糖尿病视网膜病变患者OCTA检查结果的定量分析

Quantitative analysis of OCTA findings in diabetic retinopathy

目的通过光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)检测糖尿病视网膜病变患者视网膜各部位血流密度和厚度等指标,分析不同分期的糖尿病视网膜病变患者眼底视网膜微循环的改变。方法运用OCTA对22例(39眼)正常人、73例(73眼)非增殖性糖尿病性视网膜病变(non proliferative diabetic retinopathy,NPDR)和25例(25眼)增殖性糖尿病性视网膜病变(proliferative diabetic retinopathy,PDR)患者进行检查,收集不同区域的深、浅层视网膜血管密度、厚度并进行记录分析。结果(1)浅层血流密度:与正常组相比,PDR和NPDR组的近中心凹血流密度、旁中心凹血流密度、FD-300,差异均有统计学意义(P<0.05);PDR和NPDR组相比,各项指标均无显著差异。(2)深层血流密度:PDR和NPDR组与正常组相比较,旁中心凹四方位以及近中心凹的下、颞侧血流密度有显著统计学差异(P<0.05),全图区血流密度、中心凹血流密度、以及近中心凹上、鼻侧分区血流密度无显著差异;PDR与NPDR各部位血流密度相比较,旁中心凹以及旁中心凹颞侧区域有显著差异(P<0.05),其余部位分区无显著差异。(3)视网膜厚度:正常组较NPDR组黄斑中心凹厚度相比具有显著差异(P<0.05),其余数据3组之间视网膜厚度无显著差异。结论通过OCTA检查发现,糖尿病视网膜病变患者深层和浅层血流密度下降明显,且在NPDR时期已经出现明显的血流密度下降;深层的视网膜旁中心凹尤其是旁中心凹颞侧血流密度与糖尿病视网膜病变的严重程度相关性更大。

Objective To detect the vessel density and thickness of retinal in diabetic retinopathy by optical coherence tomography angiography(OCTA).Methods OCTA was performed in 22 normal subjects(39 eyes,normal group),73 patients with non-proliferative diabetic retinopathy(73 eyes,NPDR group)and 25 patients with proliferative diabetic retinopathy(25 eyes,PDR group).The density of deep and superficial retinal vessels and retinal thickness in different areas were obtained and compared among three groups.Results Superficial vascular density:there were significant differences in perifovea vessel density,parafoveal vessel density and FD-300 between normal group and PDR,NPDR groups(P<0.05);while there was no significant difference in above indexes between PDR and NPDR groups.Deep vascular density:there were significant differences in the inferior and temporal vascular density of parafovea,near fovea between normal group and PDR,NPDR groups(P<0.05);but no significant difference in WVD,foveal VD,and superior and nasal divisions of perifovea.There was significant difference in vessel density in parafovea and temporal area of parafovea(P<0.05),but no significant difference in other parts between PDR and NPDR groups.Retinal thickness:there was significant difference in the thickness of macular fovea between normal group and NPDR group(P<0.05);while there were no significant differences in other indicators among three groups(P>0.05).Conclusion OCTA examination reveals that the density of deep and superficial retinal vessels is decreased significantly in diabetic etinopathy,and there is already a significant decrease in vessel density in NPDR.Deep paranretinal fovea,especially paraco temporal vessel density is associated with the severity of diabetic retinopathy.