糖尿病视网膜病变患眼的微视野定量分析
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摘要
目的：应用微视野(microprimetry MP1)检查技术对无糖尿病视网膜病变的糖尿病病人以及有糖尿病视网膜病变病人进行测定，探讨微视野在平均光敏感度和固视稳定性方面对糖尿病视网膜病变(diabetic retinopathy DR)的早期诊断意义，以及其在DR诊断上的临床意义。
方法：选取无DR的糖尿病病人(NDR组)21例42眼，有DR的病人(DR组)31例43眼，年龄匹配的健康志愿者30例60眼作为对照组，测量指标包括视力、2°视网膜平均光敏感度、12°视网膜平均光敏感度、固视稳定性和中心固视；同时比较DR组不同分期、不同眼底病理改变、以及后极部不同分区的光敏感度。
结果：与对照组比较，视力在NDR组无明显下降(P＞0.05)，而DR组视力明显降低(P＜0.01)；与NDR组比较，DR组视力明显降低(P＜0.01)。三组之间2°和12°视网膜平均光敏感度、中心固视、固视稳定性差别具有显著统计学意义(P＜0。001)。DR组不同病理改变的分为硬渗(8.58±3.98 dB)、水肿(6.18±2.80 dB)、软渗(4.84±2.72dB)和出血(3.02±5.01dB)，不同病理改变之间平均光敏感度比较差异无统计学意义(P＞0.05)。DR组后极部中心12°内不同分区平均光敏感度颞上组较鼻上组降低，差异有统计学意义(P＜0.05)；颞上组较鼻下组降低，差异有统计学意义(P＜0.01)。DR组2°和12°视网膜平均光敏感度与最佳矫正视力无相关关系(r=0.36、0.29，P＞0.05)。DR组不同分期之间比较，视力差异无统计学意义(P＞0.05)，2°和12°视网膜平均光敏感度差异无统计学意义。
结论：微视野在平均光敏感度和固视稳定性以及中心固视方面可以对DR进行早期诊断；DR病人颞上象限较其他部位更容易引起损伤。DR病人不同病理改变的平均光敏感度没有明显的差别。DR病人视力和中心光敏感度不相关。DR病人不同分期之间平均光敏感度无差别。
Objective: Evaluation of mean light sensitivity and fixation stability in diabetic patients with or without diabetic retinopathy to investigate early diagnosis of diabetic retinopathy and clinical significance of diabetic retinopathy by using microprimetry (MP1).
Methods: We studied 21 diabetic patients (42 eyes) without retinopathy (NDR group), 31 diabetic patients (43 eyes) with retinopathy (DR group) and 30 healthy volunteers matched with age. The visual acuity, 2° mean light sensitivity, 12° mean light sensitivity, fixation stability and central fixation were measured. At the same time, the light sensitivity of the various stages, the various pathological changes and the various areas in posterior pole of diabetic retinopathy were compared.
Results: There was no significant differences in visual acuity of NDR group(P>0.05), but the visual acuity of DR group was significantly diseased than in control group(P<0.01); the visual acuity of DR group was significantly diseased than NDR group(P<0.01). There were significant differences in mean light sensitivity, fixation stability and central fixation( P<0.001). The various pathological changes of DR group are, hard exudates(8.58±3.98 dB ), macular edema, (6.18 ±2.80 dB) soft exudates (4.84±2.72dB) and hemorrhage(3.02±5.01dB). There were no significant differences in mean light sensitivity of them(P>0.05).The mean light sensitivity of superior—temporal in posterior pole was significantly diseased than in superior —nasal and inferior—nasal(P<0.01). Linear correlation analysis showed that the 2° and 12 ° mean light sensitivity of DR group were not correlated with corrected visual acuity(r=0.36% 0.29, P>0.05). In DR group there was no significant differences in mean light sensitivity and visual acuity of various stages(P>0.05).
Conclusion: It is suggested that examination of mean light sensitivity, fixation stability and central fixation has certain clinical significance in early diagnosis of diabetic retinopathy. Compare to other areas, the superior—temporal in posterior pole of DR more be damaged. There were no significant differences in mean light sensitivity of the various pathological changes. The mean light sensitivity of DR group was not correlated with corrected visual acuity. There was no significant differences in mean light sensitivity and visual acuity of various stages.
