力(best corrected visual acuity,BCVA)、裂隙灯生物显微镜、荧光眼底血管造影(fundus fluorescein angiography,FFA)检查,根据ETDRS标准评估FAZ轮廓及大小,根据FAZ轮廓损伤程度的分级不同分为两组,A组≤2级,B组≥3级,并利用频域光学相干断层扫描(optical coherence tomography,OCT)确定黄斑中心凹1 mm直径范围内外界膜(external limiting membrane,ELM)及椭圆体带(ellipsoidal zone,EZ)的连续性及缺损长度,比较两组患者黄斑区ELM的连续性、EZ的完整性、ELM及EZ的缺损长度、FAZ直径、BCVA有无差异。结果A、B两组年龄、糖尿病病程、BCVA、DR分期差异均无统计学意义(均为P>0.05);A组FAZ直径为(785.32±81.09)μm,B组FAZ直径为(928.75±99.93)μm,两组相比差异有统计学意义(P<0.05);A组ELM连续31眼,B组ELM连续34眼,A、B两组ELM缺损长度分别为(119.56±65.09)μm、(126.87±61.23)μm;A组EZ完整30眼,B组EZ完整28眼,A、B两组EZ缺损长度分别为(176.46±79.16)μm、(174.35±96.19)μm,两组ELM连续者占比、EZ完整者占比及ELM、EZ缺损长度相比,差异均无统计学意义(均为P>0.05)。ELM连续者BCVA为(0.37±0.19)logMAR,优于ELM中断者的(0.62±0.16)logMAR,差异有统计学意义(P<0.05);EZ完整者BCVA(0.44±0.18)logMAR,优于EZ不完整者BCVA(0.64±0.16)logMAR,差异有统计学意义(P<0.05)。结论ELM和EZ形态是决定DME患者视力的重要因素,与FAZ轮廓完整程度及大小无明显相关性。Objective To investigate the association between morphology of macular foveal avascular zone(FAZ)and integrity of photoreceptor layer(external limiting membrane,ELM and ellipsoidal zone,EZ)in patients with diabetic macular edema(DME).Methods Retrospective study was conducted on 65 DME patients(100 eyes).Best corrected vision acuity(BCVA)was detected,slit lamp biomicroscopy and fundus fluorescein angiography(FFA)were performed.The outline and size of FAZ were evaluated according to ETDRS standard.All patients were classified into group A(≤grade 2)and group B(≥grade 3)based on the damage degree of macular FAZ contour.Optical coherence tomography(OCT)was used to detect the continuity and defect lengths of ELM and EZ within the diameter of 1mm of macular fovea,and the continuity and defect lengths of ELM and EZ,FAZ diameter in macular region and BCVA were compared between the two groups.Results There were no statistically significant differences in age,course of diabetes or BCVA between group A and group B(all P>0.05).FAZ diameters were(785.32±81.09)μm in group A and(928.75±99.93)μm in group B,respectively,and significant difference was found(P<0.05).ELM continuity was found in 31 eyes of group A and 34 eyes of group B.The defect lengths of ELM were(119.56±65.09)μm in group A and(126.87±61.23)μm in group B,respectively.EZ continuity was 30 eyes in group A and 28 eyes in group B.The defect lengths of EZ were(176.46±79.16)μm in group A and(174.35±96.19)μm in group B,respectively.There were no statistical differences in continuity and defect lengths of ELM and EZ between the two groups(all P>0.05).BCVA was(0.37±0.19)logMAR for patients with continuous ELM,which was better than(0.62±0.16)logMAR in patients with defect ELM,and statistical difference was found(P<0.05).BCVA was(0.44±0.18)logMAR in patients with continuous EZ,which was better than(0.64±0.16)logMAR in patients with defect EZ,and statistical difference was observed(P<0.05).Conclusion The morphology and continuity of ELM and EZ are important

关 键 词：黄斑中心凹无血管区 外界膜 椭圆体带 荧光眼底血管造影 光学相干断层扫描 

分 类 号：R774[医药卫生—眼科]