摘要目的 观察糖尿病视网膜病变(DR)不同分期脉络膜厚度的变化.方法 临床检查确诊的2型糖尿病患者150例227只眼纳入研究.其中,男性67例89只眼,女性83例138只眼;平均年龄(65.6±8.0)岁;平均糖尿病病程(12.4±6.5)年.所有患者均行最佳矫正视力(BCVA)、屈光度、裂隙灯显微镜、间接检眼镜、频域光相干断层扫描(SD-OCT)检查.参照早期DR治疗研究组制定的分级诊断标准将患者分为无DR (NDR)组、非增生型DR不伴黄斑水肿(NPDR/ME-)组、非增生型DR伴黄斑水肿(NPDR/ME+)组、增生型DR不伴黄斑水肿(PDR/ME-)组、增生型DR伴黄斑水肿(PDR/ME+)组,分别为99、64、5、25、5只眼.选取既往行全视网膜激光光凝(PRP)治疗的19例29只眼作为PRP治疗(PRP-DR)组.行PRP治疗的时间距离本研究SD-OCT检查时间为0.25～18.00个月.与患者年龄匹配的正常人17例32只眼作为正常对照组.应用SD-OCT深度增强成像技术测量受检者黄斑中心凹下脉络膜厚度(SFCT).统计分析时,因NPDR/ME+组和PDR/ME+组样本量较小,未行组间比较.结果 正常对照组、NDR组、NPDR/ME-组、PDR/ME-组、PRP-DR组SFCT分别为(310.2±54.8)、(251.1±81.4)、(262.5±83.2)、(286.2±76.8)、(327.4±83.1) μm.与正常对照组SFCT比较,NDR组、NPDR/ME-组SFCT降低,差异有统计学意义(t=2.754、2.140,P＜0.05).PDR/ME-组SFCT较NDR组增厚,差异有统计学意义(t=-2.114,P＜0.05).PRP-DR组SFCT较PDR/ME-组增厚,差异有统计学意义(U=271.500,P＜0.05).结论 早期DR患者SFCT变薄,随病变程度加重,SFCT逐渐增厚;行PRP后早期SFCT增厚.

abstractsObjective To observe the changes in choroidal thickness in type 2 diabetes patients with diabetic retinopathy (DR).Methods A total of 227 eyes from 150 type 2 diabetes patients were enrolled in this study.The patients included 67 males (89 eyes) and 83 females (138 eyes).The mean age was (65.6± 8.0) years,and the mean diabetes duration was (12.4±6.5) years.All the patients were examined for best corrected visual acuity (BCVA),diopter,slit lamp ophthalmoscopy,indirect ophthalmoscopy and spectral domain optical coherence tomography (SD-OCT) examination.The patients were divided into non-DR (NDR group,99 eyes),non-proliferative DR (PDR) without macular edema (ME) group (NPDR/ME-group,64 eyes),non-PDR with ME group (NPDR/ME+ group,5 eyes),PDR without ME group (PDR/ME-group,25 eyes),PDR with ME group (PDR/ME+ group,5 eyes) according to the Early Treatment Diabetic Retinopathy Study.The ones having a history of pan-retinal photocoagulation (PRP) were classified as PRP-DR.Age-matched normal subjects were enrolled as the control group.Sub-foveal choroidal thickness (SFCT) was measured by SD-OCT with enhanced depth imaging (EDI).Results Mean SFCT was (310.2±54.8),(251.1±81.4),(262.5±83.2),(286.2±76.8) and (327.4±83.1) μm respectively in control,NDR,NPDR/ME-,PDR/ME-and PRP-DR groups.Mean SFCT decreased significantly in NDR and NPDR/ME-group (t=2.754,2.140; P＜0.05).Mean SFCT in PDR/ME-group was thicker than that in NDR (t=-2.114,P＜0.05).Mean SFCT in PRP-DR group was thicker than that in PDR/ME-group (U=271.500,P＜0.05).Conclusion SFCT decreased during the early course of diabetics and increased significantly as the severity worsened from NDR to PDR,and increased in the early duration after PRP treatment.