| Part Ⅰ : Characteristics of morphology and microcirculation in diabetic macular edema with serous retinal detachment.Objective By comparing the morphological structure and microcirculation characteristics of macular area in DME patients with SRD(serous retinal detachment)or without SRD,in order to find the possible pathogenesis of SRD.Method Non-randomized casecontrol studies.The patients with CST(central subfield thickness)≥300μm who were diagnosed as DME in our hospital from March 2020 to November 2020 were enrolled.The DME patients were divided into eyes with SRD group and eyes without SRD group.There were 100 eyes in 81 patients,including 60 eyes in 47 patients with SRD and 40 eyes in 34 patients without SRD.The following indexes were evaluated: Age,sex,course of diabetes,Hb A1c(Hemoglobin A1c),creatinine,the extent of DR,BCVA(bestcorrected visual acuity),CST,CRT(central retinal thickness),SFCT(subfoveal choroidal thickness),HF(hyperreflective foci),the integrity of EZ(ellipsoid zone)and ELM(external memory membrane),DRIL(disorganization of the inner retinal layer),the vascular density in SCP(superficial capillary plexus)and DCP(deep capillary plexus),the FAZ area(foveal avascular area),and the vascular density in choroidal capillary.The morphological and microcirculation differences in the macular area between eyes with SRD group and without SRD group were compared.Results 1.There were no significant differences in gender,age,duration of diabetes,Hb A1 c,creatinine and the extent of DR between the two groups at baseline(P>0.05).2.There was no significant difference in BCVA between eyes with SRD group and without SRD group(P>0.05).The CST of eyes with SRD group was 487.00(392.00,595.00)μm,which was higher than that of eyes without SRD group 403.00(356.00,463.50)μm,and the CRT of eyes without SRD group was higher than that of eyes with SRD group,the differences were statistically significant(U=765.500,532.000,P=0.002,P <0.001).3.The proportion of incomplete EZ zone in eyes with SRD group(96.7%)was significantly higher than that of eyes without SRD group(82.5%),and the proportion of incomplete ELM(81.7%)was also significantly higher than that of eyes without SRD group(30.0%),the difference was statistically significant(χ2=4.279,26.930,P=0.039,P<0.001).4.The amount of total HF,outer retinal HF and subretinal HF in eyes with SRD group was higher than that of eyes without SRD group,and the differences were statistically significant(U=368.000,238.500,486.000,P<0.001).5.SFCT in eyes with SRD group was higher than that of eyes without SRD group,and the difference was statistically significant(t=2.231,P=0.028).The vascular density of the choroidal capillary(53.63%±6.87%)of eyes with SRD group was higher than that of eyes without SRD group(50.81%±5.28%),and the difference was statistically significant(t=2.112,P=0.037).6.There were no significant differences in the vascular density of SCP,DCP and FAZ area between the two groups(P>0.05).7.The presence of SRD was correlated with ELM integrity,total HF,outer retina HF and subretinal HF(χ2 =26.930,OR 0.707,0.263,0.995,P<0.001).The presence of SRD was correlated with SFCT thickness(OR=0.992,P=0.031).Conclusion 1.The ratio of incomplete EZ zone and ELM in DME patients with SRD was significantly higher than that in patients without SRD;The total HF,outer HF and subretinal HF were also higher than those of the group without SRD.2.The choroidal thickness and vascular density of choroidal capillary increased in DME patients with SRD;3.The integrity of ELM,SFCT thickness,total HF,outer retina HF and subretinal cavity HF were all correlated with SRD.Part Ⅱ : The effect of intravitreal conbercept on macular morphology and microcirculation in diabetic macular edema patients with serous retinal detachment.Objective To compare and analyze the changes of macular morphology and microcirculation in DME patients with and without SRD before and after IVC(intravitreal conbercept)treatment,in order to explore the differences of the effect of macular morphology and microcirculation between the two groups after the short-term treatment of anti-VEGF drugs,and to provide a basis for personalized treatment of DME patients.Method This part included a total of 54 cases with 66 eyes that were diagnosed with DME and treated with IVC.Two groups of eyes with SRD and without SRD were devided,including 38 eyes in 30 patients with SRD and 28 eyes in 24 patients without SRD.Following indexes before and after IVC were collected: BCVA,CST,SFCT,number of HF,FAZ area,vascular density of SCP,DCP and choroid.To compare the differences between the two groups in morphology and microcirculation after IVC treatment.Results 1.After one month of IVC treatment,BCVA in both groups was significantly higher than that before the treatment(Z=-3.925,2.346,P<0.001,P =0.019),but there was no significant difference in visual acuity improvement between the two groups(P>0.05).2.CST decreased in both groups compared with that before the treatment,and the differences were statistically significant(Z=-3.937,-3.508,P<0.001).CST decreased significantly in eyes with SRD group compared with that of eyes without SRD group(U=370.000,P=0.036),but there was no significant difference in CRT decrease between the two groups(P>0.05).SRD height decreased significantly in SRD group after the treatment(Z=-4.960,P< 0.001).3.The number of total HF and inner retina HF in both groups were significantly decreased compared with that before the treatment(P<0.05);The number of HF in the outer retina of eyes with SRD group was also significantly decreased(Z =-3.203,P=0.001).The decreased number of HF in the outer retina of eyes with SRD group was much more than that of eyes without SRD group(U=373.500,P=0.034),and the decreased number of HF in the inner retina of eyes without SRD group was significantly more than that of eyes with SRD group(U=275.000,P=0.001).4.The FAZ area,vascular density of SCP and DCP had no significant changes before and after the treatment(P>0.05);5.SFCT and vascular density of choroidal in eyes with SRD were lower than before the treatment,the differences were statistically significant(t=5.787,2.068,P<0.001,P=0.046).Conclusion 1.After the short term of IVC treatment,BCVA was significantly improved,and CST was significantly decreased among the DME patients with SRD,and the decrease of the height of SRD played the most important part in the total decrease.2.In DME patients with SRD,the choroidal thickness and vascular density of choroidal in the fovea decreased after the IVC treatment;3.The number of HF in the outer retina of DME patients with SRD significantly decreased after the IVC treatment;4.The IVC treatment had no significant effect on FAZ area and vascular density of SCP and DCP in macular area of DME patients in the short term. |
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