韓國人 糖尿病患者의 螢光眼底造影所見 = Fluorescein Fundus Angiographic Findings in Korean Diabetics

국문 초록 (Abstract)

慶北醫大 附屬病院 糖尿病診療室에서 糖尿病으로 確診된 患者 84名(124眼)中 80名(120眼)에 對하여 螢光眼底造影術을 施行하고(4眼은 硝子體出血로 因하여 螢光眼底造影術을 施行할 수 없었음)檢眼境所見과 比較觀察하였다. 檢眼境所見上 糖尿病性綱膜症은 84名中 28名으로 發生率이 33.3% 였으나 螢光眼底造影所見에서는 84名中 57名으로 71.3%로 나타나 월등히 높은 發生率을 보였다. 螢光眼底造影所見上 제일 먼저 發生되는 血管의 變化로는 小動脈瘤와 毛細血管閉??인데 그 가운데 小動脈瘤는 檢眼鏡으로 發見할 수 있는 것보다 월등히 많아서 罹患期間이 1年末滿에서 34眼中 13眼(38.2%), 1年부터 5年사이에서 52眼中 31眼(59.6%)이었다. 小動脈瘤에서 fluorescein이 漏出되는 것은 1年末滿에서 34眼中 4眼, 1年부터 5年사이에서 52眼中 14眼이었다. 檢眼鏡으로 確認하지 못하는 毛細血管閉??部位도 初期에 많이 나타났는데 罹患期間이 1年末滿인 34眼中 10眼(29.4%), 1年부터 5年사이에서 52眼中 27眼(51.9%)이나 觀察되었다. 檢眼鏡으로 浮腫을 確認할 수 있었던 것은 120眼 中에서 겨우 10眼이었으나 螢光眼底造影所見d에서는 53眼이나 發見되었고 黃斑部 浮腫은 6眼(4名)이었다. 眼底를 觀察할 수 있었던 120眼中 新生血管은 檢眼鏡으로 5眼(3名)에서 確認할 수 있었으나 螢光眼底造影所見에서는 7眼(4名)에서 觀察되었다. 黃班部浮腫과 新生血管만을 光凝固術의 適應範圍로 생각하드라도 120眼(80名)中 적어도 13眼(8名)이나 된다 이러한 事實은 糖尿病性綱膜症患者中 적어도 10%에 있어서는 光凝固術의 適應이 되는 것을 의미하며 다른 要因을 勘案하면 더욱 많은 例가 될 것으로 思料된다.

다국어 초록 (Multilingual Abstract)

At least 50 percent of the diabetics are affected by retinopathy in the western world since the 1950s and in Japan since the 1960s. In Korea, the incidence seems to be about 30 percent. The lower incidence of diabetic retinopathy in Korea may not be related with racial differences but rather with social and economic problems. This study covered 80 Korean diabetics (120 eyes) who were examined by means of the fluorescein fundus angiography and the results were compared with ordinary ophthalmoscopic findings. Diabetic retinopathy was found in 71 percent of the total studied cases by means of the fluorescein fundus angiography, but only 33 percent of the cases were recognized having diabetic retinopathy by ophthalmoscopic examination. It is very important to detect vascular changes in their early stage of diabetic retinopathy from view point of treatment. The earliest fluorescein fundus angiographic findings in diabtetic retinopathy are microaneurysm, microvasular leakage, and capillary nonperfusion. On the fluorescein fundus angiographic findings, microaneurysm was found in 75 out of 120 eyes studied but only 30 eyes were found to have microaneurysms on the ophthalmoscopic examination. Among the retinal lesions referred to duration of diabetes mellitus, microaneurysms were observed in 13 out of 34 eyes in less than one year duration, and in 31 of 52 eyes during the period from one to five years. Leakage from microaneurysm was found in 18 out of 86 eyes within five years duration. Capillary nonperfusion area was found in 10 among 34 eyes in less than one year duration, and 27 out of 52 eyes in one to five years duration. The longer the patient suffered from diabetes, the greater number of eyes showed microaneurysms and capillary nonperfusion areas. Of 120 eyes examined by the fluorescein fundus angiography, 53 eyes were found having retinal edema and of 53 eyes, 6 (4 patients) showed macular edema but through the ophthalmoscopy, only 10 eyes were found having retinal edema. Retinal neovascularization was found in 7 eyes (4 patients) through the flurescein fundus angiography but only 5 eyes (3 patients) were found by opthalmoscopic examination. The rate of having macular edema and neovascularization which were revealed through the fluorescein fundus angiographic findings clearly indicates the fact that at lest 10 percent out of diabetic retinopathy studied so far are definitely indicative of photocoagulation therapy.