应用炫彩成像技术观察视网膜分支静脉阻塞患者动静脉交叉压迫点的临床意义

Clinical significance of arteriovenous crossing pressure points in patients with branch retinal vein occlusion by multicolor imaging

目的探讨利用炫彩视网膜成像技术观察视网膜分支静脉阻塞(BRVO)患者动静脉交叉压迫点的可行性及其临床意义。方法前瞻性研究。纳入2019年7月至2020年10月就诊于遵义医科大学第二附属医院眼科门诊的BRVO患者49例49眼。散瞳后分别行传统彩色眼底照相、基于共焦扫描激光检眼镜的海德堡炫彩成像(MultiColor)以及荧光素眼底血管造影(FFA)检查,以FFA图像为依据观察动静脉交叉压迫点,利用Spectralis HRA-2炫彩成像对压迫点所处的血管进行分级评分并测量压迫点距视盘血管发出区的距离。根据FFA结果将BRVO患者分成缺血型组和非缺血型组,对比两组患者上述指标差异。结果炫彩成像观察到的BRVO患者动静脉交叉压迫点与FFA图像结果一致,49例患者均为视网膜颞侧分支静脉阻塞,颞上分支阻塞者33例,颞下分支阻塞者16例,缺血型组与非缺血型组患者阻塞部位相比差异无统计学意义(P=0.289)。缺血型组患者压迫点血管分级评分平均为1.0分,与非缺血型患者的血管分级评分平均2.5分相比,差异有统计学意义(P=0.001)。压迫点距视盘血管发出区的距离缺血型组为(2543.00±769.06)μm,非缺血型组为(3505.44±1125.42)μm,两组比较差异有统计学意义(P=0.002),压迫点血管分级评分与BRVO是否发生缺血相关(P=0.003)。结论基于共焦扫描激光检眼镜的海德堡炫彩成像技术可以直观地观察BRVO患者动静脉交叉压迫点而不受出血的影响,并可以对压迫点血管进行分级评分,有助于为BRVO患者的治疗及预后评估提供更全面准确的信息。

Objective To investigate the feasibility and clinical significance of using multicolor imaging technology to observe the arteriovenous crossing pressure points in patients with retinal branch vein occlusion(BRVO).Methods Prospective research was carried out.The subjects were 49 eyes of 49 patients with BRVO who attended the Department of Ophthalmology of the Second Affiliated Hospital of Zunyi Medical University from July 2019 to October 2020.After dilation of the pupils,all eyes were examined by traditional color fundus photography(CFP),Heidelberg multicolor imaging(MultiColor)based on confocal scanning laser ophthalmoscopy(cSLO)and fundus fluorescein angiography(FFA).The arteriovenous crossing pressure point was observed through FFA imaging,and Spectralis HRA-2 was used to grade the blood vessel where the pressure point was located and measure the distance from the pressure point to optic disc vessel origin.According to the FFA results,BRVO patients were divided into ischemic group and non-ischemic group,and the variables were compared between groups.Results The arteriovenous crossing pressure points observed through MultiColor was consistent with those observed by the FFA imaging.The patients we observed were all diagnosed with retinal temporal branch vein occlusion,including 33 cases of superior temporal branch vein occlusion and 16 cases of inferior temporal branch vein occlusion.There was no statistically significant difference in the proportion of obstructed positions between the ischemic group and the non-ischemic group(P=0.289).The average vascular grading score of the ischemic group was 1.0 point,and compared with the average 2.5 points of the non-ischemic patients,the difference was statistically significant(P=0.001).The distance between the pressure point and optic disc vessel origin was(2543.00±769.06)μm in the ischemic group and(3505.44±1125.42)μm in the non-ischemic group.The difference between the two groups was statistically significant(P=0.002).The blood vessel grading score at the pressure point was correlated with the occurrence of ischemia(P=0.003).Conclusion The Heidelberg MultiColor technology based on cSLO can visually observe the arteriovenous crossing pressure points of BRVO patients without being affected by bleeding,and grade and score the blood vessels where the pressure points are located.Combined with FFA examination,it helps to provide more comprehensive and accurate information for the treatment and prognosis assessment of BRVO.