中心性浆液性脉络膜视网膜病变的OCTA特点及与ICGA的比较分析

Comparative study of optical coherence tomography angiography and ICGA in central serous chorioretinopathy

目的:通过分析中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)患者光相干断层扫描血流成像(optical coherence tomography angiography,OCTA)的特点,并比较其与ICGA的差异,来探讨OCTA可否替代ICGA对CSC患者进行诊断,并用以指导PDT治疗。方法:2015-11/2016-03就诊于首都医科大学附属北京同仁医院,经眼底荧光血管造影(fluorescein angiography,FFA)及吲哚菁绿血管造影(indocyanine green angiography,ICGA)确诊为CSC的患者30例30眼。所有入选病例均行最佳矫正视力(best-corrected visual acuity,BCVA)、眼压、裂隙灯、间接检眼镜、彩色眼底照相、FFA、ICGA及OCTA。采用Heidelberg Spectralis OCT仪器(Spectralis HRA+OCT~?;Heidelberg Engineering,Heidelberg)获得FFA及ICGA图像;采用RTVue XR Avanti仪器(OptovueInc,Fremont),选择6mm×6mm视网膜血流OCT成像模式,获得OCTA图像。仪器自带软件(software ReVue,version 2017.100.0.1;OptovueInc)自动将视网膜和脉络膜进行分层,并对脉络膜毛细血管层进行分析。同时比较CSC患者OCTA与ICGA图像特点,测量ICGA高灌注区最大直径、面积及OCTA高血流信号区最大直径、面积,采用配对t检验来分析OCTA与ICGA最大直径及面积之间的异同。结果:入组30眼CSC患者,有27眼在OCTA中可见明确的高血流信号影,即粗颗粒区;有21眼高血流信号影内可见低血流信号影;有7眼高血流信号影外可见低血流信号晕。OCTA上显示的高血流信号影基本上与ICGA图像中高灌注相对应;ICGA中有22眼高灌注内存在低反射影,其中21眼与OCTA中显示的高血流信号影内低血流信号影相对应;ICGA中有9眼高灌注外存在低反射晕,其中有7眼与OCTA相对应;共有14眼患者ICGA晚期可见渗漏点,所有的渗漏点在OCTA上均未见相应的血流信号变化。ICGA高灌注区的最大直径1.589±0.295mm,面积0.705±0.131mm^2;OCTA高血流信号影最大直径1.576±0.293mm,面积0.745±0.138mm^2。经配对t检验,ICGA高灌注区的最大直径与OCTA高血流信号影最大直径及两者面积间均无统计学差异。结论:在CSC患者中,OCTA可以清晰显示与ICGA高灌注所对应处的高血流信号影,能部分替代ICGA对CSC患者进行诊断,并指导PDT治疗。

AIM： By analyzing optical coherence tomography angiography （OCTA） characteristics of central serous chorioretinopathy （CSC） and comparing the differences of CSC between OCTA and indocyanine green angiography（ICGA）, to explore if OCTA can substitute ICGA for diagnosis of CSC patients, and guide the treatment of photodynamic therapy （PDT）. METHODS： We reviewed 30 eyes of 30 patients with CSC, who were diagnosed by fluorescein angiography （FFA） and ICGA at Beijing Tongren Eye Center from November 2015 to March 2016. All patients underwent best- corrected visual acuity （BCVA） measurement, intraocular pressure, slitlamp examination, indirect ophthalmoscope, color fundus photography, FFA, ICGA and OCTA. FFA and ICGA were captured by Spectralis HRA ± OCT （Spectralis HRA ± OCT ; Heidelberg Engineering, Heidelberg, Germany ）. OCTA was performed by RTVue XR Avanti device （Optovuelnc, Fremont, CA） with 6mm×6mm Angio Retina mode. The software （ version 2017. 100. 0. 1; Optovuelnc ） automatically segmented the tissue into four layers, the characteristics of choriocapillaris layer were analyzed. At the same time, the differences between OCTA and ICGA images were compared among CSC patients. The maximum diameters and areas of both choroidal hyperperfusion in ICGA and high flow signal in OCTA were measured. Then, the paired t test was used to analyze the differences between the maximum diameter and area of OCTA and ICGA measurement. ~ RESULTS： Among 30 cases, high blood flow signals of OCTA were clearly visible in 27 cases, namely the coarse grain region; the inner low flow signals surrounded by high blood flow signals were seen in 21 cases; the outer low flow signals surrounding high blood flow signals were seen in 7 cases. High blood flow signals of OCTA were corresponded with the choroidal hyperperfusion of ICGA images; among these 30 cases, there were low reflection shadows in choroidal hyperperfusion with ICGA for 22 cases, for 21 cases out of these 22 cases, low flow signals inside of high flow signals of OCTA could be seen; 9 out of 30 cases, there were low reflection halo outside of choroidal hyperperfusion of ICGA, and 7 out of these 9 cases, low flow signals outside of high flow signals of OCTA could be seen; still for those 30 cases, leakage point in late ICGA could be seen with 14 cases, however, special flow signals in OCTA could not be seen for them. For ICGA, the maximum diameter of choroidal hyperperfusion was 1. 589 ± 0. 295mm, whose area was 0.705± 0. 131mm2; while for OCTA, the maximum diameter of high flow signal was 1. 576±0. 293mm, whose area was 0. 745±0. 138mm2. By using paired t test, there was no statistical difference between the maximum diameter of choroidal hyperperfusion in ICGA and the maximum diameter of high flow signal in OCTA, nor difference between the area of ICGA and OCTA. CONCLUSION： The high flow signals can be clearly visible in OCTA, which are corresponded with choroidal hyperperfusion in ICGA. OCTA can substitute ICGA for diagnosis of CSC patients, and guide the treatment of PDT.