Purpose To observe the color motion perception of patients with diabetic retinopathy (DR) in very early stage and find a good way to diagnose early DR in time． Methods The motion perceptions of patients with early DR and normal subjects were tested by using equiluminant moving chromatic grating and moving luminance grating generated on VGA monitor in a PC compatible computer and the results were compared with those of electroretinogram(ERG),oscillatory potentials(OPs) and color perception． Results When the two gratings were of equal spatial frequency and equal time frequency,the normal subjects judged that chromatic grating moved faster than luminance grating．Very signifincant differences were detected between blue/yellow grating and black/white grating while the luminance contrast of was 80% and the velocity was 20.2 mm/s or 14.3mm/s(Plt;0.01).The abnormal ratio of color motion perception(69.2%)was higher than that of color vision(43.6%) and ERG OPs(48.9%) when the luminance contrast of black/white grating was 80% and the velocity was 20.2mm/s. Conclusion The test of color motion perception provides new method for diagnosing early DR. (Chin J Ocul Fundus Dis,1998,14:135-138)
ObjectiveTo analyze the consistency of diagnostic results using simple and comprehensive reading methods on stereoscopic color fundus photographs of diabetic retinopathy (DR) with diabetic macular edema (DME). Methods450 sets of 7-field stereoscopic color fundus photographs of DR DME were compared to standard fundus photographs of early treatment and DR study group. The pictures were read by two groups of reader with similar experience. Two strategies were used to make the judgments, including simple reading which based on the color fundus photographs only, and comprehensive reading which based on color fundus photographs, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). 15 parameters were scored, including micro-aneurysms (MA), intra-retinal hemorrhage (IRH), hard exudates (HE), cotton wood spot (CW), intra-retinal microvascular abnormalities (IRMA), neovascularization on optic disc (NVD), neovascularization elsewhere (NVE), optic fiber proliferation (FPD), fiber proliferation elsewhere (FPE), pre-retinal hemorrhage (PRH), vitreous hemorrhage (VH), retinal elevation (RE), retinal detachment of central macular (RDC), venous beading (VB), Venous leak (VL). The reliability was evaluated using weighted κ(κw) statistic values. According to Fleiss statistical theory, κw≥0.75, consistency is excellent; 0.60≤κw < 0.75, consistency is good; 0.40≤κw < 0.60, consistency is general; κw < 0.40, consistency is poor. ResultsThe κw values of these 15 parameters were 0.22-1.00, 0.28-1.00 for the simple reading and comprehensive reading respectively. For simple reading, the consistency was poor for 8 parameters (MA, NVD, NVE, FPE, PRH, IRMA, VB, VL), general for 3 parameters (CW, FPD, VH), good for 2 parameters (IRH, HE) and excellent for 2 parameters (RE, RDC). For comprehensive reading, the consistency was poor for 2 parameters (NVE, VB), general for 6 parameters (MA, IRH, CW, FPE, IRMA, VL), good for 2 parameters (NVD, HE), excellent for 5 parameters (FPE, PRH, VH, RE, RDC). ConclusionThe comprehensive reading has higher consistency to judge the abnormality parameters of the fundus photographs of DR with DME.
Objective To estimate the prevalence of diabetic retinopathy (DR) in residents at the age of ge; 60 years in Beixinjing blocks, Shanghai, and to analyze the changes and risk factors of the occurrence of DR while comparing with the previous epidemiology study in the same blocks in 2003.Methods With the help of an established resident health data,a epidemiology study was performed on all of the old residents (ge; 60 years old) with diabetes mellitus from November 2007 to April 2008.The epidemiology data included resident common information, health check, examination of visual acuity,slitlamp biomicroscopy, direct ophthalmoscopy, and photography of 2 pictures covering 450 posterior ocular fundus area acquired by digital nonmydriasis fundus camera. The diagnosis of DR was drawn according to the international DR classification (2002). The DR grade was compared in 254 residents who were involved in both of the two epidemiology studies in 2003 and 2007.Chisquare method was used to analyze the risk factors of DR and stepwise logistic analysis was used for identifying the independent factors.Results A total of 483 diabetic residents was included in this study with the inclusion rate of 91.30%, in whom 121 DR patients was found with the DR prevalence of 25.05％. The prevalence of non-proliferative DR and proliferative DR was 22.36% and 2.69%, respectively. The duration of diabetes was confirmed as the independent risk factor of DR prevalence, and no risk factor was found to affect the different ratio of non-proliferative and proliferative DR. Comparing to the results of the study in 2003,the DR grade remained steadily or decreased in 92.52% of the 254 diabetes residents.Conclusion The prevalence of DR is high in the diabetic residents at the age of ge; 60 years.The intervention work of DR prevention in Beixinjing blocks is effective.
