光学相干断层扫描血管成像技术观察下的Vogt-小柳原田病的病理变化

Pathological Changes of Vogt-Koyanagi Harada Observed by Optical Coherence Tomography Angiography

【目的】观察静止期Vogt-小柳原田(VKH)患者与健康人之间的视网膜和脉络膜的微血管差异。【方法】回顾性研究静止期的Vogt-小柳原田患者12人,共20眼,正常对照13人,共21眼。所有患者与健康人均进行光学相干断层扫描血管成像(SS-OCTA)检查。对视网膜浅层毛细血管层的中心凹无血管区(FAZ)面积、非圆参数(AI)、视网膜浅层毛细血管层(SCP)的血管密度、视网膜深层毛细血管(DCP)的血管密度以及脉络膜毛细血管层(CC)的血管密度均使用ImageJ软件进行定量计算,同时用仪器内置软件测量中心凹下脉络膜厚度(SFCT)。统计学分析采用t检验与Mann-Whitney U检验。【结果】VKH静止期患者的FAZ面积明显低于健康人(P=0.004)。VKH组的SCP(6 mm)、SCP(3 mm)与DCP(6 mm)的血管密度(48.14±3.65)%、(47.73±3.23)%和(48.53±1.89)%也低于正常对照组(49.84±1.56)%、(48.23±2.41)%和(50.31±1.58)%,其中只有VKH组的DCP(6 mm)的血管密度与正常对照组的血管密度之间具有统计学差异(P=0.002)。然而,VKH组的SCP(1 mm)的血管密度(29.82±7.04)%明显高于正常对照组(25.59±5.44)%,并且具有统计学差异(P=0.037)。SFCT(408.70±66.97)μm也明显高于正常对照组(254.00±54.48)μm(P=0.000),另一方面,VKH组的脉络膜毛细血管的血管密度与正常对照组相比并无明显差异(P=0.095)。【结论】SS-OCTA检查可以发现静止期VKH患者的视网膜浅层毛细的血管层的FAZ面积由于黄斑中心凹周围1mm内的浅层视网膜毛细血管层的血管发生代偿性增加而出现减少的现象,而静止期VKH患者DCP的血管密度降低,说明静止期VKH患者的视网膜的深层毛细血管层的血供并未完全恢复。

【Objective】To observe the differences of retina and choroid microvasculature between Vogt-Koyanagi-Harada(VKH)patients in convalescent stage and healthy people.【Methods】In this retrospective study,12 Vogt-Koyanagi-Harada patients in convalescent stage(20 eyes),and 13 healthy people(21 eyes)as controls were examined by Swept-Source optical coherence tomography angiography(SS-OCTA,PLEX Elite 9000,Carl Zeiss).The area of the foveal avascular zone(FAZ)of the superficial capillary plexus(SCP)of the retina,the acircularity index(AI),the vascular density of the superficial(SCP)and deep capillary plexus(DCP),and the vascular density of choriocapillaris(CC)were analyzed by ImageJ software.The subfoveal choroidal thickness(SFCT)is measured by the built-in software of PLEX Elite 9000.t test and Mann-Whitney U test were used for statistical analysis.【Results】FAZ area of the Vogt-Koyanagi-Harada patients in convalescent stage was significantly smaller than that of healthy people(P=0.004).The vascular density of SCP(6mm),SCP(3mm)and DCP(6mm)in the VKH group(48.14±3.65)%,(47.73±3.23)%,(48.53±1.89)%,respectively,was also lower than that of the normal control group(49.84±1.56)%,(48.23±2.41)%,(50.31±1.58)%).However,only the vascular density of DCP(6 mm)in the VKH group was statistically different from that of the normal control group(P=0.002).The vascular density of SCP(1 mm)in the VKH group(29.82±7.04)%was significantly higher than that of the normal control group(25.59±5.44)%,and there was a statistical difference(P=0.037).SFCT(408.70±66.97)μm was also significantly higher than the normal control group(254.00±54.48)μm(P=0.000).On the other hand,the vascular density of choriocapillaris in the VKH group was not significantly different from that in the normal control group(P=0.095).【Conclusions】SS-OCTA examination can discover the changes that the FAZ area in SCP of the VKH patients in convalescent stage has decreased due to the blood vessels compensatory increase in the superficial capillary plexus within 1mm around the macular fovea.The decrease in the vascular density of the DCP can also indicate that the retinal blood supply of VKH patients in convalescent stage has not been fully restored.