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Guyon, B., Elphege, E., Flores, M., Gauthier, A.S., Delbosc, B., Saleh, M.

期刊名称:Investigative Ophthalmology & Visual Science



摘要:目的:糖尿病性黄斑水肿(DME)消退后,怀疑光感受器丧失与视力恢复不全有关。最近的研究表明,周边区域视锥密度可以通过体外光学相干断层扫描(OCT)测量外部视网膜反射率来估计。本研究的主要目的是评估DME消退后的感光层反射率,并确定其与最终视力(VA)的关系。方法:本研究采用横断面病例对照研究,将58例患者的77只眼分为三组,第一组(n = 34)包括已消退的DMER-DME)眼,第二组(n = 24)无DME糖尿病眼(无DME),第三组(n = 19)对照组非糖尿病健康眼。DME消退后3个月体积光谱域(SD-OCT扫描上测量感光体椭球面(EZ)和视网膜色素上皮(RPE)外部视网膜反射率。结果:R-DME组平均DME持续时间为26.5±13.4个月。与没有DME的糖尿病眼相比,EZ反射率低19.8%(P <0.0001),比非糖尿病对照眼低26.5%(P <0.0001)。无DME组的反射率比对照组低7.8%(P <0.0001)。 三组间的RPE反射率相当(P> 0.05)。 VA与糖尿病患者的EZ反射率显着相关(r2 = 0.57; P <0.0001)。随着DME持续时间延长,反射率趋于下降,但未达到统计学意义(P = 0.10)。结论:DME显着影响感光层。通过测量水肿再吸收之后OCT图像上的外部视网膜反射率可以估计这种损伤。我们还提供了证据表明,没有DME病史的糖尿病患者中,除了之前报道的内部视网膜变性之外,还存在早期光感受器缺失或至少外节段(OS)破坏。这提示糖尿病的神经退行性过程。这种定量方法可能有助于监测神经保护策略,以抢救糖尿病患者眼感光细胞。

Purpose:Photoreceptor loss has been suspected of being involved in incomplete visual recovery after diabetic macular edema (DME) resolution. Recent studies have shown that cone density in the perifoveal area could be estimated by in vivo measurements of the outer retinal reflectivity on optical coherence tomography (OCT). The main objective of this study was to assess the photoreceptor layer reflectivity after DME resolution and to determine its relationship with final visual acuity (VA).Methods:In this cross-sectional case-control study, 77 eyes of 58 patients were divided into three groups: a first group (n = 34) encompassed eyes with resolved DME (R-DME), a second group (n = 24) corresponded to diabetic eyes without DME (no-DME), and a third group (n = 19) comprised a control group of nondiabetic healthy eyes. Outer retinal reflectivity was measured on volumetric spectral-domain (SD)-OCT scans acquired 3 months after DME resolution, from the photoreceptor ellipsoid zone (EZ) and the retinal pigment epithelium (RPE).Results:The mean DME duration was 26.5 ± 13.4 months in the R-DME group. EZ reflectivity was 19.8% lower (P < 0.0001) in this group compared to diabetic eyes without DME and 26.5% lower (P < 0.0001) than in nondiabetic control eyes. Reflectivity was 7.8% lower in the no-DME group compared to controls (P < 0.0001). RPE reflectivity was comparable among the three groups (P > 0.05). VA was significantly correlated with EZ reflectivity in diabetic patients (r2 = 0.57; P < 0.0001). Reflectivity tended to decrease with prolonged DME duration without reaching statistical significance (P = 0.10).Conclusions:DME significantly impacts the photoreceptor layer. This impairment can be estimated by measuring outer retinal reflectivity on OCT images after edema resorption. We also provide evidence that in diabetic eyes without a history of DME, there is early photoreceptor loss, or at least outer segment (OS) disorganization, in addition to the inner retinal degeneration reported previously. This suggests the neurodegenerative process in diabetes. This quantitative approach may help monitor neuroprotective strategies to rescue photoreceptor cells in diabetic eyes.


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