OCTA在脉络膜新生血管治疗效果评估中的作用

Role of OCTA in Evaluating the Effect of Anti-VEGF Therapy on Choroidal Neovascularization

目的:采用光学相干断层扫描血管成像(OCTA)技术观察抗血管内皮生长因子(VEGF)治疗后脉络膜新生血管(CNV)的形态变化,并探讨OCTA在诊断该类疾病以及在判断预后方面的优势。方法:回顾性系列病例研究。收集2017年7月至2018年4月在青岛眼科医院就诊的CNV患者17例(17眼)。所有患者常规进行最佳矫正视力(BCVA)、频域相干光断层扫描(SD-OCT)以及OCTA等检查,对患眼行玻璃体腔注射抗VEGF药物(雷珠单抗或康博西普)0.05ml,治疗后每个月随访1次,采用OCTA观察CNV在治疗前后的变化情况。采用配对t检验比较治疗前后BCVA和SD-OCT显示的黄斑中心凹视网膜厚度(CMT)的变化。结果:所有患者治疗前BCVA(LogMAR)为0.69±0.35,治疗后改善到0.49±0.38,差异有统计学意义(t=3.541,P=0.003)。CMT由治疗前的(363±66)μm下降到了治疗后的(302±66)μm,差异有统计学意义(t=4.227,P=0.001)。OCTA显示,抗VEGF治疗后所有患者CNV密度呈不同程度降低;部分患者CNV基本消失,神经上皮层脱离与水肿减轻甚至消失;部分患者虽仍存在粗大的异常血管,但神经上皮层脱离与水肿已完全消失。1例患者虽神经上皮层水肿消失,但仍存在边缘血管吻合,随访3个月复发。结论:OCTA能够清晰显示抗VEGF治疗后CNV的形态变化,可作为临床上CNV的诊断以及治疗效果评估的可靠工具。

Objective:To observe the morphological changes in choroidal neovascularization(CNV)after anti-vascular endothelial growth factor(VEGF)therapy by using optical coherence tomography angiography(OCTA),and to discuss the advantages of OCTA in diagnosing CNV and judging prognoses.Methods:Seventeen patients(seventeen eyes)diagnosed with CNV in Qingdao Eye Hospital from July 2017 to April 2018 were included in this retrospective case series study.All patients were tested for best corrected visual acuity(BCVA),and regularly examined with spectral domain optical coherence tomography(SD-OCT)and OCTA.All affected eyes were treated with 0.05 ml of intravitreal anti-VEGF agents(Ranibizumab or Conbercept),and all patients were followed up monthly.The changes in BCVA and central macular thickness(CMT)were noted on OCT images and compared with a paired t test.The changes in CNV were observed before and after therapy by using OCTA.Results:The BCVA of(LogMAR)all patients was 0.69±0.35 before treatment,and this indicator was raised to 0.49±0.38 after treatment;the difference was statistically significant(t=3.541,P=0.003).The CMT of all patients decreased from 363±66μm before treatment to 302±66μm after treatment,and the difference was statistically significant(t=4.227,P=0.001).OCTA showed that the density of CNV decreased by different degrees in all patients after treatment.CNV almost disappeared in some patients,meanwhile,neuroepithelial detachment and edema decreased or completely disappeared.Although OCTA showed the thickened and abnormal vessels in some patients,neuroepithelial detachment and edema disappeared completely on OCTA.While neuroepithelial edema vanished completely,marginal vessel anastomosis could still be seen in one patient,and CNV recurred after 3 months in that patient.Conclusions:OCTA clearly demonstrates the morphological changes in CNV after anti-VEGF therapy,and it can be a reliable tool for the clinical diagnosis and therapeutic evaluation of CNV.