OCTA联合微视野计在视网膜静脉阻塞黄斑水肿中的应用

Application of OCTA combined with microperimetry in macular edema secondary to retinal vein occlusion

目的:应用光学相干断层扫描血管成像(OCTA)联合微视野计对视网膜静脉阻塞(RVO)黄斑水肿患者的黄斑区微血管及视功能进行定量评价。方法:收集单眼RVO并发黄斑水肿患者36例36眼,其中视网膜中央静脉阻塞(CRVO)组15例15眼,视网膜分支静脉阻塞(BRVO)组21例21眼(均为颞上分支静脉阻塞),收集同期年龄匹配的健康人15例24眼作为对照组。三组均应用OCTA扫描黄斑3mm×3mm范围视网膜,定量浅层、深层毛细血管丛(SCP、DCP)的血流密度(VD)、黄斑中心凹无血管区(FAZ)面积及黄斑中央视网膜厚度(CRT);应用MP-3微视野计测量患者黄斑10°范围视网膜平均敏感度(RMS)。BRVO组将VD及RMS进一步区分为病变区(上方)、非病变区(下方)VD及RMS,对照组病变区及非病变区的划分依据BRVO组相对应的区域。分别比较CRVO组和BRVO组与对照组上述指标变化,并对CRVO组和BRVO组RMS与VD、CRT、FAZ面积进行相关性分析。结果:CRVO组整体VD(SCP和DCP)较对照组均减少(t=-2.536,P=0.016;t=-8.834,P<0.001);FAZ面积较对照组增大(t=3.354,P=0.002);CRT较对照组增加(t=13.888,P<0.001);整体RMS较对照组明显降低(t=-6.250,P<0.001)。BRVO组整体VD(SCP和DCP)较对照组均减少(t=-5.186,P<0.001;t=-5.238,P<0.001);病变区VD(SCP和DCP)较对照组相应区域均明显减少(t=-5.611,P<0.001;t=-6.940,P<0.001);未病变区VD(DCP)较对照组相应区域减少(t=-3.047,P=0.004),未病变区VD(SCP)较对照组相应区域无差异(t=-1.459,P=0.156);FAZ面积较对照组增大(t=2.722,P=0.011);CRT较对照组增加(t=7.764,P<0.001);整体RMS较对照组明显降低(t=-10.931,P<0.001);病变区及未病变区RMS较对照组相应区域均下降(t=-13.183,P<0.001;t=-8.074,P<0.001)。CRVO组整体RMS与整体VD(SCP和DCP)均呈正相关(r=0.571,P=0.026;r=0.813,P<0.001),与FAZ面积及CRT均呈负相关(r=-0.621,P=0.014;r=-0.533,P=0.041)。BRVO组整体RMS与整体VD(SCP和DCP)均呈正相关(r=0.465,P=0.034;r=0.611,P=0.003),与CRT呈负相关(r=-0.547,P=0.01),与FAZ面积无相关性(r=-0.421,P=0.057)。结论:OCTA与微视野计的联合应用,能够对RVO黄斑水肿患者黄斑区结构与功能进行对应式的定量评估,为临床决策者提供更详细的信息,以做好疾病的解释工作。

AIM:To quantitatively evaluate the macular microvasculature and visual function in patients with macular edema secondary to retinal vein occlusion(RVO)by optical coherence tomography angiography(OCTA)combined with microperimetry.METHODS:Totally 36 patients(36 eyes)with monocular RVO complicated with macular edema were enrolled,including 15 patients(15 eyes)in central retinal vein occlusion(CRVO)group and 21 patients(21 eyes)in branch retinal vein occlusion(BRVO)group(all with superior temporal vein occlusion),15 age-matched healthy subjects(24 eyes)were included as controls.OCTA was used to scan macular retina in the range of 3mm×3mm in all three groups and measure the vascular density(VD)of superficial capillary plexus(SCP)and deep capillary plexus(DCP),the area of foveal avascular zone(FAZ)and the central retinal thicknes(CRT);the retinal mean sensitivity(RMS)at 10°was measured by MP-3 microperimetry.VD and RMS in BRVO group were further divided into lesion area(superior),non-lesion area(inferior)VD and RMS.The lesion area and non-lesion area of the control group were divided according to corresponding regions of the BRVO group.The changes of above indexes in CRVO group and BRVO group were compared with control group respectively,and the correlation between RMS and VD,CRT and FAZ areas in CRVO group and BRVO group was analyzed.RESULTS:The overall VD(SCP and DCP)in CRVO group were lower than those in control group(t=-2.536,P=0.016;t=-8.834,P<0.001);the area of FAZ was larger than that in control group(t=3.354,P=0.002);the CRT was thicker than that in control group(t=13.888,P<0.001);the overall RMS was significantly lower than that in control group(t=-6.250,P<0.001).The overall VD(SCP and DCP)in BRVO group were decreased compared to those in control group(t=-5.186,P<0.001;t=-5.238,P<0.001);the VD of SCP and DCP in the affected sector were decreased compared to those in the corresponding sector of the control group(t=-5.611,P<0.001;t=-6.940,P<0.001);the VD in the unaffected sector was significantly less than that in the corresponding sector of the control group only in DCP,but not in SCP(t=-3.047,P=0.004;t=-1.459,P=0.156);the area of FAZ was larger than that in control group(t=2.722,P=0.011);the CRT was thicker than that in control group(t=7.764,P<0.001);the overall RMS was significantly lower than that in control group(t=-10.931,P<0.001);the RMS in both the affected sector and the unaffected sector were lower than those in the corresponding sector of the control group(t=-13.183,P<0.001;t=-8.074,P<0.001).In CRVO group,the overall VD of SCP and DCP was positively correlated with the overall RMS(r=0.571,P=0.026;r=0.813,P<0.001)and the area of FAZ and CRT was negatively correlated with the overall RMS(r=-0.621,P=0.014;r=-0.533,P=0.041).In BRVO group,the overall VD of SCP and DCP was positively correlated with the overall RMS(r=0.465,P=0.034;r=0.611,P=0.003),and the CRT was negatively correlated with the overall RMS(r=-0.547,P=0.01),while there was no correlation between the area of FAZ and the overall RMS(r=-0.421,P=0.057).CONCLUSION:The combined application of OCTA and microperimetry can corresponding quantitatively evaluate the structure and function of macular area in patients with macular edema secondary to retinal vein occlusion,providing more detailed information for clinical decision makers to explain the disease well.