OCTA观察高度近视眼ICL植入术后视网膜血流密度的变化

Changes in Retinal Blood Flow Density after ICL Implantation in High Myopia Using Optical Coherence Tomography Angiography

目的:利用光学相干断层扫描血管成像技术(OCTA)观察高度近视眼行有晶状体眼后房型人工晶状体(ICL)植入术对黄斑区视网膜血流密度、视网膜厚度的影响。方法:前瞻性临床研究。选取2019年12月至2020年5月于南京医科大学附属眼科医院行ICL植入术的高度近视患者25例(43眼),术眼等效球镜度(SE)>-6.00 D。观察患者术前,术后1周、1个月、3个月的视力、眼压、拱高及黄斑区视网膜血流密度、视网膜厚度的变化。数据采用方差分析进行统计分析。结果:患者手术前后各时间点裸眼视力和最佳矫正视力总体差异均有统计学意义(F=500.975,P<0.001;F=16.032,P<0.001),术后各时间点指标均较术前明显提高(均P<0.001)。术后各时间点黄斑中心凹无血管区(FAZ)面积均较术前减少(均P<0.001),术后黄斑中心凹视网膜厚度(CRT)无明显改变。患者手术前后黄斑中心凹、黄斑旁中心凹、颞侧、上方、鼻侧及下方各区域浅层视网膜血流密度差异均无统计学意义。与术前相比,术后1周、1个月、3个月黄斑中心凹、颞侧、上方及下方各区域深层视网膜血流密度差异均无统计学意义,而术后黄斑旁中心凹、鼻侧深层视网膜血流密度较术前均有所降低(均P<0.05)。结论:OCTA观察显示高度近视眼行ICL植入术对鼻侧深层视网膜血流密度有影响,同时FAZ面积降低,但对其余视网膜血流密度及视网膜厚度无影响。

Objective:To observe the effect of posterior chamber intraocular lens(ICL)implantation on retinal blood flow density and retinal thickness in high myopia using optical coherence tomography angiography(OCTA).Methods:This was a prospective clinical study.Twenty-five patients(43 eyes)who underwent ICL implantation from December 2019 to may 2020 in the Affiliated Eye Hospital of Nanjing Medical University were selected.The spherical equivalent(SE)was>-6.00 D.Visual acuity,intraocular pressure,arch height,macular blood flow density and retinal thickness were measured before the operation and 1 week,1 month and 3 months after the operation.The data were analyzed with repeated measures ANOVA.Results:The postoperative uncorrected visual acuity(UDVA,LogMAR)and postoperative best corrected visual acuity(BCVA,LogMAR)were statistically significant(F=500.975,P<0.001;F=16.032,P<0.001,respectively),and all improved compared to the preoperative values(P<0.001).The macular foveal retinal thickness(CRT)did not change significantly after surgery,but the area of the avascular zone(FAZ)decreased significantly after surgery(all P<0.001),and difference between preoperative and postoperative were statistically significant(P<0.001),respectively.There was no significant difference in superficial retinal blood flow density in the fovea,parafovea,temporal,superior,nasal or inferior regions before the operation,and 1 week,1 month and 3 months after the operation.There was no significant difference in the deep retinal blood flow density in the fovea,temporal,superior or inferior regions 1 week,1 month and 3 months after the operation,but the deep retinal blood flow density in the parafovea and nasal region decreased after the operation(all P<0.05).Conclusions:According to the OCTA,ICL implantation has a significant effect on deep nasal retinal blood flow density,and decreases the area of FAZ,however there is no significant effect on other retinal blood flow and thickness parameters.