方法：选取无DR的糖尿病病人(NDR组)21例42眼，有DR的病人(DR组)31例43眼，年龄匹配的健康志愿者30例60眼作为对照组，测量指标包括视力、2°视网膜平均光敏感度、12°视网膜平均光敏感度、固视稳定性和中心固视；同时比较DR组不同分期、不同眼底病理改变、以及后极部不同分区的光敏感度。
结果：与对照组比较，视力在NDR组无明显下降(P＞0.05)，而DR组视力明显降低(P＜0.01)；与NDR组比较，DR组视力明显降低(P＜0.01)。三组之间2°和12°视网膜平均光敏感度、中心固视、固视稳定性差别具有显著统计学意义(P＜0。001)。DR组不同病理改变的分为硬渗(8.58±3.98 dB)、水肿(6.18±2.80 dB)、软渗(4.84±2.72dB)和出血(3.02±5.01dB)，不同病理改变之间平均光敏感度比较差异无统计学意义(P＞0.05)。DR组后极部中心12°内不同分区平均光敏感度颞上组较鼻上组降低，差异有统计学意义(P＜0.05)；颞上组较鼻下组降低，差异有统计学意义(P＜0.01)。DR组2°和12°视网膜平均光敏感度与最佳矫正视力无相关关系(r=0.36、0.29，P＞0.05)。DR组不同分期之间比较，视力差异无统计学意义(P＞0.05)，2°和12°视网膜平均光敏感度差异无统计学意义。
结论：微视野在平均光敏感度和固视稳定性以及中心固视方面可以对DR进行早期诊断；DR病人颞上象限较其他部位更容易引起损伤。DR病人不同病理改变的平均光敏感度没有明显的差别。DR病人视力和中心光敏感度不相关。DR病人不同分期之间平均光敏感度无差别。
Objective: Evaluation of mean light sensitivity and fixation stability in diabetic patients with or without diabetic retinopathy to investigate early diagnosis of diabetic retinopathy and clinical significance of diabetic retinopathy by using microprimetry (MP1).
Methods: We studied 21 diabetic patients (42 eyes) without retinopathy (NDR group), 31 diabetic patients (43 eyes) with retinopathy (DR group) and 30 healthy volunteers matched with age. The visual acuity, 2° mean light sensitivity, 12° mean light sensitivity, fixation stability and central fixation were measured. At the same time, the light sensitivity of the various stages, the various pathological changes and the various areas in posterior pole of diabetic retinopathy were compared.
Results: There was no significant differences in visual acuity of NDR group(P>0.05), but the visual acuity of DR group was significantly diseased than in control group(P<0.01); the visual acuity of DR group was significantly diseased than NDR group(P<0.01). There were significant differences in mean light sensitivity, fixation stability and central fixation( P<0.001). The various pathological changes of DR group are, hard exudates(8.58±3.98 dB ), macular edema, (6.18 ±2.80 dB) soft exudates (4.84±2.72dB) and hemorrhage(3.02±5.01dB). There were no significant differences in mean light sensitivity of them(P>0.05).The mean light sensitivity of superior—temporal in posterior pole was significantly diseased than in superior —nasal and inferior—nasal(P<0.01). Linear correlation analysis showed that the 2° and 12 ° mean light sensitivity of DR group were not correlated with corrected visual acuity(r=0.36% 0.29, P>0.05). In DR group there was no significant differences in mean light sensitivity and visual acuity of various stages(P>0.05).
Conclusion: It is suggested that examination of mean light sensitivity, fixation stability and central fixation has certain clinical significance in early diagnosis of diabetic retinopathy. Compare to other areas, the superior—temporal in posterior pole of DR more be damaged. There were no significant differences in mean light sensitivity of the various pathological changes. The mean light sensitivity of DR group was not correlated with corrected visual acuity. There was no significant differences in mean light sensitivity and visual acuity of various stages.
引文
[1] Gary L, Linda R, Charles K. Visual field defects in patients with insul in-dependentand noninsul in-dependent diabetes. Ophthalmol 1990, 97: 478-480.
[2] Roth J A. Centual visual field in diabetes. Br J Ophthalmol 1996, 53: 16-25.
[3] Toke B, Henrik LA. Localized boold-retinal barrier leak age and retinal light sensitivity in diabetic retinopathy. Br J Ophthalmol 1990, 74: 388-390.
