目的：分析糖尿病患者(DM)在未出现糖尿病视网膜病变(DR)前的黄斑区神经纤维层形态学、对比敏感度及黄斑视野阈值的变化。

方法：选取2015-01/2017-01在我院住院的双眼均未出现DR的2型DM患者59例(DR0组)与40例体检正常者(正常组)及40例双眼均为轻度非增殖性糖尿病视网膜病变患者(DR1组)，每位被检查者均取右眼纳入研究。分别对其黄斑区神经纤维层形态学及对比敏感度、黄斑视野阈值进行对比分析。

结果：正常组、DR0组及DR1组的黄斑中心凹厚度(FT)分别为244.45±22.863、237.53±18.240、240.78±23.946μm。三组受试者间FT、黄斑中心区视神经纤维层(RNFL)，周边区RNFL平均厚度无差异(P>0.05)，黄斑中心凹体积(FV)，旁中心区RNFL三组间均有差异(P<0.05)。三组受试者在3、6、12、18c/d的对比敏感度和黄斑中心MS、MS1～4、MS5～16、MS1～16的视敏度阈值比较均有差异(P<0.05)。

结论：DM患者在发生DR前会出现RNFL变薄和FV减小、视功能对比敏感度下降和视野的改变； 光学相干断层扫描、对比敏感度和视野检查可为DR早期筛查及及干预提供了重要依据。

METHODS: Case-control study, from Jan 2015 to Jan 2017 choose 59 cases of type 2 diabetes without diabetic retinopathy were selected as the observation group, 40 normal persons and 40 patients with mild non-proliferative diabetic retinopathy were selected as the control group. The morphology of the nerve fiber layer in the macular area, the contrast sensitivity of visual function, and the threshold of macular field were compared and analyzed.

RESULTS: The average thickness of the fovea(FT)in normal group, DR0 group and DR1 group were 244.45±22.863, 237.53±18.240, 240.78±23.946μm. There was no statistically significant difference in the average FT, retinal nerve fiber layer thickness in foveal central field(RNFL-C), RNFL thickness in perifovea among the three groups(P>0.05). The foveal volume(FV), RNFL thickness in parafove between the three groups was statistically significant(P<0.05). Visual function contrast sensitivity test: the differences in contrast sensitivity of normal group, DR0 group and DR1 group at 3, 6, 12, 18c/d spatial frequency were statistically significant(P<0.05). Visual function of macular field: the difference in visual acuity threshold of the macular centers MS, MS1-4, MS5-16, MS1-16 in the normal group, DR0 group and DR1 group is statistically significant(P<0.05).

CONCLUSION: Before diabetic retinopathy, diabetic patients will have macular nerve fiber thinning and fovea volume reduction, visual function contrast sensitivity decline and visual field changes. OCT, contrast sensitivity and visual field examination can be diabetic retinopathy. Early screening and intervention provide important evidence.