黄斑水肿对糖尿病性视网膜病变黄斑区光学相干断层扫描血管成像测量值的影响

Effect of macular edema on the measurement of optical coherence tomography angiography in macula of diabetic retinopathy

目的:评估光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)在糖尿病性黄斑水肿(diabetic macular edema,DME)患眼的黄斑区微血管改变及其与视功能的相关性。方法:采用横断面研究,纳入临床检查确诊的无糖尿病性黄斑水肿的糖尿病性视网膜病变(diabetic retinopathy,DR)患者23例24只眼(明确无DME组)及曾经罹患过黄斑水肿但经抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗后水肿消退的DR患者14例16只眼(DME经抗VEGF水肿消退组)。受检者均行眼压(intraocular pressure,IOP)、收缩压/舒张压(systolic blood pressure/diastolic blood pressure,SBP/DBP)、黄斑中心凹敏感度(foveal sensitivity,FT)及OCTA技术测量黄斑区3 mm×3 mm范围内中心凹无血管灌注区面积(foveal avascular zone,FAZ)、浅层毛细血管密度(superior vessel density,SVD)、深层毛细血管密度(deep vessel density,DVD)。采用Pearson分析FT与其年龄,眼灌注压(ocular perfusion pressure,OPP),平均动脉压(mean arterial pressure,MAP),FA Z,SVD,DVD之间的相关性。结果:两组受检眼性别、年龄、眼灌注压对比差异无统计学意义,FT,FAZ,SVD,DVD比较,差异亦无统计学意义(均P>0.05)。相关性检验结果显示:两组受检眼之间FT与SVD,DVD比较,差异无统计学意义(均P>0.05);明确无DME组中,FT与FAZ之间呈中等程度负相关,差异有统计学意义(r=-0.554,P<0.01);而DME经抗VEGF水肿消退组中,FT与FAZ比较,差异无统计学意义(P>0.05)。结论:与明确无DME组相比,DME经抗VEGF水肿消退组OCTA各参数差异无统计学意义,提示抗VEGF治疗DME具有安全性。此外,黄斑水肿对糖尿病性视网膜病变患者OCTA中FAZ与FT的相关性有影响。

Objective： To quantitatively evaluate the macular microvascular changes in optical coherence tomography（OCTA） in patients with diabetic macular edema（DME） and its relationship with visual function. Methods： Twenty-three patients（24 eyes） with diabetic retinopathy（DR） without diabetic macular edema and 14 patients with DR who had macular edema but regained edema after anti-VEGF treatment（the DME subsided group） into the study. All subjects underwent intraocular pressure（IOP）, systolic blood pressure/diastolic blood pressure（SBP/DBP）, foveal sensitivity（FT）, foveal avascular zone（FAZ）, superior vessel density（SVD）, and deep vessel density（DVD） in a 3 mm × 3 mm OCTA scan of macular. Pearson was used to analyze the correlation between FT and age, ocular perfusion pressure（OPP）, mean arterial pressure（MAP）, FAZ, SVD, DVD. Results： There was no significant difference in sex, age and eye perfusion pressure between the two groups. There were no significant differences between FT, FAZ, SVD and DVD（all P〉0.05）. Correlation test showed that there were no significant differences in FT, SVD and DVD between the two groups（all P〉0.05）. In addition, there was a significant difference between FT and FAZ（P〈0.01）. However, there was no significant difference between FT and FAZ in the DME subsided group（P〉0.05）. Conclusion： There is no significant difference in OCTA parameters between two groups, indicating the safety of anti-vascular endothelial growth factor in treating DME. In addition, macular edema exerts an effect on the relationship between FAZ and FT by OCTA.