The Effects of Macular Ischemia on Visual Acuity in Diabetic Retinopathy
The Effects of Macular Ischemia on Visual Acuity in Diabetic Retinopathy
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DOI：
10.1167/iovs.12-11103
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发表时间：
2013-03-01
影响因子：
4.4
通讯作者：
Egan, Catherine A.
中科院分区：
文献类型：
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作者：
Sim, Dawn A.;Keane, Pearse A.;Egan, Catherine A.
目的.通过分析新的荧光素血管造影（FA）参数，探讨糖尿病性黄斑缺血（diabetic macular ischemia，DAI）对视力（visual acuity，VA）的影响。在6个月的时间内回顾性收集数据。使用早期治疗糖尿病视网膜病变研究（ETDRS）方案对视网膜病变的严重程度进行分级。自定义软件用于量化中心凹无血管区（FAZ）的面积，乳头状黄斑神经纤维层束和颞黄斑的毛细血管无灌注面积，并与VA. MTS进行相关性测试。共纳入了488例2型糖尿病患者，其FA质量足以进行详细的定量分析。ETDRS-Risk严重程度分级为：无，39.7%;可疑，18.4%;轻度，25.2%;中度，11.0%;重度，5.6%。中位FAZ面积为0.19 mm（2）（四分位距[IQR]，0.13-0.25）; 0.25 mm（2）（IQR，0.18-0.32）; 0.27 mm（2）（IQR，0.19-0.38）; 0.32 mm（2）（IQR，0.25-0.54）;和0.78 mm（2）（IQR，0.60-1.32），并且除了“可疑”与“轻度”等级之外，在所有等级之间均存在显著差异（P < 0.002）。仅在中度（β = 0.406，SE = 0.101，P = 0.001）和重度（β = 0.299，SE = 0.108，P = 0.006）亚组中观察到VA与FAZ面积的显著相关性，但在轻度ETDRS-DR分级中未观察到。在乳头状黄斑缺血的病例中观察到与VA的强相关性（β = 1.123，SE = 0.355，P = 0.005），与FAZ大小或黄斑水肿的存在无关。糖尿病性黄斑缺血与中度至重度ETDRS分级缺血的眼睛中VA降低相关，但在轻度缺血中保持不变。此外，我们描述了乳头状斑神经纤维束缺血与VA降低的独立相关性。（Invest Ophthalmol维斯科学。2013;54：2353-2360）DOI：10.1167/iovs.12-11103
PURPOSE. To investigate the impact of diabetic macular ischemia (DMI) on visual acuity (VA), through the analysis of novel fluorescein angiography (FA) parameters.METHODS. Data were retrospectively collected over a 6-month period. DMI severity was graded using Early Treatment Diabetic Retinopathy Study (ETDRS) protocols. Custom software was used to quantify areas of the foveal avascular zone (FAZ), and of capillary nonperfusion over the papillomacular nerve fiber layer bundle, and temporal macula, and associations tested with VA.RESULTS. A total of 488 patients with type 2 diabetes mellitus and FAs of sufficient quality to allow detailed quantitative analyses were included. ETDRS-DMI severity was graded as: none, 39.7%; questionable, 18.4%; mild, 25.2%; moderate, 11.0%; and severe, 5.6%. Median FAZ areas were 0.19 mm(2) (interquartile range [IQR], 0.13-0.25); 0.25 mm(2) (IQR, 0.18-0.32); 0.27 mm(2) (IQR, 0.19-0.38); 0.32 mm(2) (IQR, 0.25-0.54); and 0.78 mm(2) (IQR, 0.60-1.32), respectively, and were significantly different between all grades (P < 0.002), apart from "questionable" versus "mild" grades. Significant association of VA to FAZ area was observed only in the moderate (beta = 0.406, SE = 0.101, P = 0.001) and severe (beta = 0.299, SE = 0.108, P = 0.006) subgroups, but not in milder ETDRS-DMI grades. A strong association with VA was observed in cases with papillomacular ischemia (beta = 1.123, SE = 0.355, P = 0.005), independent of FAZ size or the presence of macular edema.CONCLUSIONS. Diabetic macular ischemia is associated with reduced VA in eyes with moderate to severe ETDRS-DMI grades of ischemia but preserved in milder grades. In addition, we describe the independent association of papillomacular nerve fiber bundle ischemia with reduced VA. (Invest Ophthalmol Vis Sci. 2013;54:2353-2360) DOI: 10.1167/iovs.12-11103