[4] Arend O, Wolf S, Harris A, et al. The relationship of macular micro-circulation to visual acuity in diabetic patients. Arch Ophthalmol 1995, 113: 610-614.
[5] Sonkin PL, Kelly LW, Sinclair SH, et al. Pentoxifylline in creases retinal capillary blood flow velocity in patients with diabetes. Arch Ophthalmol 1993, 111: 1647-1650.
[6] 韩伟，王竟．非胰岛素依赖性糖尿病病人的自动化视野改变．眼科新进展 2000，20：58-59．
[7] Mori F, Ishiko S, Kitaya N, et al. Use of scanning laser ophthalmoscope microperimetry in clinically significant macular edema in type 2 diabetesmellitus. Jpn J Ophthalmol 2002; 46: 650-655.
[8] Moller F, Bek T: Lack of correlation between visual acuity and fixation stability after photocoagulation for diabetic maculopathy. Graefes Arch Clin Exp Ophthalmol 2000; 238: 566-570.
[9] Moller F, Bek T. The relation between visual acuity and the size of fixational eye movements in patients with diabetic and non-diabetic macular disease. Acta Ophthalmol Stand 1998; 76: 38-42.
[10] Voutilainen-Kaunisto R, Terasvirta M, et al. Maculopathy and visual acuity in newly diagnosed type 2 diabetic patients and non-diabetic subjects: A 10-year follow-up study. Acta Ophthalmol Stand 2001; 79: 163-168.
[11] Toonen F, Wolf S, et al. Automatic microperimetry with a scanning laser ophthalmoscope in patients with diabetic maculopathy. Invest Ophthalmol VisSci 1996; 37: S975.
[12] Ishiko S, Ogasawara H. The use of scanning laser ophthalmoscope microperimetry to detect visual impairment caused by macular photocoagulation. Ophthalmic Surg Lasers 1998; 29: 95-98.
[13] Orzalesi N, Miglior S et al. Microperimetry of localized retinal nerve fiber layer defects. Vision Res 1998; 38: 763-771.
[14] 黄叔仁，张晓峰主编．眼底病的诊断与治疗．北京：人民卫生出版社，2003．
[15] 钱彤，黎晓新，姜燕荣，等．糖尿病视网膜病变激光术后视野的改变．中国实用眼科杂志 2000；18：358-3609．
[16] Hudson C, Flanagan JG, et al. Correlation of scanning laser derive doema index and vision function following grid laser treatment for diabetic macular doema. Br J Ophthalmol 2003, 87: 455-461.
[17] 陈君毅，刘哲丽．DR黄斑水肿不同光凝顺序治疗近期疗效的观察．中华眼底病杂志 2000；16：150-152．
[18] 袁援生，胡敏，程玉霞．弥漫性糖尿病黄斑水肿光凝后黄斑区视野和视网膜厚度变化．中国实用眼科杂志 2004；22：797-801．
[19] Wolf S, Arend O, et al. Quantification of retinal capillary density and flow velocity in patients with essential hypertension. Hypertension 1994; 23: 464-467.
[20] Kutschbach P, Wolf S, et al. Retinal capillary density in patients with arterial hypertension: A prospective study. Clin Hemorheol 1995; 15: 248.
[21] Gupta A, Sinclair SH, Sinclair MJ: Non-invasive measurement of the foveal avascular and perifoveal capillary density in normal individuals. Invest Ophthalmol Vis Sci Suppl 1993; 34: 1391.
[22] Classification of diabetic retinopathy from fluorescein angiograms. ETDRS report No 11. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;
[23] Vande Vdlde FJ, Timberlake GT, Jalkh AE, et al. Static mieroperimetry with the laser scanning opthalmo scope. Ophtalmologie 1991; 4: 291-294.
[1] Van de Velde FJ, Timhcrlakce GT, Jalkh AE, et al. Ophtalmologie, 1990, 4: 291-294.
[2] Oyagi T, Fujikado T, et al. Retina, 2004, 24(4): 548-555.
