糖尿病虹膜病变的荧光素虹膜血管造影和荧光素眼底血管造影特征分析

李士清; 王志立; 陈晓; 李晓华

doi:10.3760/cma.j.cn115989-20210218-00115

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中华实验眼科杂志

• 临床研究 •

ENGLISH ABSTRACT

糖尿病虹膜病变的荧光素虹膜血管造影和荧光素眼底血管造影特征分析

作者及单位信息

出版日期： 2022 -09 -10 ·

DOI： 10.3760/cma.j.cn115989-20210218-00115

Features of iris and fundus fluorescein angiography in diabetic iridopathy

Authors Info & Affiliations

Li Shiqing

Department of Ophthalmology, Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, Zhengzhou 450003, China

Wang Zhili

Department of Ophthalmology, Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, Zhengzhou 450003, China

Chen Xiao

Department of Ophthalmology, Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, Zhengzhou 450003, China

Li Xiaohua

Department of Ophthalmology, Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, Zhengzhou 450003, China

Published： 2022 -09 -10 ·

DOI： 10.3760/cma.j.cn115989-20210218-00115

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摘要

目的探讨糖尿病虹膜病变在荧光素虹膜血管造影(IFA)联合荧光素眼底血管造影(FFA)影像中的特征。

方法采用横断面研究，纳入2013年5月至2020年5月在河南省立眼科医院接受IFA联合FFA检查的增生型糖尿病视网膜病变(PDR)合并糖尿病虹膜病变(DI)患者44例65眼，包括非增生性糖尿病虹膜病变(NPDI)组和虹膜红变组。所有患者均行视力、眼压、裂隙灯显微镜、IFA联合FFA检查。应用IFA检查观察2个组虹膜影像特征和前房内荧光素消退时间，应用FFA检查观察2个组视网膜影像特征和视盘新生血管发生率。为避免患者对侧眼IFA检查时间存在统计误差，仅对双眼患者的单眼数据进行分析。

结果IFA影像显示30例50眼为NPDI，14例15眼为虹膜红变。NPDI组前房内荧光素消退时间为(3.37±0.11)min，明显短于虹膜红变组的(6.02±0.29)min，差异有统计学意义( t＝8.541， P<0.001)。NPDI组和虹膜红变组FFA检查均见视网膜新生血管性强荧光。NPDI组视盘新生血管发生率为20%(6/30)，明显低于虹膜红变组的50%(7/14)，差异有统计学意义( P＝0.04)。

结论糖尿病虹膜红变可以通过IFA动态的影像特征和前房内荧光素消退时间来确诊，PDR合并视盘新生血管需IFA联合FFA检查来评估。

关键词：虹膜疾病/诊断;糖尿病虹膜红变;糖尿病视网膜病变;荧光素虹膜血管造影;荧光素眼底血管造影

ABSTRACT

ObjectiveTo investigate the imaging features of iris fluorescein angiography (IFA) combined with fluorescein fundus angiography (FFA) in diabetic iridopathy.

MethodsA cross-sectional study was conducted.Sixty-five eyes of 44 patients with proliferative diabetic retinopathy (PDR) combined with diabetic iridopathy (DI) were enrolled in Henan Eye Hospital from May 2013 to May 2020.Patients were divided into non-proliferative diabetic iridopathy (NPDI) group and rubeosis iridis group according to the imaging results.Ophthalmic examinations including visual acuity, intraocular pressure, slit lamp miacroscopy, IFA and FFA were carried out in all patients.IFA was used to detect the iris imaging characteristics and the regression time of fluorescein in anterior chamber, and FFA was used to observe the retinal image characteristics and the incidence of optic disc neovascularization.To avoid the statistical error of recording the IFA examination time of the contralateral eye, only the relevant data of the affected eyes were analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2020[06]). Written informed consent was obatined from all patients before any medical examination.

ResultsAmong the patients, 30 cases (50 eyes) were with NPDI and 14 cases (15 eyes) were with rubeosis iridis.The fluorescein regression time in anterior chamber of NPDI group was (3.37±0.11) minutes, which was significantly shorter than (6.02±0.29) minutes of rubeosis iridis group ( t=8.541, P<0.001). Strong fluorescence of retinal neovascularization was observed in both groups.The incidence of optic disc neovascularization in NPDI group was 20% (6/30), which was significantly lower than 50% (7/14) in rubeosis iridis group ( P=0.04).

ConclusionsDiabetic rubeosis iridis can be diagnosed by the imaging features of IFA and the fluorescein regression time in anterior chamber.PDR combined with optic disc neovascularization should be evaluated by FFA combined with IFA.

KEYWORDS： Iris diseases/diagnosis;Diabetic rubeosis iridis;Diabetic retinopathy;Fluorescein angiography, iris;Fluorescein angiography, fundus

Corresponding author: Li Xiaohua, Email: mocdef.6ab210932slbsky

FUNDING:

National Natural Science Foundation of China（81770952）

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引用本文

李士清,王志立,陈晓,等. 糖尿病虹膜病变的荧光素虹膜血管造影和荧光素眼底血管造影特征分析[J]. 中华实验眼科杂志,2022,40(09)：847-851.

DOI:10.3760/cma.j.cn115989-20210218-00115

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糖尿病虹膜病变(diabetic iridopathy，DI)是增生型糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)诱导的虹膜并发症，与糖尿病病程长或视盘新生血管等密切相关 ^{[
1
,

2
,

3
]}。DI可分为非增生性DI(non-proliferative DI，NPDI)和增生性DI(proliferative DI，PDI)，PDI又分为虹膜红变和新生血管性青光眼(neovascular glaucoma，NVG)，其中虹膜红变是NVG的早期病变 ^{[
4
]}。由于虹膜红变在黄种人棕色虹膜背景下不易被裂隙灯显微镜检查发现，从而导致患者病情向NVG进展，甚至因治疗不及时而致盲。研究表明荧光素虹膜血管造影(iris fluorescein angiography，IFA)检查可通过虹膜血管荧光素渗漏特征来诊断DI，荧光素眼底血管造影(fluorescein fundus angiography，FFA)检查可通过视网膜血管渗漏特征或无灌注区来评估DR，IFA联合FFA检查有助于综合评估PDR合并DI的病情 ^{[
5
,

6
,

7
]}。目前国内鲜见虹膜红变患者IFA影像特征的研究报道。本研究拟对DI的IFA联合FFA影像表现进行分析，为临床上糖尿病虹膜红变的及时诊疗提供影像学依据。

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备注信息

通信作者：李晓华，Email： mocdef.6ab210932slbsky

作者贡献声明

李士清：参与设计试验、实施研究、采集数据、分析和解释数据、文章撰写；王志立：参与实施研究、文章修改；陈晓：数据采集和统计分析；李晓华：参与设计试验、分析和解释数据、文章审阅及定稿

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基金项目：

国家自然科学基金项目 (81770952) 查看更多基金信息

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