非增生期糖尿病视网膜病变患者黄斑区血流密度变化:基于OCTA的定量分析

Quantitative analysis of macular vessel density changes in non-proliferative diabetic retinopathy through optical coherence tomography angiography

目的应用光学相干断层扫描血管成像(OCTA)定量分析非增生期糖尿病视网膜病变(NPDR)患者黄斑区视网膜血流密度(retinal vessel density,RVD)的改变。方法回顾性横断面观察性研究。纳入2019年1月至12月在温州医科大学附属眼视光医院杭州院区就诊的2型糖尿病且伴NPDR的患者28例45眼(NPDR组),以及同期年龄、性别与之匹配的正常体检者20人40眼(正常对照组)。所有受检眼均采用分频幅去相关血流成像算法OCTA检查,扫描以黄斑中心凹为中心的3 mm×3 mm范围视网膜,自动获取黄斑旁中心凹区(中心1~3 mm)浅层和深层RVD并进行比较。结果NPDR组黄斑旁中心凹区RVD平均值与正常对照组相比,浅层下降6.47%(43.54±4.43)%、(46.55±4.13)%,深层下降6.06%(45.62±5.87)%、(48.56±5.31)%,差异均有统计学意义(均为P<0.05)。NPDR组浅层RVD各象限平均值均低于正常对照组,差异均有统计学意义颞侧(42.34±4.40)%、(46.06±3.85)%,上方(44.33±5.57)%、(47.92±4.26)%,鼻侧(42.96±4.50)%、(45.50±4.31)%,下方(44.58±4.45)%、(46.88±4.94)%,均为P<0.05,其中颞侧RVD下降幅度最大(8.07%)。NPDR组深层RVD各象限平均值均低于正常对照组,除上方象限差异无统计学意义外(45.43±6.30)%、(47.82±5.54)%,P=0.068,其他象限差异均有统计学意义颞侧(45.84±5.71)%、(49.54±4.86)%,鼻侧(46.53±5.91)%、(49.45±5.29)%,下方(44.62±6.64)%、(47.43±5.91)%,均为P<0.05,其中颞侧RVD下降幅度最大(7.48%)。结论NPDR患者存在黄斑区浅层和深层视网膜毛细血管损害,颞侧尤甚。

Objective To investigate quantitative changes of macular retinal vessel density(RVD)in non-proliferative diabetic retinopathy(NPDR)through optical coherence tomography angiography(OCTA).Methods A retrospective cross-sectional observational study.From January to December 2019,twenty-eight patients(45 eyes)with NPDR from Type 2 diabetes mellitus(NPDR group)and 20 individuals(40 eyes)of age and sex matched healthy subjects(control group)in Hangzhou Branch of Eye Hospital of Wenzhou Medical University were included in the study.Automated OCTA/split-spectrum amplitude decorrelation angiography was applied in all eyes.A 3 mm×3 mm scan centered on the fovea was obtained,and the RVDs of superficial and deep retinal plexuses in parafoveal(central 1-3 mm)zone were analyzed.Results Compared with the control group,the average parafoveal superficial and deep RVD of NPDR group decreased by 6.47%(43.54±4.43)%,(46.55±4.13)%and 6.06%(45.62±5.87)%,(48.56±5.31)%respectively,and both differences were statistically significant(all P<0.05).The superficial RVDs in all quadrants of the NPDR group were lower than those of the normal control group temporal(42.34±4.40)%,(46.06±3.85)%,superior(44.33±5.57)%,(47.92±4.26)%,nasal(42.96±4.50)%,(45.50±4.31)%,inferior(44.58±4.45)%,(46.88±4.94)%,respectively,all P<0.05).Furthermore,the temporal quadrant had the largest vessel density reduction(8.07%).Similarly,the deep RVDs of all quadrants of the NPDR group were lower than their counterparts,and except that the difference in the superior quadrant was not statistically significant(45.43±6.30)%,(47.82±5.54)%,P=0.068,the difference in the other quadrants was statistically significant temporal(45.84±5.71)%,(49.54±4.86)%,nasal(46.53±5.91)%,(49.45±5.29)%,inferior(44.62±6.64)%,(47.43±5.91)%,respectively,all P<0.05.The temporal area also had the largest vessel density reduction(7.48%).Conclusion The macular superficial and deep retinal capillary layers are damaged in the patients with NPDR,especially in the temporal part.