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糖尿病视网膜病变和视网膜静脉阻塞视敏度与中心凹血管区域面积相关

Balaratnasingam C, Inoue M, Ahn S, et al.

期刊名称:Ophthalmology

卷期:2016年第123卷第11期

马进 主任医师,副教授,眼科中心玻璃体与视网膜病科副主任,研究生导师。中华医学会眼底病学组委员,中国医师协会眼科分会委员。熟练开展多种眼病的诊疗和手术,并积累了丰富的经验。擅长各类复杂的视网膜脱离手术、严重眼外伤的救治、视网膜静脉阻塞手术(动静脉鞘切开、视乳头放射状切开)等,领先创新性开展黄斑水肿、黄斑裂孔的无缝合微创性(25G)玻璃体切割联合曲胺奈德染色、内界膜剥离手术,同时对白内障超生乳化手术,眼眶整形以及视神经管减压手术亦有丰富的经验。已在国内外杂志第一作者发表论文20余篇。有3篇眼底方面的研究论文被SC

该作者的研究主题是探究视网膜黄斑中心凹无血管区域的面积与糖尿病视网膜病变和静脉阻塞患者的视力是否存在正相关,这项研究对视网膜血管疾病的自然进程和治疗是有必要的,测量对象是否考虑可加入黄斑中心凹神经纤维层厚度的测量。

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摘要

目的:旨在确定中心凹无血管区(FAZ)面积是否与糖尿病性视网膜病变(DR)和视网膜静脉阻塞(RVO)视敏度力(VA)相关。设计:横断面研究。 研究对象:66名受试者(DR 65只眼,视网膜分支静脉阻塞19只眼和中央视网膜静脉阻塞11只眼的95只眼。方法:对结构光学相干断层扫描(OCT; SpectralisHeidelberg Engineering)和OCT血管造影AvantiOptovue RTVue XR)数据进行分析。 测量FAZ面积,中央凹点厚度,中央1mm区域厚度,视网膜内囊肿发生,椭圆体区域破裂和视网膜内层(DRIL)长度紊乱。记录VA。使用回归模型研究FAZ面积和VA之间的相关性。主要预后指标为VA。结果:平均年龄62.9±13.2岁。视网膜静脉分支阻塞和视网膜中央静脉阻塞组之间的人口统计学和OCT衍生解剖学测量没有差异(所有P0.058);因此,将2组数据合并到单个RVO组进行进一步的统计比较。单变量和多元回归分析显示,FAZ面积与DRRVOVA显著相关(P0.003)。 FAZ面积和VA之间的关系随年龄而变化(P = 0.026),因此,对于固定的FAZ面积,患者年龄增加与视力较差(视力最小分辨角对数升高)相关。在单变量和多元回归分析中,椭圆体区破裂与VA明显相关(P <0.001)。在单变量回归分析中,视网膜内囊肿,DRIL长度和晶状体状态与VA明显相关(P0.018),但在多元回归分析则显示不相关(P0.210)。本研究中评估的剩余变量不能预测VAP0.225)。结论:FAZ面积与DRRVOVA显著相关,这种关系由患者年龄调节。还需进一步研究视网膜血管疾病自然病程中和治疗后FAZ面积和VA之间的相关性。

PURPOSE:To determine if the area of the foveal avascular zone (FAZ) is correlated with visual acuity (VA) in diabetic retinopathy (DR) and retinal vein occlusion (RVO).DESIGN:Cross-sectional study.PARTICIPANTS:Ninety-five eyes of 66 subjects with DR (65 eyes), branch retinal vein occlusion (19 eyes), and central retinal vein occlusion (11 eyes).METHODS:Structural optical coherence tomography (OCT; Spectralis, Heidelberg Engineering) and OCT angiography (OCTA; Avanti, Optovue RTVue XR) data from a single visit were analyzed. FAZ area, point thickness of central fovea, central 1-mm subfield thickness, the occurrence of intraretinal cysts, ellipsoid zone disruption, and disorganization of retinal inner layers (DRIL) length were measured. VA was also recorded. Correlations between FAZ area and VA were explored using regression models. Main outcome measure was VA.RESULTS:Mean age was 62.9±13.2 years. There was no difference in demographic and OCT-derived anatomic measurements between branch retinal vein occlusion and central retinal vein occlusion groups (all P 0.058); therefore, data from the 2 groups were pooled together to a single RVO group for further statistical comparisons. Univariate and multiple regression analysis showed that the area of the FAZ was significantly correlated with VA in DR and RVO (all P 0.003). The relationship between FAZ area and VA varied with age (P=0.026) such that for a constant FAZ area, an increase in patient age was associated with poorer vision (rise in logarithm of the minimum angle of resolution visual acuity). Disruption of the ellipsoid zone was significantly correlated with VA in univariate and multiple regression analysis (both P < 0.001). Occurrence of intraretinal cysts, DRIL length, and lens status were significantly correlated with VA in the univariate regression analysis (P 0.018) but not the multiple regression analysis (P 0.210). Remaining variables evaluated in this study were not predictive of VA (all P 0.225).CONCLUSIONS:The area of the FAZ is significantly correlated with VA in DR and RVO and this relationship is modulated by patient age. Further study about FAZ area and VA correlations during the natural course of retinal vascular diseases and following treatment is warranted.


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