国际眼科纵览 ›› 2025, Vol. 49 ›› Issue (4): 309-314.doi: 10. 3760/cma.j.cn115500-20250415-25412

• 综述 • 上一篇    下一篇

糖尿病脉络膜病变的研究进展

任兰心 黄定国   

  1. 汕头大学·香港中文大学联合汕头国际眼科中心,广东汕头 515041
  • 收稿日期:2025-04-15 出版日期:2025-08-22 发布日期:2025-08-12
  • 通讯作者: 黄定国,Email: hdg@jsiec.org E-mail:hdg@jsiec.org
  • 基金资助:
    广东省医学科研基金(B2024179)

Research progress of diabetic choroidopathy

Ren Lanxin, Huang Dingguo   

  1. Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou Guangdong 515041, China
  • Received:2025-04-15 Online:2025-08-22 Published:2025-08-12
  • Contact: Huang Dingguo, Email: hdg@jsiec.org E-mail:hdg@jsiec.org
  • Supported by:
    Guangdong Medical Research Foundation(B2024179)

摘要: 糖尿病脉络膜病变(diabetic choroidaphy,DC)是糖尿病视网膜病变(diabetic retinopathy,DR)的重要协同因素,其早期微循环障碍可能加速视网膜缺血缺氧进程。DC的特征包括:(1)结构改变:脉络膜厚度在DR前期即显著变薄,但增生期可能因代偿性血管扩张而增厚;(2)微循环异常:脉络膜毛细血管(choriocapillaris,CC)血流缺陷百分比(flow deficit percentage,FD%)在无DR的糖尿病患者中已明显增加,且与DR严重程度正相关;(3)大中血管损伤:脉络膜血管指数(choroidal vascularity index,CVI)降低早于DR出现,尤以黄斑区Haller层为著。CC 的FD%及CVI可作为DR亚临床期筛查的指标,而抗血管内皮生长因子治疗与激光光凝术对脉络膜血流动力学的差异化影响为个体化治疗策略制定提供了依据。

关键词: 糖尿病脉络膜病变, 脉络膜毛细血管, 相干光断层扫描, 相干光断层血管成像

Abstract: Diabetic choroidopathy (DC), as an important co-factor of diabetic retinopathy (DR), may accelerate the process of retinal ischemia and hypoxia due to early microcirculation disorders.The characteristics of DC include: (1) Structural alterations: Choroidal thickness (CT) exhibits significant thinning during the preclinical stages of DR, while paradoxical thickening may manifest in the proliferative phase, attributable to compensatory vasodilation mechanisms. (2) Microcirculatory abnormalities: Choriocapillaris (CC) flow deficit percentage (FD%) demonstrates significant elevation in diabetes mellitus patients without DR, and exhibits a positive correlation with DR severity progression. (3) Macrovascular and medium vessel impairment: Choroidal Vascularity Index (CVI) reduction precedes the onset of clinically detectable retinal vasculopathy, with particular predilection for the Haller's layer within the macular region. CC FD% and CVI can be used as quantitative indicatorsfor early detection of subclinical DR, while the divergent impacts of anti-vascular endothelial growth factor therapy versus panretinal laser photocoagulation on choroidal perfusion dynamics provide a basis for the formulation of individualized treatment strategies.

Key words: Diabetic choroidopathy, Choroidal capillaries, Optical coherence tomography, Optical coherence tomography angiography