[3] 袁援生．现代临床视野检测．人民卫生出版社，1999．124
[4] Schneider U et al. Klin Monatsbl Angenheilkd, 1993, 203(3), 212
[5] RohrschneiderK, Becker M, et al. Am Ophthalmol, 1998, 126: 52-58
[6] Sutter EE. Nonlinear Vision. Cleveland, OH: CRC press. 1992, 171-220
[7] Kondo M, Miyake Y. Invest Opthalmol Vis Sci, 1995, 36(10): 2146
[8] Sutter EE, Tran D. Vision Res. 1992, 32: 433
[9] Bearse MA, Sutter EE. J Opt Snc AM, 1996, 36: 2146
[10] Masaru Yoshii, Kenji Yanashima. Jpn J Ophthalmol, 1998, 42: 136
[11] Rohrschneider K et alAm J Ophthalmol. 2005 Jan; 139(1): 125-34
[12] Tsujikawa M, et al. Br J Ophthalmol, 1997, 81(2), 117
[13] Ranmond N, Ophthalmology, 1993, 100(4), 1513
[14] Sjaarda RN et al, Am J Ophthalmol, 1993, 116 (2), 129
[15] Hikichi T et al, Am J Ophalmol, 2000, 118(2), 193
[16] 陈晶华等，黄斑裂孔手术前后固视微视野和mERG的检测．临床研究，2002，20(4)：328-329
[17] Midena E et al, Semin Ophthalmol. 2004 Mar-Jun; 19(1-2): 55-61
[18] Oshima Y et al, Retina. 1998; 18(2): 109-17.
[19] Ishiko S et al, Ophthalmic Surg Lasers, 1998, 29(2), 95
[19] Toonen F et al, Ger, J OphThalmol, 1995, 4(5), 311
[20] 俞素勤，王卫俊，等．黄斑区脉络膜新生血管病人的微视野检查．中华眼底病杂志，2004，20(2)：116-117
[21] Mori F, Ishiko S, Kitaya N, et al. Am J Ophthalmol, 2001, 132: 897-902
[22] Nilsson UL, Frennesson C, et al, Vision Res, 2003, 43: 1777-1787
[23] Orzalesi N et al, Vision Res, 1998; 38(5): 763
[2] Roth J A. Centual visual field in diabetes. Br J Ophthalmol 1996, 53: 16-25.
[3] Toke B, Henrik LA. Localized boold-retinal barrier leak age and retinal light sensitivity in diabetic retinopathy. Br J Ophthalmol 1990, 74: 388-390.
[4] Arend O, Wolf S, Harris A, et al. The relationship of macular micro-circulation to visual acuity in diabetic patients. Arch Ophthalmol 1995, 113: 610-614.
[5] Sonkin PL, Kelly LW, Sinclair SH, et al. Pentoxifylline in creases retinal capillary blood flow velocity in patients with diabetes. Arch Ophthalmol 1993, 111: 1647-1650.
[6] 韩伟，王竟．非胰岛素依赖性糖尿病病人的自动化视野改变．眼科新进展 2000，20：58-59．
[7] Mori F, Ishiko S, Kitaya N, et al. Use of scanning laser ophthalmoscope microperimetry in clinically significant macular edema in type 2 diabetesmellitus. Jpn J Ophthalmol 2002; 46: 650-655.
[8] Moller F, Bek T: Lack of correlation between visual acuity and fixation stability after photocoagulation for diabetic maculopathy. Graefes Arch Clin Exp Ophthalmol 2000; 238: 566-570.
[9] Moller F, Bek T. The relation between visual acuity and the size of fixational eye movements in patients with diabetic and non-diabetic macular disease. Acta Ophthalmol Stand 1998; 76: 38-42.
[10] Voutilainen-Kaunisto R, Terasvirta M, et al. Maculopathy and visual acuity in newly diagnosed type 2 diabetic patients and non-diabetic subjects: A 10-year follow-up study. Acta Ophthalmol Stand 2001; 79: 163-168.
[11] Toonen F, Wolf S, et al. Automatic microperimetry with a scanning laser ophthalmoscope in patients with diabetic maculopathy. Invest Ophthalmol VisSci 1996; 37: S975.
[12] Ishiko S, Ogasawara H. The use of scanning laser ophthalmoscope microperimetry to detect visual impairment caused by macular photocoagulation. Ophthalmic Surg Lasers 1998; 29: 95-98.
