重度非增生型糖尿病视网膜病变患眼微创玻璃体切割手术后黄斑区形态结构及血流变化观察

Macular morphology and vascular parameters changes following micro-invasive vitrectomy in patients with severe non-proliferative diabetic retinopathy

目的观察重度非增生型糖尿病视网膜病变(sNPDR)患眼微创玻璃体切割手术(PPV)后黄斑区形态结构及血流的变化。方法前瞻性临床研究。2020年1月至2021年4月于中山大学中山眼科中心检查确诊并接受PPV治疗的连续sNPDR患者17例17只眼纳入研究。其中,男性12例12只眼,女性5例5只眼;平均年龄55岁;平均糖尿病病程11年;平均糖化血红蛋白7.9%。手术前及手术后1、3、6个月,所有患眼均行最佳矫正视力(BCVA)、标准7视野眼底彩色照相及光相干断层扫描血管成像(OCTA)检查。采用OCTA仪对患眼黄斑区3 mm×3 mm范围进行扫描,测量黄斑中心凹厚度(CST)、黄斑区神经节细胞复合体(GCC)厚度、视网膜神经纤维层(RNFL)厚度、黄斑区浅层视网膜血管丛(SCP)血流密度和灌注密度以及黄斑区无血管区(FAZ)面积、非圆度指数(AI)。手术前、手术后6个月两两比较采用最小显著差法检验。结果手术前及手术后1、3、6个月,患眼黄斑区FAZ面积分别为(0.34±0.14)、(0.35±0.10)、(0.37±0.10)、(0.36±0.13)mm2,AI分别为0.52±0.13、0.54±0.11、0.57±0.10、0.60±0.11,CST分别为(282.6±66.7)、(290.4±70.9)、(287.2±67.5)、(273.2±49.6)μm,GCC厚度分别为(77.1±15.5)、(74.3±13.9)、(72.6±16.2)、(78.5±18.3)μm,RNFL厚度分别为(97.9±13.8)、(101.3±14.6)、(97.7±12.0)、(96.1±11.4)μm;黄斑区SCP整体血流密度分别为(16.79±1.43)%、(16.71±1.82)%、(17.30±2.25)%、(17.35±1.22)%,整体灌注密度分别为0.32±0.02、0.32±0.03、0.33±0.03、0.33±0.02。手术后CST呈先升高后降低趋势;RNFL厚度手术后1个月升高,其后逐渐降低。手术前与手术后6个月各参数比较,AI提高,差异有统计学意义(P=0.049);FAZ面积以及CST、GCC、RNFL厚度比较,差异均无统计学意义(P=0.600、0.694、0.802、0.712);黄斑区视网膜SCP血流密度、灌注密度比较,差异均无统计学意义(P=0.347、0.361)。结论与手术前比较,微创PPV后6个月内sNPDR患者黄斑区结构和血流密度无明显变化。

Objective To observe the changes of macular morphology and blood flow after minimally invasive vitrectomy(PPV)in patients with severe non-proliferative diabetic retinopathy(sNPDR).Methods A prospective clinical study.From January 2020 to April 2021,17 consecutive sNPDR patients with 17 eyes who were diagnosed and received PPV treatment at the Zhongshan Ophthalmic Center of Sun Yat-sen University were included in the study.There were 12 males with 12 eyes and 5 females with 5 eyes;the average age was 55 years old;the average duration of diabetes was 11 years;the average glycosylated hemoglobin was 7.9%.Before the operation and 1,3,and 6 months after the operation,all the affected eyes underwent best corrected visual acuity(BCVA),standard 7-field fundus color photography,and optical coherence tomography angiography(OCTA).An OCTA instrument was used to scan the macular area of the affected eye with in the range of 3 mm×3 mm to measure the central subfoveal thickness(CST),the thickness of the ganglion cell complex(GCC)in the macular area,the thickness of the retinal nerve fiber layer(RNFL),and the superficial capillary plexus(SCP)vessel density and perfusion density in the macular area,macular avascular zone(FAZ)area,a-circularity index(AI).Before the operation and 6 months after the operation,the least significant difference test was used for the pairwise comparison.Results Before the operation,1,3,and 6 months after the operation,the FAZ area of the macular area were 0.34±0.14,0.35±0.10,0.37±0.10,0.36±0.13 mm2,respectively;AI were 0.52±0.13,0.54±0.11,0.57±0.10,0.60±0.11;CST was 282.6±66.7,290.4±70.9,287.2±67.5,273.2±49.6μm;GCC thickness were 77.1±15.5,74.3±13.9,72.6±16.2,78.5±18.3μm;the thickness of RNFL was 97.9±13.8,101.3±14.6,97.7±12.0,96.1±11.4μm,respectively.The overall blood flow density of SCP in the macula were(16.79±1.43)%,(16.71±1.82)%,(17.30±2.25)%,(17.35±1.22)%;the overall perfusion density were 0.32±0.02,0.32±0.03,0.33±0.03,0.33±0.02,respectively.After the operation,the CST increased first and then decreased;the thickness of RNFL increased 1 month after the operation,and then gradually decreased.Comparison of the parameters before and 6 months after the operation showed that the AI improved,and the difference was statistically significant(P=0.049);the difference in FAZ area and the thickness of CST,GCC,and RNFL was not statistically significant(P=0.600,0.694,0.802,0.712);There was no statistically significant difference in the retina SCP blood flow density and perfusion density in the macular area(P=0.347,0.361).Conclusion Compared with before surgery,there is no significant change in macular structure and blood flow density in sNPDR patients within 6 months after minimally invasive PPV.