OCTA定量分析无临床可见糖尿病视网膜病变的2型糖尿病患者视盘旁血流密度

Quantifying peripapillary vessel density in type 2 diabetic patients without clinically detectable retinopathy using OCTA

目的:应用光学相干断层扫描血管成像(OCTA)定量分析无明显临床可见糖尿病视网膜病变(NDR)临床特征的2型糖尿病患者视盘旁血流密度的变化。方法:回顾性临床研究。收集2019-01/12于温州医科大学附属眼视光医院杭州院区连续就诊的NDR患者(NDR组)38例38眼和健康体检者(正常对照组)30例30眼纳入研究。两组受检者均行OCTA检查,选择视盘HD 4.5mm×4.5mm血流成像扫描模式,设备自带软件将视盘旁划分为鼻上(NS),鼻下(NI),下鼻(IN),下颞(IT),颞下(TI),颞上(TS),上颞(ST)和上鼻(SN)8个象限,测量平均及各象限视盘旁放射状毛细血管网血流密度(ppVD)和视盘旁视网膜神经纤维层(pRNFL)厚度。观察两组受检眼ppVD和pRNFL变化情况,Pearson相关分析NDR组各象限ppVD与pRNFL的相关性。结果:与正常对照组受检眼比较,NDR组患眼平均及NS、NI、IN、IT、TI、TS、ST和SN各象限ppVD均降低(P<0.05);平均及各象限pRNFL厚度均降低,但无差异(P>0.05)。Pearson相关性分析结果显示,NDR组TI、TS、SN、NS和NI象限pRNFL厚度与ppVD呈正相关(r=0.578、0.427、0.577、0.397、0.317,均P<0.05)。结论:2型糖尿病患者在尚无明显临床可见糖尿病视网膜病变之前已经出现视盘旁血流密度下降,OCTA有助于早期监测。

AIM:To quantify changes in peripapillary vessel density in patients with type 2 diabetic mellitus(DM)without clinical features of diabetic retinopathy(DR)by OCT angiography(OCTA).METHODS:A retrospective clinical study.From January to December 2019,38 type 2 DM patients without DR(38 eyes,NDR group)and 30 normal subjects(30 eyes,control group)in Eye Hospital of Wenzhou Medical University at Hangzhou were included in the study.The optic nerve head was scanned by OCTA with HD 4.5mm×4.5mm imaging scanning mode for all subjects.The software automatically divides the peripapillary region into 8 sectors,designated as nasal superior(NS),nasal inferior(NI),inferior nasal(IN),inferior tempo(IT),tempo inferior(TI),tempo superior(TS),superior tempo(ST)and superior nasal(SN).Radial peripapillary capillaries vessel density(ppVD)and peripapillary retinal nerve fiber layer(pRNFL)thickness of entire peripapillary area and each sector were measured.The discrepancy of ppVD and pRNFL thickness between the two groups was also analyzed.Pearson correlation analysis was used to analyze the correlation between ppVD and pRNFL in each quadrant of NDR group.RESULTS:The mean ppVD value and NS,NI,IN,IT,TI,TS,ST and SN sector values were all significantly lower in NDR group compared to normal controls(all P<0.05).The mean and each sector pRNFL thickness was reduced in NDR group compared with the control group,but the difference was not statistically significant(all P>0.05).Pearson correlation analysis showed that the significant positive correlation was found between ppVD and pRNFL thickness in TI,TS,SN,NS and NI sector(r=0.578,0.427,0.577,0.397,0.317;all P<0.05).CONCLUSION:Peripapillary vessel density has decreased in eyes of patients with type 2 DM before clinically detectable retinopathy and OCTA is helpful for early monitoring.