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目的 :本文通过对 6 3例 (113只眼 )糖尿病性视网膜病变 (diabeticretinopathy ,DR)的分析 ,探讨对糖尿病性黄斑病变 (diabeticmaculopathy ,DM )独立分型的必要性以及DM分期对激光治疗DR的指导意义。方法 :Ⅱ型糖尿病人 6 3例 ,113只眼 ,行眼底荧光血管造影及眼科常规检查 ,根据结果将DR分为Ⅴ期 ,DM分为Ⅳ期。结果 :(1)不同分期DR与中心视力的关系 :DRⅠ Ⅳ期中心视力在 0 2～ 0 0 5的低视力眼分别为 33 3%、36 %、5 2 %、5 4 5 %。DRⅢ、Ⅳ期视力 0 0 4以下分别为17 4 %、4 5 5 %。DR愈重 ,视力下降愈重。 (2 )DR与DM的关系 :Ⅰ Ⅴ期DR发生DM的眼分别为 5 2 4 %、72 %、78 3%、10 0 %、10 0 %。随着DR的加重 ,DM也随之加重 ,但Ⅱ、Ⅲ期DR有黄斑未受累病例。DRⅠ Ⅲ期 ,发生DM占 5 1 3% ,非增殖期DR中 ,DM对视力带来损害是明显的。 (3)不同分期DM对中心视力的影响 :发生DM后视力均有所下降。视力 0 3以上 ,DM大多处于Ⅱ期或以下 ,视力 0 2以下大多进入DMⅢ期、Ⅳ期。结论 :DR与DM虽然有共同的发病机制 ,但不完全平行 ,对DM单独分期完全必要 ,DM独立分型对激光治疗具有重要指导意义。DMⅡ期为最佳光凝时机 ,可以改善或保存视力。DMⅢ期进行激光治疗可以减轻黄斑水肿 ,防止视力进一步下降。D
OBJECTIVE: To investigate the necessity of independent classification of diabetic maculopathy (DM) in 63 patients with diabetic retinopathy (113 eyes) and the relationship between DM staging and laser treatment of DR Guiding significance. Method: diabetes type Ⅱ 63 cases, 113 eyes and fundus fluorescein angiography routine ophthalmic examination, according to the results of the DR into Ⅴ, Ⅳ of the DM divided. Results: (1) The relationship between different stages of DR and central visual acuity: The central visual acuity of DR Ⅰ Ⅳ was 33 3%, 36%, 52% and 54 5% respectively in the range of 0 2 ~ 0 0 5. The visual acuity of DR III and IV was 0% or less of 174% and 455% respectively. The heavier the DR, the worse the vision loss. (2) The relationship between DR and DM: The incidence of DM in Ⅰ Ⅴ DR was 52.4%, 72%, 78.3%, 100% and 100% respectively. With the exacerbation of DR, DM also aggravate, but Ⅱ, Ⅲ DR unoccluded cases. DR Ⅰ Ⅲ stage, the occurrence of DM accounted for 51.3%, non-proliferative phase DR, DM damage to vision is obvious. (3) The impact of different staging DM on central vision: Visual acuity decreased after DM occurred. Visual acuity 0 3 above, most of the DM in phase Ⅱ or less, most of the visual acuity of 0 2 into the DM Ⅲ, Ⅳ. Conclusion: Although DR and DM have a common pathogenesis, they are not completely parallel and are completely necessary for DM staging. DM independent typing is of great guiding significance for laser treatment. DM Ⅱ phase for the best timing of photocoagulation, can improve or save vision. DM Ⅲ laser treatment can reduce macular edema, to prevent further decline in vision. D