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Clinical Reseach of Vitreopapillary Tractional Diabetic Optic Neuropathy

Author: WangJingZuo
Tutor: MaJingXue
School: Hebei Medical University
Course: Ophthalmology
Keywords: Diabetic retinopathy Optic neuropathy Papilledema Traction Posterior vitreous detachment Vitrectomy
CLC: R774.6
Type: Master's thesis
Year: 2010
Downloads: 33
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Abstract

As we all know, diabetes and arteriosclerosis in patients prone to ischemic optic neuropathy. However, with the in-depth study of diabetic retinopathy, the clinical application of optical coherence tomography (OCT), a new understanding of the vitreoretinal interface diseases, as well as advances in vitreoretinal surgical techniques, there is evidence that patients with diabetes also occur important reason species diabetic optic neuropathy caused by traction traction because of the optic disc, the disease is caused by diabetes patients with visual impairment. At present, the international research in this area has just started, the domestic research in this area has not been reported. View of the ophthalmologist their lack of knowledge, this study is divided into two parts, respectively, to explore the pathogenesis of optic disc area incomplete posterior vitreous detachment and proliferation of optic disc fiber membrane traction on the optic disc, and speculated that the traction diabetic optic neuropathy. The first part is not completely vitreous detachment with traction diabetic optic neuropathy purpose: The purpose of this study is to analyze incomplete posterior vitreous detachment relations, to investigate the pathogenesis of diabetic optic neuropathy with traction. Method: the optic disc with mild to moderate edema, and except for the optic disc ischemia-induced diabetic optic disc edema in 11 patients (17), best corrected visual acuity (BCVA), fundus examination, fundus fluorescein angiography angiography (FFA), optical coherence tomography scanning (OCT), visual evoked potential (VEP), perimetry 6 checks. 1-year follow-up, close observation of the disease evolution. 3 months after the first visit, the 6-month and nine-month review of BCVA, fundus examination and OCT observation vitreous after limiting membrane traction disc situation. Check again followed up for 1 year after more than six indicators. Results: 1 best-corrected visual acuity (BCVA) in newly diagnosed BCVA 0.1-0.8 mean BCVA was 0.45 ± 0.32; followed up for 3 months, 6 months, 9 months and 1 year BCVA were 0.48 ± 0.66,0.41 ± 0.33,0.44 ± 0.42,0.44 ± 0.73; respectively with the first visit showed no statistical significance (P gt; 0.05). Which takes place the vitreous detachment 2/17 (11.76%), 1-year follow-up BCVA was 0.76 ± 0.47, compared with the first visit, BCVA significantly improve. Optic disc edema leakage area of ??20% sodium fluorescein 3ml quickly injected into the antecubital vein after seven minutes as a point of reference. Newly diagnosed optic disc edema leakage area (19.85 ± 15.06) mm2, and the 1-year follow-up of optic disc edema leakage area (20.02 ± 13.77) mm2, compared with the first visit without statistical significance (P gt; 0.05); which takes place the vitreous entirely after the Detachment 2/17 (11.76%), optic disc edema infiltration area (5.27 ± 3.77) mm2, and a significant reduction in the leakage area of ??the optic disc edema compared with the first visit. 3 OCT shown in the present study, 14/17 (82.35%) showed incomplete vitreous detachment high reflective tape, disc generate traction posterior vitreous community film and video disc and surrounding retina there were many stretch adhesions. 1-year follow-up, 2/17 vitreous detachment, optic disc edema of the optic disc traction lift; 15/17 I still optic disc traction. The degree of disc bulge at diagnosis (314.36 ± 20.24) μm; follow-up of 3 months, 6 months, 9 months and 1 year disc bulge degrees (323.42 ± 19.92) μm (343.23 ± 30.98) μm, (378.56 ± 29.48) μm, (388.12 ± 27.27) μm. No statistically significant compared with newly diagnosed optic disc bulge degrees; the 2 occurred vitreous detachment, optic disc bulge degrees (126.48 ± 79.62) μm, compared with newly diagnosed optic disc edema significantly reduced. 4 VEP (P100 latency) in newly diagnosed 15/17 (88.23%) performance to extend the P100 latency, 2/17 (11.76%) patients showed normal P100 latency. VEP-P100 latency (118.87 ± 12.54), followed up for 1 year P100 latency (109.12 ± 3.99), both compared with no statistical significance (P gt; 0.05). The vitreous detachment 2/17 (11.76%) were followed up for 1 year mean P100 latency (108.27 ± 16.55), compared with newly diagnosed latency. 