摘要目的 观察糖尿病视网膜病变(DR)视盘新生血管(DNVD)的临床特点.方法 回顾分析内科确诊为糖尿病,服科经间接检眼镜,荧光素眼底血管造影(FFA)检查确诊的DR患者526例1052只眼的临床资料.所有患者均进行最佳矫正视力(BCVA)、裂隙灯显微镜、散瞳后双目间接检眼镜和FFA检查,对其中间接检眼镜及FFA检查发现视盘有新生血管者纳入研究.分析患者不同DR分期,糖尿病病程、血糖控制水平和全视网膜激光光凝术(PRP)与DNVD发生、发展的相互关系.结果 1052只眼中,DNVD167只眼,占15.87%.BCVA<0.1者91只眼,占54.49%,0.1≤BCVA<0.4者58只眼,占34.73%,BCVA≥0.4者18只眼,占19.78%.眼底检查见视网膜新生血管位于视盘表面或距离视盘1个视盘直径范围以内;FFA检查显示视盘早期新生血管显影,荧光充盈迅速,中、晚期新生血管处大量荧光渗漏,形成局部强荧光.167只眼均为增生期DR(PDR),其中Ⅳ期43只眼,占25.75%;Ⅴ期52只眼,占31.14%;Ⅵ期72只眼,占43.11%.糖尿病病程<3年者5只眼,占2.99%;3年≤病程<5年者12只眼,占7.19%;5年≤病程<10年者21只眼,占12.57%;10年≤病程<15年者56只眼,占33.53%;病程≥15年者73只眼,占43.71%;空腹血糖(FBG)<7.0 mmol/L者15只眼,占8.98%;7.0≤FBG<9.0 mmol/L者26只眼,占15.57%;9.0≤FBG<12.0 mmol/L者50只眼,占29.94%.FBG≥12.0 mmol/L者76只服,占45.51%.餐后2 h血糖(2 h PBG)<10.0 mmol/L者28只眼,占16.77%;10.0≤2 h PBG<12.0mmol/L者35只眼,占20.96%;12.0≤2 h PBO<16.0 mmol/L者42只眼.占25.15%;2 h PBG≥16.0mmol/L者62只眼,占50.30%,经Person相关分析,DNVD的发生与糖尿病病程、FBG和餐后2 h PBG均成正相关(r=0.991、0.984、0.960,P=0.001、0.016、0.040).重度非增生期(NPDR)曾行PRP治疗的257只眼,发生DNVD15只眼,占行RPR治疗眼的5.84%;未行PRP治疗的795只眼,发生DNVD152只眼,占未行RPR治疗眼的19.12%,两者发生率比较,差异有统计学意义(χ~2=25.659,P<0.01).结论 DNVD不少见,其发生与DR分期、糖尿病病程、FBG和餐后血糖控制水平均密集相关.

abstractsObjective To observe the clinical characteristics of diabetic neovascularization on the disc (DNVD). Methods The clinical data of 526 patients (1052 eyes) who were diagnosed as diabetes in Department of intern medicine, as diabetic retinopathy by ophthalmoscope and fundus fluorescein angiograph (FFA) was retrospectively reviewed. All patients were carried out with best corrected visual acuity (BCVA), slit-lamp microscope, ophthalmoscope and FFA after mydriasis. In which, who has neovascularization on the optic disc with ophthalmoscopy and FFA examination were included in this study. The relationship between the occurrence and development of DNVD and phase of DR, disease duration, the level of blood glucose and panretinal photocoagulation were analyzed. Results DNVD was found in 167/1052 eyes (15.87%). There were 91 eyes (54.49%) with BCVA<0. 1, 58 eyes (34. 73%) with BCVA<0. 4 but ≥0. 1,and 18 eyes(19.78%) with BCVA≥0. 4. Retinal neovascularization was located in the surface of disc surface or within 1PD from the optic disc;Those vessels filled early and rapidly, and with local strong fluorescence due to fluorescence leakage at middle and late stage of FFA examination. All 167 DNVD eyes are proliferative diabetic retinopathy (PDR) with 43 eyes (25.75%) in stage Ⅳ, 52 eyes (31.14%) in stage Ⅴ and 72 eyes (43. 11%) in stage Ⅵ. Of those DNVD eyes, there were 5 eyes (2. 99%) with course of diabetes <3 years, 12 eyes (7.19%) s<5 years but ≥3 years, 21 eyes (12. 57%)<10 but ≥5 years, 56 eyes (33. 53%)<15 but ≥10 years and 73 eyes (43. 71%)≥15 years. There were 15 eyes (8. 98%) with fasting blood glucose (FBG)<7. 0 mmol/L, 26 eyes (15.57%) with FBG< 9.0 but ≥7.0 mmol/L, 50 eyes (29. 94%) with FBG<12. 0 but ≥9. 0 mmol/L and 76 eyes (45.51%) with FBG ≥12.0 mmol/L; there were 28 eyes (16. 77%) with 2 hour postprandial blood glucose(2hPBG)<10. 0 mmol/L, 35 eyes (20. 96%) with 2hPBG<12. 0 but ≥10. 0 mmol/L, 42 eyes (25.15%) with 2hPBG <16.0 but ≥12.0 mmol/L and 62 eyes (50. 30%) with 2hPBG ≥16.0 mmol/L. The occurrence of DNVD and duration of diabetes, FBG and 2hPBG were all positively correlated (r= 0. 991, 0. 984, 0. 960, P= 0. 001, 0. 016, 0. 040) by the Person correlation analysis. 15 eyes (5.84%) of DNVD happened in 257 eyes who treated with PRP in severe nonproliferative diabetic retinopathy (NPDR), 152 eyes (19.12%) DNVD happened in 795 eyes who untreated with PRP in severe NPDR,the differences were statistically significant (χ~2 =25. 659,P<0. 01) between them. Conclusion DNVD happened commonly in DR, the occurrence of DNVD is intensive related with diabetic retinopathy stage, duration of diabetes, FBG and PBG.