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.
Purpose To investigate the relationship between the changes of the thickness of retina in macula and the abnormalities in multifocal electroretinog rams (mERG) in diabetic retinopathy. Methods mERG and optical coherence tomography (OCT) examination were performed in 38 patients (60 eyes) with DR (phase Ⅲ～Ⅳ). The data were processed with software SPSS and line relation analysis was done. Results The response densities of N1, P1 and N2 in central 5deg; area was significantly negative related to the thickness of neuroretina in macular fovea (correlation efficient -0.252～-0.266，Plt;0.05). The response density of N2 in central 10deg; area was also significantly negative related to the thickness of neuroretina in macular fovea (correlation efficient -0. 332，P=0.01).There was no significant relationship between the latencies of N1 in central 5deg;, 10deg; area and the thickness of macula, whereares the latenc ies of P1 and N2 in central 5deg; were negatively related to the thickness of retinal pigment epithelium in the macular fovea (correlation efficient-0.271～ - 0.322，Plt;0.05). Conclusion The changes of the thickness of neuroretina in macula may affect the local retinal function in macula, which may be revealed by the reduction of response densities in mERG in patients with diabetic retinopathy. (Chin J Ocul Fundus Dis, 2001,17:257-259)
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)
Objective To verify the pattern characteristics of optical coherance tomography (OCT) images in diabetic maculopathy (DM). Methods OCT were performed in sixty cases of DM and 30 cases of normal control group,and in 54 cases of DM,fundus fluorescein angiography (FFA) was performed simutaneously.The results from 2 kinds of examinations were compared each other. Results The average retinal thickness at the central fovea was (314.54plusmn;154.13) mu;m in DM group.The macular edema in the cases of DM accounted to 57.1% on OCT examination. The rate of retinal swelling associated with cystoid macular edema (CME) was 38.5%,with retinal detachment (RD) 9.2%,and with both CME and RD was 16.9%Those with mormal macular thickness and mild macular edema primarily showed focal leakage in FFA exam,while those with moderate and severe macular edema showed diffuse leakage in FFA exam.The rate of CME was 28.6% presented in FFA and 58.9% in OCT examination (t= 3.39,Plt;0.05). Conclusion OCT images of DM reveal 3 kinds of morphological features：retinal welling,CME,and sensory retinals de tachment.OCT is superior to FFA in detecting CME. (Chin J Ocul Fundus Dis, 2001,17:184-186)
ObjectiveTo compare the consistency and difference of nonmydriatic ultrawide field retinal imaging system versus nonmydriatic 2-field 45°digital fundus photography system in a large-scale diabetic retinopathy (DR) screening. MethodsA total of 733 with type 2 diabetic patients (1466 eyes) underwent nonmydriatic ultrawide field retinal imaging and nonmydriatic 2-field 45°digital fundus photography examination. Two independent readers graded images respectively to determine the stage of DR. A third masked retinal specialist adjudicated discrepancies. Using nonmydriatic 2-field 45°digital fundus photography examination as the standard, the consistency of nonmydriatic ultrawide field retinal imaging was evaluated. The statistic index included sensitivity, specificity, Youden index and Kappa value. The difference of two methods was analyzed by comparative t-test. ResultsBased on nonmydriatic ultrawide field retinal imaging, the results were as follows: non DR (NDR) in 1062 eyes (74.1%), DR in 340 eyes (23.7%), ungradable in 32 eyes (2.2%). Among 340 DR eyes, there were mild nonproliferative DR (NPDR) in 48 eyes, moderate NPDR in 216 eyes, severe NPDR in 57 eyes, proliferative DR (PDR) in 19 eyes. Based on nonmydriatic 2-field 45°digital fundus photography, the results were as follows: NDR in 1080 eyes (75.3%), DR in 270 eyes (18.8%), ungradable in 84 eyes (5.6%). Among 270 DR eyes, there were NPDR in 36 eyes, moderate NPDR in 175 eyes, severe NPDR in 53 eyes, PDR in 6 eyes. Compared with nonmydriatic 2-field 45°digital fundus photography for screening DR, the sensitivity was 98.0%, the specificity was 95.0%, and the kappa value was 0.87. For screening severe NPDR and PDR, the sensitivity was 100.0%, the specificity was 99.0%, and the kappa value was 0.94. The DR detection rate and the ratio of the picture can't interpretation between two methods both had significant difference (P=0.00). ConclusionsIn rapid large-scale DR screening, there is high consistency between nonmydriatic ultrawide field retinal imaging versus nonmydriatic 2-field 45°digital fundus photography. Nonmydriatic ultrawide field retinal imaging is proved to be more adaptive, and more comprehensive and precise.
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.
Objective To observe the ocular fundus features and consistency of classification of diabetic retinopathy (DR) by ultra-wide-field fluorescein angiography (UWFA) and the simulated early treatment diabetic retinopathy study (ETDRS) 7 standard field (7SF) imaging. Methods This is a retrospective clinical description study. Ninety-six eyes of 55 DR patients were included. The ages ranged from 25 to 73 years, with a mean age of (41.34±15.07) years. UWFA examination (British Optos 200Tx imaging system) using the protocol for obtaining 7SF images as described in the ETDRS, 7 circular regions with a range of 30 degrees are spliced as 7SF templates to determine the observation range. This template was then overlaid on the UWFA image to identify the potential viewable area of 7SF. And the visualized area of the retina, retinal non-perfusion (NP) area, retinal neovascularization (NV) area, and pan-retinal photocoagulation (PRP) area of UWFA and 7SF were quantified by a retinal specialist. Results UWFA imaging and 7SF imaging have a high degree of consistency in judging DR classification (kappa=0.851,P=0.000). The retinal visual area, NP area, NV area and PRP area of the UWFA imaging were 3.16, 3.38, 2.22 and 3.15 times more comparing with the simulated 7SF imaging (t=213.430, 45.013, 22.644, 142.665;P=0.000, 0.000, 0.003, 0.000). The lesions of 8 eyes were found outside the range of simulated 7SF imaging, including peripheral NP in 5 eyes, NV areas in 3 eyes, respectively. Conclusion UWFA imaging and simulated 7SF imaging are consistent to judge DR classification, but UWFA can find more peripheral retinal lesions.
There are many topics in clinical studies of diabetic retinopathy (DR). The current hot topics include the relationship between DR and systemic diseases, major factors for initiation and progression of DR, early DR screening strategies, DR prevention strategies and how to improve the therapeutic effects of DR. However, due to the complexity of DR pathogenesis, multiple risk factors, long cycle of DR prevention and control, it is difficult to exclude all the confounding factors in the DR clinical research. From the long-term perspective, delaying the occurrence and progression of DR and establishing an efficient and practical prevention and control system is the focus of the future DR research in China.
Chinese Guideline of Diabetic Retinopathy was developed by the Chinese Ocular Fundus Society and Chinese Ophthalmological Society. It is the first prevention and intervention guideline document of diabetic retinopathy (DR) in China. Clinical pathways and strategies are clearly identified and described in this document for DR screening, referral, intervention, systematic management and patient education. The new DR stage classification combines the first Chinese DR classification since 1985 and the updated international classification of DR. This guideline is based on Chinese health care system, but also reflects the tradition and innovation, and reaches international practice standard. Learning and practice the guideline will promote the prevention and reduce the occurrence and development of DR in China.