OCTA评估抗VEGF治疗老年性黄斑变性患者视网膜血流密度变化

Evaluation of retinal blood flow density with OCTA in patients with age-related macular degeneration undergoing anti-VEGF therapy

目的采用OCTA方法观察“3+PRN”方案治疗老年性黄斑变性(aged-related macular degeneration,AMD)疗效。方法选取2018年6月~2021年1月间同济大学附属杨浦医院眼科确诊的湿性AMD患者50例(共50只患眼),按照“3+PRN”方案给予玻璃体腔注射雷珠单抗(0.5 mg/0.05 mL)。所有患者分别在治疗前和治疗后的第1、3个月采用国际标准视力表检查、OCTRadial Lines平扫模式和OCTA HD Angio Retina 6.0 mm血流成像模式对黄斑区视网膜进行扫描,比较患者治疗前后最佳矫正视力,黄斑中心凹0.5 mm和1 mm范围视网膜的形态,视网膜毛细血管密度,以及黄斑中心凹无血管区面积间的差异。结果与治疗前相比,患者在治疗后1个月最佳矫正视力显著提高(P<0.05),治疗后3个月无显著改变(P>0.05);治疗后1个月和3个月的视网膜厚度均明显降低(P<0.001)。通过OCTA检查发现,与治疗前相比,治疗后第1个月视网膜浅层和深层血管密度均有增加(P<0.05),治疗后第3个月均无明显差异(P>0.05);其中,深层血管丛的所有位点在治疗后1个月均显著改善(P<0.05),术后3个月仍有3个位点保持着血流改善状态;浅层血管丛在术后1个月仅有鼻侧和下方位点的血流密度显著提高(P<0.05),其余的均无明显改善,术后3个月仅下方位点血管密度保持着恢复状态;面积仅在术后1个月明显减少(P<0.05);相关性分析发现,治疗前与治疗后1个月视网膜血管密度与最佳矫正视力呈显著正相关(P<0.05);治疗前与治疗后1个月黄斑中心凹鼻侧0.5 mm和1 mm处视网膜厚度差与深层血管密度差呈显著正相关(P<0.05);治疗前与治疗后1个月各方位的视网膜厚度差与FAZ面积差呈显著负相关(P<0.05)。结论“3+PRN”方案治疗老年性黄斑变性短期疗效较好,但3个月后需进行严格的主动随访策略以保证患者的预后;OCTA可对湿性AMD患者的疗效进行量化评估,除视网膜厚度指标的评估外,视网膜血流密度和FAZ指标也应在随访中予以重视。

Objective To evaluate the retinal blood flow density with optical coherence tomography angiography(OCTA)in patients with wet age-related macular degeneration(wAMD)undergoing anti-VEGF therapy.Methods Fifty patients(50 affected eyes)with wAMD admitted in our hospital from June 2018 to January 2021 were enrolled in the study.Patients were treated with intravitreal anti-VEGF ranibizumab(0.5 mg/0.05 mL)with the“3+PRN”regimen.The macular retina was scanned by OCT Radial Lines mode and OCTA HD Angio Retina 6.0 mm flow imaging mode before treatment and at 1 and 3 months after treatment.The best corrected visual acuity,retinal morphology in the foveal 0.5 mm and 1 mm ranges,retinal capillary density,and difference of foveal avascular zone were compared before and after treatment.Results Compared with that before treatment,the best corrected visuala acuity was significantly improved at 1 month after treatment(P<0.05),there was no significant change at 3 months after treatment(P>0.05).The retinal thickness was significantly reduced at 1 and 3 months after treatment(P<0.001).The density of superficial and deep retinal vessels were both increased(P<0.05)at the 1st month after treatment;however,there was no significant difference at 3 months after treatment(P>0.05)by OCTA treatment.All the sites of the deep retinal capillary plexus were significantly improved at 1 month after treatment(P<0.05),and significant improvement was maintained in three sites at 3 months after treatment.The vascular density of the superficial retinal capillary plexus was significantly increased only at the nasal and inferior sites at 1 month after treatment(P<0.05),the others had no significant improvement,and only the vascular density at the inferior site maintained a state of recovery at 3 months after treatment.The FAZ area decreased significantly only at the 1st month after treatment(P<0.05).The macular retinal vascular density was positively correlated with the best corrected visual acuity difference before and 1 month after treatment(P<0.05).There was a significant positive correlation between retinal thickness difference of 0.5 mm and 1 mm nasal macular fovea and deep retinal capillary plexus difference before and 1 month after treatment(P<0.05).There was a significant negative correlation between retinal thickness difference with the FAZ area at all sites before and 1 month after treatment(P<0.05).Conclusion The anti-VEGF therapy has a good short-term efficacy in the treatment of patients with age-related macular degeneration,but a strict active follow-up strategy is required after 3 months;OCTA can quantitatively evaluate the efficacy of wAMD patients under the therapy.