动脉瘤型毛细血管扩张症伴黄斑水肿患眼抗血管内皮生长因子药物治疗前后黄斑区血流密度观察

The changes of macular blood flow density in patients of macular telangiectasis type 1 with macular edema before and after the treatment of anti-vascular endothelial growth factor

目的观察动脉瘤型毛细血管扩张症(1型Mac-Tel)伴黄斑水肿患眼抗VEGF药物治疗前后黄斑区血流密度的变化。方法回顾性临床研究。2016年1月至2017年12月于南京医科大学附属眼科医院检查确诊的1型Mac-Tel伴黄斑水肿患者14例14只眼纳入研究。其中,男性6例6只眼,女性8例8只眼;平均年龄(35.3±9.3)岁。所有患者均行BCVA、OCT血管成像(OCTA)检查。BCVA检查采用Snellen视力表并转换为logMAR视力记录。患眼均给予玻璃体腔注射抗VEGF药物治疗,每一个月1次,连续3个月。采用OCTA仪对患眼黄斑区3 mm×3 mm范围进行扫描,测量治疗前及治疗后1周,1、3个月,停止治疗后2个月时的视网膜浅层毛细血管层(SCP)、深层毛细血管层(DCP)血流密度,黄斑中心凹无血管区范围300μm宽度内的血流密度(FD-300),黄斑中心凹视网膜厚度(CMT)。治疗前后黄斑区血流密度、CMT比较行配对t检验;血流密度与CMT的相关性采用Pearson相关性分析。结果治疗前,患眼平均logMAR BCVA为0.69±0.07,平均CMT为(468.43±26.59)μm。SCP、DCP平均血流密度分别为(50.99±1.19)%、(43.79±1.44)%,FD-300为(50.73±1.16)%。治疗后1周,1、3个月和停止治疗后2个月与治疗前logMAR BCVA、CMT、DCP血流密度、FD-300比较,差异均有统计学意义(logMAR BCVA:t=6.77、13.30、16.99、9.51,P=0.00、0.01、0.00、0.01;CMT:t=6.99、15.88、26.10、6.50,P=0.00、0.01、0.01、0.00;DCP血流密度:t=6.75、8.61、15.12、7.63,P=0.00、0.01、0.01、0.00;FD-300:t=11.86、13.08、14.36、4.41,P=0.00、0.01、0.01、0.03)。治疗前SCP血流密度与停止治疗后2个月比较,差异无统计学意义(t=1.36,P=0.19);其余各治疗后时间点差异均有统计学意义(t=5.50、6.84、6.27,P=0.00、0.01、0.01)。Pearson相关性分析结果显示,FD-300与CMT呈显著正相关(r2=0.54,P=0.04)。结论1型Mac-Tel伴黄斑水肿患眼SCP血流密度无明显变化,DCP血流密度降低,FD-300增加;抗VEGF药物治疗后,DCP血流密度增加,FD-300降低;FD-300与CMT呈显著正相关。

Objective To observe the changes of macular blood flow density in patients of macular telangiectasis type 1(Mac-Tel type 1)with macular edema before and after the treatment of anti-VEGF.Methods A retrospective clinical study.From January 2016 to December 2017,14 Mac-Tel type 1 patients(14 eyes)diagnosed in Nanjing Medical University Eye Hospital were included in the study.There were 6 males(6 eyes)and 8 females(8 eyes),with the mean age of 35.3±9.3 years.All patients underwent BCVA and OCT angiography examinations.The BCVA examination was performed using the Snellen visual acuity chart,which was converted into logMAR visual acuity.All the patients were received anti-VEGF injection treatment once a month for 3 consecutive months.The OCTA scanning region in the macular area was 3 mm×3 mm.Macular blood flow density in the superficial capillary plexus(SCP)and deep capillary plexus(DCP),the vessel density within a 300μm width ring surrounding the foveal avascular area(FD-300)and central macular thickness(CMT)were measured in all eyes.Paired samples t-test and Pearson correlation analysis were used in this study.Results At the baseline,logMAR BCVA was 0.69±0.07,CMT was 468.43±26.59μm,SCP blood flow density was(50.99±1.19)%,DCP blood flow density was(43.79±1.44)%,FD-300 was(50.73±1.16)%.Compared with the baseline,there were significant differences between logMAR BCVA,CMT,DCP blood flow density and FD-300 in 1 week,1 month,3 months after treatment and 2 months after cessation of treatment(logMAR BCVA:t=6.77,13.30,16.99,9.51;P=0.00,0.01,0.00,0.01.CMT:t=6.99,15.88,26.10,6.50;P=0.00,0.01,0.01,0.00.DCP:t=6.75,8.61,15.12,7.63;P=0.00,0.01,0.01,0.00.FD-300:t=11.86,13.08,14.36,4.41;P=0.00,0.01,0.01,0.03).There was no significant difference in blood flow density of SCP between baseline and 2 months after cessation of treatment(t=1.36,P=0.19),but there was significant difference at the other time points after treatment(t=5.50,6.84,6.27;P=0.00,0.01,0.01).The Pearson's correlation analysis showed that there was a significant positive correlation between FD-300 and CMT(r2=0.54,P=0.04).Conclusions There is no significant change in the SCP blood flow density in the patients of Mac-Tel type 1 with macular edema,while the DCP blood flow density decreased and FD-300 increased.After anti-VEGF treatment,DCP blood flow density increased and FD-300 decreased.FD-300 is positively correlated with CMT.