目的:观察糖尿病视网膜病变患者血管荧光素造影微动脉瘤处渗出与视网膜增厚的关系。方法:选取糖尿病视网膜病变患者24例38眼,首次及末次血管荧光素造影检查确定是否存在微动脉瘤荧光素渗出。根据毛细血管闭塞区的位置选取微动脉瘤荧光素渗出与未渗出各1眼配对进行对比。在微动脉瘤和直径为1mm区域使用光学相干断层成像术(OCT)测量视网膜厚度。结果:微动脉瘤荧光素渗出眼视网膜厚度明显高于未渗出眼(356±69μmvs318±56μm,P<0.001),渗出眼平均增长厚度高于未渗出眼(95%的可信区间为25～51μm,P<0.001).在直径为1mm区域,渗出眼视网膜厚度和平均增长厚度均明显高于未渗出眼(351±67μmvs319±59μm;最小值311±62μmvs284±60μm;最大值389±78μmvs352±66μm)。结论:血管荧光素造影显示微动脉瘤荧光素渗出可以增加视网膜厚度,并运用高分辨率OCT测量。因此,对糖尿病视网膜病变患者早期诊断微动脉瘤荧光素是否渗出可以抑制视网膜增厚。

AIM:To investigate the contribution of fluorescein angiographic leaking microaneurysms ( leak-MA) versus non- leaking microaneurysms ( non-leak-MA) to retinal thickening in diabetic retinopathy. METHODS:A consecutive series of 38 eyes from 24 patients with diabetic retinopathy was included. Leak-MA and non-leak-MA in each eye were selected in pairs at corresponding topographic location. Leaking was defined by late phase fluorescein angiograms compared to early phase. Retinal thickness was measured with Heidelberg Spectralis OCT topographically aligned on early phase angiograms at the MA site and within a 1 mm circle. RESULTS:In all eyes,significant retinal thickening at the site of leaking compared to non-leaking microaneurysms was observed ( 356 ±69μm vs 318 ±56μm,P <0.001) ,showing a mean increase in thickness in the areas of leak-MA vs non- leak-MA of 38 ± 39μm ( 95% confidence interval 25-51μm,P < 0. 001 ) . All 1mm area measurements also showed significant ( P <0.001) thickening of the leak-MA with average thickness of leak-MA vs non-leak-MA as 351 ± 67μm vs 319 ± 59μm; minimum thickness 311 ±62μm vs 284 ±60μm; maximum thickness 389 ±78μm vs 352 ±66μm; and retina volume 26.4 ±6. 0mm3 vs 23.6 ±3.7mm3,respectively. CONCLUSION:Leaking of microaneurysms on fluorescein angiography appears to cause focal thickening of retina,which can be measured with high-resolution OCT. Therefore, targeting leaking microaneursyms in diabetic retinopathy has the potential to reduce retinal thickening.

R774.1