方法：采用单中心非随机对照临床回顾性研究。选择2008-07/2014-01在我院眼科门诊就诊和内分泌科要求会诊诊断为DME的62例103眼患者的临床资料。采用糖尿病早期治疗研究(ETDRS)视力表检查患者的最佳矫正视力(best corrected visual acuity，BCVA)，所有患者行非接触眼压、裂隙灯、间接检眼镜、荧光素眼底血管造影(fundus fluorescein angiography，FFA)检查，并利用光学相干断层扫描(optical coherence tomography，OCT)确定黄斑中心1mm直径范围即中心子域平均厚度(central subfield mean thickness，CSMT)及中心350μm内光感受器内节/外节(IS/OS)及外界膜(external limiting membrane，ELM)反射光带的完整性。不同类型临床有意义的糖尿病性黄斑水肿(clinical significant diabetic macular edema，CSME)的BCVA及CSMT分析采用Kruskal-Wallis秩和检验； DME的4种分型的BCVA及CSMT组间差异两两比较采用Nemenyi检验； 与BCVA相关因素分析采用多元回归分析。

结果：患者103眼中，局限型DME者47眼(45.6%)，弥漫型DME者35眼(34.0%)，缺血型DME者6眼(5.8%)，增生型DME者15眼(14.6%)。不同类型DME患者的BCVA(H=69.167，P<0.01)、CSMT(H=57.113，P<0.01)差异均有显著统计学意义。不同类型组间两两比较：局限性和弥漫性(BCVA：χ²=14.982，P<0.01； CSMT：χ²=14.537，P<0.01)、局限型与缺血型(BCVA：χ²=15.596，P<0.01； CSMT：χ²=15.393，P<0.01)、局限型与增生型(BCVA：χ²=16.567，P<0.01； CSMT：χ²=15.687，P<0.01)及弥漫型与缺血型之间(BCVA：χ²=12.974，P=0.008； CSMT：χ²=13.999，P<0.01)，BCVA和CSMT的差异有统计学意义。多元回归分析患者的BCVA与CSMT(r=-0.064)、IS/OS及ELM反射光带的完整性(r=-0.207)、病程(r=-0.082)、DME水肿类型(r=-0.160)相关(P<0.05)； 与患者的糖化血红蛋白(r=-0.885)、眼压(r=-2.522)、年龄(r=-1.504)、性别(r=-0.595)无相关性(P>0.05)。

结论：不同类型DME在形态学和功能学上具有差异。

METHODS: Presented study was single-center, uncontrolled retrospective clinical study. Sixty-two patients(103 eyes)with DME were included. Best corrected visual acuity(BCVA)was evaluated using early treatment diabetic retinopathy study(ETDRS)vision test chart. All patients were examined by non-contact tonometer, slit lamp, indirect ophthalmoscope, and fundus fluorescein angiography(FFA). Central subfield mean thickness(CSMT)in the macular area of diameter 1mm was measured by optical coherence tomography(OCT).And in the same time the integrity of inner segments/ outer segments(IS/OS)and external limiting membrane(ELM)reflecting light strip of 350μm center horizontal scanning line was investigated by OCT. BCVA and CSMT in different types of DME patients were analyzed using Kruskal- Wallis test. BCVA and CSMT between the two-two groups in different types of DME patients were analyzed using Nemenyi test, and multiple regression analysis was used to analyze the relative factors of BCVA.

RESULTS: In the 103 eyes, 47 eyes(45.6%)were focal DME, 35 eyes(34.0%)were diffuse DME, 6 eyes(5.8%)were ischemic DME and 15 eyes(14.6%)were proliferative DME. The difference of mean BCVA(H=69.167, P<0.01)and mean CSMT(H=57.113, P<0.01)in different types of DME patients was statistically significant. Comparison of BCVA and CSMT between the two-two groups showed statistically significant difference in focal DME and diffuse DME(BCVA:χ²=14.982,P<0.01; CSMT:χ²=14.537,P<0.01), focal DME and ischemic DME(BCVA:χ²=15.596,P<0.01; CSMT:χ²=15.393,P<0.01), focal DME and proliferative DME(BCVA:χ²=16.567,P<0.01; CSMT:χ²=15.687,P<0.01), diffuse DME and ischemic DME(BCVA:χ²=12.974、P=0.008; CSMT:χ²=13.999,P<0.01). By multiple lineal regression analysis, CSMT, the integrity of IS/OS and ELM reflecting light strip of 350μm center horizontal scanning line, the course of disease and the type of DME correlated to BCVA(r=-0.064,-0.207,-0.082 and -0.160, respectively, P<0.05). The glycosylated hemoglobin, intraocular pressure, age and sex were not associated to BCVA(r=-0.885, -2.522, -1.504, and-0.595, respectively, P>0.05).

CONCLUSION: There are statistically significant differences on macular morphology and vision function among different types of DME patients.