Diabetic retinopathy (DR) is one of the microvascular complications of diabetes mellitus (DM). Like other macrovascular complications of DM, the development and progression of DR is influenced by a variety of systemic and local factors. It is essential to understand the importance of multidisciplinary collaboration. Systemic risk fators such as hyperglycemia, hypertension, dyslipidemia and diabetic nephropathy should be treated before effective DR management can be implemented. Through multidisciplinary collaboration, we can prevent the development of DR, slow the progression of DR, and improve the safety of perioperative care. Thereby enhancing the level of prevention and control of DM complications, including DR.
Objective To investigate the distribution patterns of diabetic macular edema (DME) based on optical coherence tomography (OCT), and explore its correlation with diabetic retinopathy (DR) stages and systemic factors. Methods A total of 135 patients (242 eyes) with type 2 diabetes were included in this retrospective study. There were 75 males (138 eyes) and 60 females (104 eyes), the ages were from 29 to 83 years, with an average age of (58.8±11.1) years. The general information such as height, weight, smoking history and blood glucose [such as glycosylated hemoglobin (HbA1c)], blood pressure, blood lipid, 24 hours urine protein and other examinations were collected. The diagnosis of DR and DME were made, and the staging of DR and typing of DME were performed based on fundus color imaging and OCT. DR were divided into mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR and proliferative DR (PDR). DME were categorized into 4 types including sponge-like retinal swelling (SME), cystoid macular edema (CME), serous retinal detachment (SRD) and posterior hyaloid traction (PHT). The correlation between DME types and DR staging were analyzed byχ2 test and Fisher exact test. Multivariate logistic regression analysis was used to analyze the correlation between DME types and systemic factors. Results In 242 DR eyes the proportions of mild, moderate, severe NPDR and PDR were 30.99%, 32.64%, 23.14% and 13.23%, respectively. There were 199 eyes (82.23%) with DME. There were statistically significant differences in the proportion of DME in different stages of DR (χ2=21.077,P＜0.01). In the 199 eyes with DME, There were 165 eyes (68.18%) of SME, 22 eyes (9.09%) of CME, 7 eyes (2.89%) of SRD and 5 eyes (2.07%) of PHT. The distribution of DME patterns in different stages of DR was statistically significant (χ2=156.273,P＜0.01). Logistic regression analysis showed that the duration of diabetes, HbA1c and macroalbuminuria were independent risk factors for DME [odds ratio (OR)=1.090, 1.510, 4.123;P＜0.05], and were also independent for SME (OR=1.092, 1.445, 3.942;P＜0.05); HbA1c was an independent risk factor for SRD (OR=2.337,P＜0.05). Conclusions There are differences in the distribution of different DME types in each stage of DR. The duration of diabetes, HbA1c and macroalbuminuria were independent risk factors for DME and SME, and macroalbuminuria and HbA1c for CME and SRD.