5, 30 ° field of view (the average light sensitivity and mean defect) in newly diagnosed patients with vision 11/17 (64.70%) showed expansion of the physiological blind spot, 3/17 (17.64%) patients showed central scotoma, 1/17 (5.88 %) manifested as arcuate visual field defects, more than the normal field of vision. The newly diagnosed center 30 ° field of view photosensitivity (18.50 ± 4.77) dB, followed up for 1 year after the average light sensitivity (19.45 ± 4.58) dB, both compared to no statistical significance (P gt; 0.05); followed up for 1 years occurred vitreous detachment 2/17 (11.76%) and the average light sensitivity (22.86 ± 4.66) dB compared with the first visit, the average increased photosensitivity. Newly diagnosed center 30 ° visual field mean defect (3.31 ± 0.45) dB, average defect followed up for 1 year (3.71 ± 1.56) dB, both compared with no statistical significance (P gt; 0.05). Occurred vitreous detachment 2/17 (11.76%) of the average defect (2.00 ± 1.83) dB, compared to the average defect with newly diagnosed reduce the absolute value. Conclusion: Most of a non-ischemic diabetic optic disc edema after incomplete and vitreous detachment caused by optic disc traction relevant to the situation can be attributed to the traction diabetic optic neuropathy. 2 vitreous (spontaneous vitreous detachment after the release of the optic disc traction) optic disc edema subsided, along with part of the restoration of visual function. The second part of the optic disc fibroproliferative membrane stretch and stretch diabetic optic neuropathy Objective: To explore the relationship of proliferative diabetic retinopathy disc fiber proliferative membrane stretch factors traction diabetic optic neuropathy, and its pathogenesis. Evaluation of the vitrectomy film dissection for the treatment of diabetic optic neuropathy traction. Methods: proliferative diabetic retinopathy combined optic disc before fibrovascular membrane, macular degeneration or diseased minor can not explain the severe vision loss, and 8 patients (11 eyes), best corrected visual acuity (BCVA), fundus examination, fundus photography and fundus fluorescein angiography angiography (FFA), optical coherence tomography the Scan (OCT), visual evoked potential (VEP), the six inspection of the center of a 30 ° field of view, and then the the vitrectomy film dissection. Check again after more than six indicators. Results: 1 BCVA vitrectomy visual acuity before treatment 0.02-0.15, average 0.06 ± 0.04; postoperative patients with a visual acuity of 0.04-0.3, average 0.15 Guests 0.08; 3 months after vitrectomy visual acuity of 0.08-0.6 average of 0.34 Sze 0.17. Vision preoperative vitrectomy after one month, three months compared to visual acuity improved, there is a statistically significant (P lt; 0.05). Vitrectomy after 3 months eyesight after a month, there is a significant statistical significance (P lt; 0.01). 2 OCT the vitrectomy preoperative disc bulge degrees gt; 300μm 6 ,200-300μm 5, The average disc bulge degrees (300.64 ± 48.90) μm; vitrectomy after a disc bulge degrees gt; 300μm for 4, 200 - 300μm 6 disc bulge degrees lt; 200μm a The average disc bulge degrees (260.35 ± 39.11) μm; 3 months after vitrectomy disc bulge degrees lt; 200μm 9, 200 - 300μm for two the average disc bulge degrees (164.36 ± 30.81) μm. Ranked data exact test, vitrectomy surgery before and after 3 months, after a significant difference (P lt; 0.05). Optic disc edema leakage area of ??20% sodium fluorescein 3ml quickly injected into the antecubital vein after seven minutes as a point of reference. Optic disc edema leakage area before vitrectomy surgery (17.46 ± 10.23) mm2, 3 months after vitrectomy leakage area of ??the optic disc edema (9.33 ± 8.95) mm2, 3 months after vitrectomy leakage area of ??the optic disc edema and preoperative significant statistical significance (P lt; 0.01). VEP P1 latency and amplitude vitrectomy preoperative patients Pl incubation period average (200.36 ± 40.26) ms 3 months after surgery, vitrectomy (171.27 ± 34.40) ms. The paired t-test, vitrectomy preoperative patients P1 latency 3 months after a significant difference (P = 0.018). Vitrectomy preoperative patients P1 amplitude average (4.87 ± 3.77) μν vitrectomy after 3 months (7.23 ± 3.30) μν. Paired t-test, patients with preoperative vitrectomy P1 amplitude and 3 months after surgery a significant difference (P lt; 0.05). 5 center 30 ° field of view before vitrectomy surgery in patients with a 30 ° field of view, the average light sensitivity (16.36 ± 0.24) dB; photosensitivity after 3 months (21.14 ± 2.55) dB. The paired t-test, vitrectomy preoperative patients with central 30 ° field of view light sensitivity and 3 months after surgery there is a significant difference (p lt; 0.01). Vitrectomy 3 months after a 30 ° field of view, mean sensitivity (MS), compared with the preoperative improve. Vitrectomy preoperative patients with central 30 ° visual field mean defect (22.55 ± 2.86) dB, after 3-month average defect (12.85 Sze 2.13) dB. By paired t-test, vitrectomy preoperative patients with central 30 ° visual field mean defect after 3 months there is a significant difference (p lt; 0.01). 3 months postoperatively mean defect (MD) reduce the absolute value. Conclusions: 1 proliferative diabetic retinopathy disc proliferation produce stretch film on the disc can cause traction diabetic optic neuropathy, caused serious damage to visual function. Vitrectomy surgery to remove the proliferative membrane disc traction treatment effective method of traction diabetic optic neuropathy, visual function can be restored to some extent.

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