方法：选取2018-01/12于我院确诊的2型糖尿病合并非增生期(NPDR组)和增生期(PDR组)糖尿病视网膜病变患者各60例60眼，另选取年龄、性别相匹配的健康志愿者60例60眼作为正常对照组。三组受检者均经Lipiview眼表面干涉仪检查LLT，OCT血流成像仪(OCTA)检查黄斑无血管区面积(FAZ)、视网膜浅层毛细血管层(SCL)和视网膜深层毛细血管层(DCL)血管密度，比较各参数之间的差异和相关性。

结果：正常对照组受检者LLT(69.87±11.401nm)高于NPDR(54.87±7.453nm)和PDR组(42.67±5.246nm)，FAZ(0.312±0.021mm²)小于NDPR组(0.389±0.037mm²)和PDR组(0.437±0.032mm²)，SCL血管密度(51.977%±4.164%)显著高于NPDR(47.067%±4.757%)和PDR组(41.865%±5.512%)，DCL血管密度(49.578%±2.619%)高于NPDR组(46.032%±2.622%)和PDR组(40.598%±2.671%)(均P<0.01)。正常受检者LLT与FAZ、SCL和DCL血管密度无相关性； NPDR组和PDR组患者LLT与FAZ均呈负相关关系(r=-0.922、-0.923，均P<0.01)，与SCL血管密度均呈正相关关系(r=0.798、0.902，均P<0.01)，与DCL血管密度均无相关性(r=0.140、0.073，P=0.285、0.581)。

结论：糖尿病视网膜病变患者泪膜脂质层厚度降低，泪膜稳定性下降，并与黄斑微血管结构改变存在相关关系。

METHODS: Totally 60 eyes of type 2 diabetes patients with non-proliferative stage(NPDR group)and 60 eyes of proliferative stage(PDR group)with diabetic retinopathy diagnosed in our hospital from 2018-01/12 were selected, and 60 eyes of healthy volunteers with appropriate age and gender were selected as the normal control group. The tear film lipid layer thickness(LLT)was examined by Lipiview eye surface interferometer, while the foveal avascular zone(FAZ), superficial capillary layer(SCL)vessel density and deep capillary layer(DCL)vessel density were measured by optical coherence tomography angiography(OCTA)in three groups. The differences and correlations between the parameters were compared.

RESULTS: LLT(69.87±11.401nm)in normal control group was higher than that in NPDR(54.87±7.453nm)and PDR group(42.67±5.246nm), and FAZ(0.312±0.021mm²)was lower than that in NDPR group(0.389±0.037mm²)and PDR group(0.437±0.032mm²). The vascular density of SCL(51.977%±4.164%)was significantly higher than that of NPDR(47.067%±4.757%)and PDR(41.865%±5.512%), and that of DCL(49.578%±2.619%)was higher than that of NPDR(46.032%±2.622%)and PDR(40.598%±2.671%)(all P<0.01). There was no correlation between LLT, FAZ, SCL and DCL in normal subjects. LLT was negatively correlated with FAZ in both NPDR group and PDR group(r=-0.922, r=-0.923, all P<0.01), positively correlated with SCL(r=0.798, r=0.902, all P<0.01), and had no correlation with DCL(r=0.140, r=0.073, P=0.285, P=0.581).

CONCLUSION: In diabetic retinopathy, the lipid layer of tear film is lower and the stability of tear film is decreased, and there is a correlation between diabetic dry eye and macular microvascular changes.