The ocular fundus changes and the damage of visual function were various at different stages of diabetic retinopathy (DR). To get hold of timing and different therapic method correctly of early diagnosis, whole body treatment, laser photocoagulation and vitreous-retina surgery and adopting targeted interventions could help patients receiving the most reasonable and effective treatment at different stages, both of them are keys to reduce the damage of visual function. （Chin J Ocul Fundus Dis，2008，24：240-243）
Objective To estimate the prevalence rate and risk factors of diabetic retinopathy (DR) in rural residents in Shandong．Methods A total of 16 330 residents in 8 counties in Shandong province underwent the screening of diabetes by multistage randomized clustersampling; while the standard of diagnosis of diabetes was in accordance with the WHO standard (1990). Diabetes was diagnosed in 707 residents who then underwent questionnaire survey and examinations of fasting bloodglucose，urine protein, visual acuity, slitlamp microscope, and direct opthalmoscope. The standard of DR screening was drawn according to the international DR classification (2002). The data were statistically analyzed with SPSS 11.5 software. Results In 16 330 residents,707 were with diabetes (4.33%), 26.30% of them (181 cases) had DR (1.11% of all the residents). Multivariable analysis showed that kidney damage, hypertension and high blood glucose were the risk factors for DR; while the age, sex, and family history were not related much to DR. Conclusion The prevalence rate of DR in rural residents of Shandong is high. Kidney involvement, hypertension and high blood glucose are the risk factors of DR.
Objective To investigate the feasibility and clinical significance of monitoring diabetic macular edema by Heidelberg retina tomograph Ⅱ (HRT). Methods The diabetic macular edema (DME) was diagnosed by slit-lamp microscopy combined with three-mirror contact lens examination and fundus fluorescein angiography (FFA). The exponential of macular edema (e value) of healthy people and patients with DME or without DME (NDME) (the total number is 77 individuals and 120 eyes) were detected by HRT Ⅱ. All of the 77 people were divided into three groups. In DME group, there were 23 patients (40 eyes), including 13 males (23 eyes) and 10 females (17 eyes), at the age of 44-68 (average of 55.17plusmn;8.26). In NDME group, there were 32 patients (40 eyes), including 18 males (22 eyes) and 14 females (18 eyes), at the age of 44-68 (average of 55.17plusmn;6.5). In normal control group, there were 22 patients (40 eyes), including 10 males (19 eyes) and 12 females (21 eyes), at the age of 42-65 (average of 53.32plusmn;6.04). According to the results of FFA, the 40 eyes in DME group were divided into: grade 1 of FFA in 9 eyes, with macular suspicious leakage or the area of leakage of lt;25%; grade 2 of FFA in 10 eyes, with the area of leakage between 25% and 66%; grade 3 of FFA in 21 eyes, with the area of leakage of gt;66%. The differences of sex and age among the 3 groups were not significant (Pgt;0.05). The relationship among e value, leakage area, and visual acuity was observed. Results There was a significant difference of e value (the macular diameter was 1, 2, and 3 mm) among the 3 groups(Plt;0.05). The e value in normal control group didnrsquo;t differ much from which in NDME group (Pgt;0.05), but was statistically different from which in DME group (Plt;0.05). Significant difference of e value was also found between NDME group and DME group (Plt;0.05). There was a correlation between visual acuity and e value in DME group (Plt;0.05). In DME group, the difference of e value among FFA grade 1, 2, and 3 groups was found according to the variance analysis; the macular leakage area in FFA grade 3 group differed much from which in grade 1 (Plt;0.05) and grade 2 group (Plt;0.05), while no significant difference was found between grade 1 and grade 2 group. The result was not correlated with the macular diameter. Conclusion E value in the macular module of HRT Ⅱ can detect and evaluate the degree of DME. (Chin J Ocul Fundus Dis,2007,23:252-255)
Diabetic retinopathy (DR) is one of the most common causes of visual impairment and blindness in diabetic patients. It is particularly important to set up simpler, safer, non-invasive and highly effective methods for diagnosis as well as monitoring DR. A variety of new fundus imaging techniques show great advantages in early diagnosis, treatment and monitoring of DR in recent years. The main characteristics of wide-field scanning laser imaging system is achieving a large range of retinal image in a single photograph and without mydriasis. It provides several options for color images, FFA and FAF, which satisfy to detect the retina, choroid and vascular structure. Multi spectral fundus imaging system is suitable for DR screening, because it is able to recognize the typical characteristics of DR, such as microaneurysms, hemorrhage and exudation, and is non-invasive and convenient. OCT angiography is a quantitative examination that provides foveal avascular zone area, macular blood flow density, which provides strong evidence for DR diagnosis. The improvement of these new techniques will help us to build up a personalized evaluation system of DR.