视网膜深层血流密度对康柏西普治疗糖尿病性黄斑水肿预后的影响:基于OCTA的评价

Effect of vessel density in retinal deep capillary plexus on the prognosis of diabetic macular edema treated with Conbercept based on optical coherence tomography angiography

目的研究糖尿病性黄斑水肿(DME)患者视网膜深层毛细血管丛(DCP)的血流密度(VD)与康柏西普治疗预后的关系。方法回顾性分析2020年1月至2021年7月就诊于潍坊医学院附属医院眼科中心的46例非增生型糖尿病视网膜病变(NPDR)期DME患者(DME组)和同期37例无DME的NPDR患者(对照组)资料。DME组患者连续3次玻璃体内注射康柏西普,根据3次治疗后黄斑中心视网膜厚度(CRT)的降低程度分为有效组(>50μm)和疗效欠佳组(≤50μm)。OCTA测量患者治疗前及治疗后1个月、3个月的视网膜浅层毛细血管丛VD(SCP-VD)、DCP-VD、CRT、黄斑中心凹无血管区(FAZ)面积、FAZ旁300μm的血流密度(FD300)等参数,分析各参数的差异及相关性。结果DME组患者整体、中心凹和旁中心凹SCP-VD、DCP-VD均较对照组低,差异均有统计学意义(均为P<0.05);除CRT外,DME组患者治疗后1个月、3个月的OCTA参数与治疗前比较差异均无统计学意义(均为P>0.05);DME组患者治疗后1个月、3个月BCVA(logMAR)(0.38±0.28、0.37±0.29)均较治疗前(0.54±0.39)显著提高,治疗后1个月CRT(327.457±73.684)μm、治疗后3个月CRT(304.761±58.537)μm均较治疗前(380.065±82.685)μm显著降低(均为P<0.05);有效组患者中心凹DCP-VD(36.258%±13.187%)较疗效欠佳组(28.564%±8.855%)大(P=0.024),两组患者间其余OCTA参数(FAZ面积、FD300、整体SCP-VD、中心凹SCP-VD、旁中心凹SCP-VD、整体DCP-VD、旁中心凹DCP-VD、CRT)差异均无统计学意义(均为P>0.05);DME组患者治疗前中心凹DCP-VD与治疗后3个月CRT下降值呈正相关(P=0.040),患者治疗前整体DCP-VD和旁中心凹DCP-VD与治疗后3个月BCVA提高值均呈正相关(P=0.033、0.036),余参数间均无明显相关性(均为P>0.05)。结论DME患者DCP-VD与黄斑水肿的发展密切相关,DCP-VD可能可以作为预测DME患者抗VEGF治疗预后的指标。

Objective To investigate the correlation between the vessel density(VD)in retinal deep capillary plexus(DCP)and the prognosis of patients with diabetic macular edema(DME)treated with Conbercept.Methods This was a retrospective study.A total of 46 DME patients with non-proliferative diabetic retinopathy(NPDR)were selected into the DME group,and 37 NPDR patients without DME were selected into the control group.Patients in the DME group were subdivided into the effective group(>50μm)and ineffective group(≤50μm)according to the reduction of central retinal thickness(CRT)after three consecutive intravitreal injections of Conbercept.The vessel density in superficial capillary plexus(SCP-VD),vessel density in deep capillary plexus(DCP-VD),CRT,foveal avascular zone(FAZ),VD in a 300-μm-wide region around the FAZ(FD300)and other parameters were measured by optical coherence tomography angiography(OCTA)before,1 month and 3 months after treatment with Conbercept,and their correlations were analyzed.Results Compared with the control group,the global,foveal and parafoveal SCP-VD and DCP-VD in the DME group were significantly lower(all P<0.05).Except CRT,OCTA parameters in the DME group at 1 month and 3 months after treatment had no significant difference compared with those before treatment(all P>0.05).The BCVA(logMAR)in the DME group was 0.38±0.28 at 1 month after treatment and 0.37±0.29 at 3 months after treatment,significantly better than that before treatment(0.54±0.39)(both P<0.05).The CRT in the DME group was(327.457±73.684)μm at 1 month after treatment and(304.761±58.537)μm at 3 months after treatment,significantly lower than that before treatment(380.065±82.685)μm(both P<0.05).The foveal DCP-VD in the effective group(36.258±13.187)%was higher than that in the ineffective group(28.564±8.855)%(P=0.024),while other OCTA parameters(FAZ,FD300,global SCP-VD,foveal and parafoveal SCP-VD,global and parafoveal DCP-VD,CRT)had no significant difference between the two groups(all P>0.05).The preoperative foveal DCP-VD was positively correlated with the CRT decrease at 3 months after treatment(P=0.040).The global and parafoveal DCP-VD at baseline were positively correlated with the BCVA recovery at 3 months after treatment(P=0.033,0.036).There was no correlation between the rest parameters(all P>0.05).Conclusion DCP-VD is closely related to the development of macular edema in DME patients.It may be used as an indicator to predict the prognosis of anti-vascular endothelial growth factor therapy in DME patients.