Overnight thickness variation in diabetic macular edema
Overnight thickness variation in diabetic macular edema
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DOI：
10.1167/iovs.04-0893
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发表时间：
2005-07-01
影响因子：
4.4
通讯作者：
Sander, B
中科院分区：
文献类型：
--
作者：
Larsen, M;Wang, M;Sander, B
目的.目的研究糖尿病黄斑水肿患者视网膜厚度的昼夜变化。年龄39 ~ 78岁12例12眼7例30 ~ 70岁健康志愿者14只眼，平均57只眼（平均57）通过光学相干断层扫描进行检查，在晚上和早上之后>=在黑暗中以卧位睡眠6小时，然后在室内光线下以相同位置清醒0.5小时，双眼睁开。糖尿病性黄斑水肿患者的黄斑厚度在夜间增加，从晚上的316 +/- 72 μ m增加到早晨的336 +/- 81 μ m（P=0.003）。视力从晚上的平均41个ETDRS字母（糖尿病视网膜病变早期治疗研究;范围，4-61）下降到早上的平均36个字母（范围，2-60）（P=0.03）。平均动脉血压（MABP; P=0.48）、血糖（P=0.25）或角膜厚度（P=0.26）没有总体变化。黄斑厚度的夜间变化与MABP的变化直接相关（r=0.65，P=0.03），但与基线MABP或血糖无关。在对动脉血压的影响进行统计学调整后，视网膜厚度的过夜增加仍然显著（P=0.002）。健康受试者的任何参数均无显著变化。在涉及黄斑中心凹的糖尿病性黄斑水肿中，视力下降伴随着夜间视网膜增厚，其程度与夜间血压变化有关。结果表明，视网膜毛细血管充盈压调节不足促进水肿，但黄斑水肿的夜间增加的大部分是由其他机制引起的，其中静脉血压的姿势变化和黑暗中视网膜代谢的增加值得进一步研究。
Purpose. To study the evening-to-morning variation in retinal thickness in patients with fovea-involving diabetic macular edema.Methods. Twelve eyes in 12 patients aged 39 to 78 years (mean, 57) with fovea-involving diabetic macular edema and 14 eyes in 7 healthy volunteers aged 30 to 70 years (mean, 57) were examined by optical coherence tomography, in the evening and in the morning after >= 6 hours of sleep in the recumbent position in darkness followed by 0.5 hour wakefulness in the same position in room light with both eyes open.Results. In patients with diabetic macular edema, macular thickness increased overnight, from 316 +/- 72 mu m in the evening to 336 +/- 81 mu m in the morning (P=0.003). Visual acuity decreased from a mean of 41 ETDRS letters (Early Treatment of Diabetic Retinopathy Study; range, 4-61) in the evening, to a mean of 36 letters (range, 2-60) in the morning (P=0.03). No overall change was found in mean arterial blood pressure (MABP; P=0.48), blood glucose (P=0.25), or corneal thickness (P=0.26). The overnight change in macular thickness correlated directly with the change in MABP (r=0.65, P=0.03) but not with baseline MABP or blood glucose. The overnight increase in retinal thickness remained significant after statistical adjustment for the effect of arterial blood pressure (P=0.002). Healthy subjects demonstrated no significant change in any parameter.Conclusions. In fovea-involving diabetic macular edema, a reduction in visual acuity accompanies overnight retinal thickening, the magnitude being related to the nocturnal change in blood pressure. The results indicate that deficient regulation of retinal capillary filling pressure promotes edema, but the bulk of the overnight increase in macular edema is caused by other mechanisms, of which postural variation in venous blood pressure and increased retinal metabolism in the dark merit further study.