| 目的：
探讨糖尿病性黄斑水肿光学相干断层扫描和眼底荧光素血管造影的形态学特征、分类及相互关系。
方法：
本研究包括临床有意义糖尿病性黄斑水肿（Clinically significant diabetic macular edema，CSME）患者 102 例 177只眼及正常对照组60例120只眼。CSME组眼底荧光素血管造影（fundus fluorescein angiography, FFA）图像特征可以分为局限水肿型、弥漫水肿型和囊样水肿型。而其光学相干断层扫描（optical coherence tomography，OCT）的形态学特征也归纳为三型：1型：中心凹视网膜增厚伴视网膜全层同质性光反射；2型：中心凹视网膜增厚伴外层视网膜光反射显著性降低；3型：中心凹视网膜增厚伴有明显视网膜脱离边界的中心凹下积液，其中无明显中心凹玻璃体视网膜牵引者为3A型，有则为3B型。
用OCT仪对CSME组及正常对照组的黄斑部进行扫描,测定黄斑中心凹中心厚度。
分别对CSME组患者进行OCT及FFA检查，将其OCT及FFA图像特征归纳分类，观察两种形态学分类之间的相互关系，并将两种形态学分类与黄斑中心凹中心厚度、最佳矫正视力、糖尿病病程、空腹血糖等临床资料进行对比分析。
结果：
CSME组患者的黄斑中心凹中心厚度与正常对照组相比差异有统计学意义（P< 0.05）。FFA分类的局限水肿型在OCT 1型中所占的比例为70.6%，高于弥漫水肿型（27.2%）和囊样水肿型(2.2%)，其差异有统计学意义（P< 0.05）。FFA弥漫水肿型在OCT2型中所占的比例为47.9%，明显高于局限水肿型（25.0%）和囊样水肿型(27.1%)（P< 0.05）。FFA分类的囊样水肿型在OCT3型（3A型＋3B型）中所占比例为56.8%，明显高于局限水肿型（10.8%）和弥漫水肿型(32.4％)。OCT1型及FFA局限水肿型的矫正视力最好，黄斑中心凹中心厚度值最小（P< 0.05）。
结论：
1.糖尿病性黄斑水肿患者的光学相干断层扫描形态学类型与眼底荧光素血管造影形态学类型密切相关。OCT结合FFA的检查,可更加全面地反映DME患者黄斑区视网膜的变化，为以后揭示糖尿病性黄斑水肿的病理机制、寻求每种类型的最佳治疗方案提供有价值的参考。
2.糖尿病性黄斑水肿患者的视力预后与黄斑中心凹中心厚度以及黄斑水肿的类型有关。
3.黄斑中心凹中心厚度是视功能评价的重要指标。并可作为诊断黄斑水肿的客观定量的重要指标。
关键词 糖尿病性黄斑水肿,糖尿病视网膜病变,光学相干断层扫描,眼底荧光素血管造影
Purpose To assess the correlation between the features of optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) in clinically significant diabetic macular edema.
Methods This study involved 177 eyes (102 patients) with clinically significant diabetic macular edema and 120 normal eyes. The FFA features were categorized into focal leakage type, diffuse leakage type, and diffuse cystoid leakage type. The OCT features were categorized into four types: type 1, thickening with homogenous optical reflectivity; type 2, thickening with markedly decreased optical reflectivity in the outer retinal layer; type 3A, foveolar detachment without traction; and type 3B, foveolar detachment with apparent vitreofoveal traction. The central foveal thickness between the normal and the patients were compared. The correlation between FFA types and OCT types were analyzed, and their associations with the best visual acuity, central foveal thickness, fasting blood glucose ，diabetic duration were evaluated. Measure central foveal thickness in clinically significant diabetic macular edema group and normal controls and compare them.
RESULTS There was a significant difference in the central foveal thickness between the normal controls and clinically significant diabetic macular edema group (p<0.05). The prevalence of focal leakage type was higher in the OCT type 1 (70.6%) than in the diffuse leakage type (27.2%) and diffuse cystoid leakage type (2.2%) of fluorescein angiography (P<0.05). The prevalence of diffuse leakage type was higher in the OCT type 2 (47.9%) than in the focal leakage type (25.0%) and diffuse cystoid leakage type (27.1%; P < 0.05). The prevalence of diffuse cystoid leakage type was higher in the OCT type 3 (56.8%) than in the focal leakage type (10.8%) and diffuse leakage type (32.4%; P < 0.05) Optical coherence tomography type 1 and the focal leakage type of fluorescein angiography showed the least central foveal thickness and the best visual acuity (P < 0.05).
Conclusion
1. There was a significant correlation between the features of OCT and FFA in diabetic macular edema. The analysis of clinically significant macular edema based on both OCT and FFA can provide information that may be useful to disclose the pathogenesis of the edema and to optimize the treatment for each type.
2. Visual acuity and prognosis correlated significantly not only with central foveal thickness but also with OCT types and FFA types.
3. Central foveal thickness is an important index to evaluate visual function and can be taken as an important objective quantitative index to diagnose diabetic macular edema.
KEY WORDS diabetic macular edema, diabetic retinopathy, optical coherence tomography, fluorescein angiography
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