[13] Orzalesi N, Miglior S et al. Microperimetry of localized retinal nerve fiber layer defects. Vision Res 1998; 38: 763-771.
[14] 黄叔仁，张晓峰主编．眼底病的诊断与治疗．北京：人民卫生出版社，2003．
[15] 钱彤，黎晓新，姜燕荣，等．糖尿病视网膜病变激光术后视野的改变．中国实用眼科杂志 2000；18：358-3609．
[16] Hudson C, Flanagan JG, et al. Correlation of scanning laser derive doema index and vision function following grid laser treatment for diabetic macular doema. Br J Ophthalmol 2003, 87: 455-461.
[17] 陈君毅，刘哲丽．DR黄斑水肿不同光凝顺序治疗近期疗效的观察．中华眼底病杂志 2000；16：150-152．
[18] 袁援生，胡敏，程玉霞．弥漫性糖尿病黄斑水肿光凝后黄斑区视野和视网膜厚度变化．中国实用眼科杂志 2004；22：797-801．
[19] Wolf S, Arend O, et al. Quantification of retinal capillary density and flow velocity in patients with essential hypertension. Hypertension 1994; 23: 464-467.
[20] Kutschbach P, Wolf S, et al. Retinal capillary density in patients with arterial hypertension: A prospective study. Clin Hemorheol 1995; 15: 248.
[21] Gupta A, Sinclair SH, Sinclair MJ: Non-invasive measurement of the foveal avascular and perifoveal capillary density in normal individuals. Invest Ophthalmol Vis Sci Suppl 1993; 34: 1391.
[22] Classification of diabetic retinopathy from fluorescein angiograms. ETDRS report No 11. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;
[23] Vande Vdlde FJ, Timberlake GT, Jalkh AE, et al. Static mieroperimetry with the laser scanning opthalmo scope. Ophtalmologie 1991; 4: 291-294.
[1] Van de Velde FJ, Timhcrlakce GT, Jalkh AE, et al. Ophtalmologie, 1990, 4: 291-294.
[2] Oyagi T, Fujikado T, et al. Retina, 2004, 24(4): 548-555.
[3] 袁援生．现代临床视野检测．人民卫生出版社，1999．124
[4] Schneider U et al. Klin Monatsbl Angenheilkd, 1993, 203(3), 212
[5] RohrschneiderK, Becker M, et al. Am Ophthalmol, 1998, 126: 52-58
[6] Sutter EE. Nonlinear Vision. Cleveland, OH: CRC press. 1992, 171-220
[7] Kondo M, Miyake Y. Invest Opthalmol Vis Sci, 1995, 36(10): 2146
[8] Sutter EE, Tran D. Vision Res. 1992, 32: 433
[9] Bearse MA, Sutter EE. J Opt Snc AM, 1996, 36: 2146
[10] Masaru Yoshii, Kenji Yanashima. Jpn J Ophthalmol, 1998, 42: 136
[11] Rohrschneider K et alAm J Ophthalmol. 2005 Jan; 139(1): 125-34
[12] Tsujikawa M, et al. Br J Ophthalmol, 1997, 81(2), 117
[13] Ranmond N, Ophthalmology, 1993, 100(4), 1513
[14] Sjaarda RN et al, Am J Ophthalmol, 1993, 116 (2), 129
[15] Hikichi T et al, Am J Ophalmol, 2000, 118(2), 193
[16] 陈晶华等，黄斑裂孔手术前后固视微视野和mERG的检测．临床研究，2002，20(4)：328-329
[17] Midena E et al, Semin Ophthalmol. 2004 Mar-Jun; 19(1-2): 55-61
[18] Oshima Y et al, Retina. 1998; 18(2): 109-17.
[19] Ishiko S et al, Ophthalmic Surg Lasers, 1998, 29(2), 95
[19] Toonen F et al, Ger, J OphThalmol, 1995, 4(5), 311
[20] 俞素勤，王卫俊，等．黄斑区脉络膜新生血管病人的微视野检查．中华眼底病杂志，2004，20(2)：116-117
[21] Mori F, Ishiko S, Kitaya N, et al. Am J Ophthalmol, 2001, 132: 897-902
[22] Nilsson UL, Frennesson C, et al, Vision Res, 2003, 43: 1777-1787
[23] Orzalesi N et al, Vision Res, 1998; 38(5): 763