光学相干断层扫描血管成像评估弱视儿童视盘和黄斑参数变化的临床意义

Clinical significance of optical coherence tomography angiography in evaluating the changes of optic disc and macular parameters in children with amblyopia

目的 探讨光学相干断层扫描血管成像(OCTA)评估弱视儿童视盘和黄斑参数变化的临床意义。方法 选取2020年2月-2022年2月在丽水市人民医院门诊就诊的屈光参差性弱视患儿108例为研究对象,将弱视眼归为弱视眼组(108眼),对侧非弱视眼归为非弱视眼组(108眼),另选取同期在该院检查的50例正常视力儿童左眼(50眼)为对照组,采用眼部常规检查统计最佳矫正视力(BCVA)、眼轴长度及等效球镜度,并采用OCTA对黄斑区(3 mm×3 mm)、视盘(4.5 mm×4.5 mm)进行扫描,将获取图像传输至Image软件进行分析计算3组视网膜微血流参数[包括浅层视网膜毛细血管丛血流密度(SCP)、深层视网膜毛细血管丛血流密度(DCP)、视盘和视盘旁血流密度、黄斑中心凹无灌注区(FAZ)面积及黄斑中心凹厚度(CMT)],且经屈光矫正、健眼遮盖及弱视眼视功能训练治疗后,统计3个月BCVA、立体式差及视网膜微血流参数,行Pearson分析BCVA和立体式差与视网膜微血流参数间的相关性。结果 对照组、非弱视眼组及弱视眼组BCVA[(1.01±0.15)vs.(0.96±0.20)vs.(0.49±0.24)]、眼轴长度[(23.69±0.92)mm vs.(22.08±1.11)mm vs.(21.85±1.03)mm]及等效球镜度[(0.36±0.15)D vs.(1.69±0.64)D vs.(3.62±1.37)D]比较,差异均有统计学意义(F=173.422、56.699及222.055,均P<0.05);相比于对照组,弱视眼组BCVA、眼轴长度更低,等效球镜度更高,非弱视眼组眼轴长度更低,等效球镜度更高,差异均有统计学意义(均P<0.05);相比于非弱视眼组,弱视眼组BCVA更低,等效球镜度更高,差异均有统计学意义(均P<0.05),但眼轴长度比较,差异无统计学意义(P>0.05)。3组视盘旁血流密度、FAZ面积及CMT比较,差异均无统计学意义(均P>0.05)。对照组、非弱视眼组及弱视眼组SCP[(30.05±2.93)%vs.(29.19±4.26)%vs.(24.88±5.72)%]、DCP[(30.39±2.38)%vs.(30.18±2.47)%vs.(27.65±4.09)%]及视盘血流密度[(52.38±3.37)%vs.(52.01±3.80)%vs.(48.85±4.14)%]比较,差异均有统计学意义(F=30.755、20.979及23.176,均P<0.05);相比于对照组,弱视眼组SCP、DCP及视盘血流密度更低,非弱视眼组视盘血流密度更低,差异均有统计学意义(均P<0.05);相比于非弱视眼组,弱视眼组SCP、DCP及视盘血流密度更低,差异均有统计学意义(均P<0.05)。相比于治疗前,弱视眼组治疗3个月后BCVA更低[(0.75±0.20)vs.(0.49±0.24)],立体式差更高[(1 416.08±489.54)vs.(2 385.56±746.32)],差异均有统计学意义(t=8.322、10.862,均P<0.05)。弱视眼组治疗3个月后视盘旁血流密度[(52.31±2.27)%vs.(52.18±2.33)%]、FAZ面积[(0.38±0.06)mm^(2)vs.(0.37±0.07)mm^(2)]及CMT[(261.43±15.24)μm vs.(262.35±17.02)μm]与治疗前比较,差异均无统计学意义(t=0.400、1.085及0.403,均P>0.05)。治疗后,SCP[(27.32±4.25)%vs.(24.88±5.72)%]、DCP[(29.48±2.86)%vs.(27.65±4.09)%]及视盘血流密度[(53.71±3.45)%vs.(48.85±4.14)%]均高于治疗前,差异均有统计学意义(t=3.424、3.667及9.018,均P<0.05)。经Pearson分析,BCVA与SCP、DCP及视盘血流密度呈中高度呈正相关关系(r=0.531、0.526及0.541,均P<0.05),立体式差与SCP、DCP及视盘血流密度呈中高度负相关关系(r=-0.571、-0.513及-0.565,均P<0.05)。结论 屈光参差性弱视患儿弱视眼微血流状态存在异常,且观察微血流状态变化可一定程度反映临床治疗效果。

Objective To investigate the clinical significance of optical coherence tomography angiography(OCTA) in evaluating the changes of optic disc and macular parameters in children with amblyopia.Methods From February 2020 to February 2022, 108 children with anisometropic amblyopia who visited the outpatient department of our hospital from February 2020 to February 2022 were selected as the research objects. In the eye group(108 eyes), the left eyes(50 eyes) of 50 children with normal vision were selected as the control group during the same period. OCTA scans the macular area(3 mm×3 mm) and optic disc(4.5 mm×4.5 mm), and transfers the acquired images to Image software for analysis and calculation of three groups of retinal micro-blood flow parameters [including the superficial retinal capillary plexus blood flow density(SCP), deep retinal capillary plexus blood flow density(DCP), optic disc and paraoptic disc blood flow density, foveal nonperfusion zone(FAZ) area and foveal thickness(CMT)], and after refractive correction, healthy After occlusion and amblyopic visual function training, BCVA, stereoscopic differences, and retinal micro-blood flow parameters were counted for 3 months, and the correlation between BCVA, stereoscopic differences and retinal micro-blood flow parameters was analyzed by Pearson.Results After F analysis, there were statistically significant differences in BCVA, axial length and spherical equivalent power between the control group, the non-amblyopic eye group and the amblyopic eye group [(1.01±0.15) vs.(0.96±0.20) vs.(0.49±0.24),(23.69±0.92) mm vs.(22.08±1.11) mm vs.(21.85±1.03) mm,(0.36±0.15) D vs.(1.69±0.64) D vs.(3.62 ±1.37) D](F=173.422,56.699,222.055,all P<0.05);compared with the control group, the BCVA and axial length of the amblyopic eye group were lower, and the equivalent spherical power was higher;The spherical power was higher(P<0.05);compared with the non-amblyopia group, the BCVA of the amblyopic group was lower, and the spherical equivalent power was higher(P<0.05), but there was no significant difference in the axial length(P>0.05);by F analysis, in addition to the paraoptic blood flow density, FAZ area and CMT, there were statistically significant differences in SCP, DCP and optic disc blood flow density between the control group, the non-amblyopic eye group and the amblyopic eye group [(30.05±2.93) % vs.(29.19±4.26) % vs.(24.88±5.72) %,(30.39±2.38) % vs.(30.18±2.47) % vs.(27.65±4.09) %,(52.38±3.37) % vs.(52.01±3.80) % D vs.(48.85±4.14) %](F=30.755,20.979,23.176,all P<0.05);compared with the control group, SCP, DCP and optic disc in the amblyopic group The blood flow density was lower, and the blood flow density of the optic disc was lower in the non-amblyopic eye group(P<0.05). Compared with before treatment, the BCVA of the amblyopic eye group was lower after 3 months of treatment, and the stereoscopic difference was higher, and the difference was statistically significant [(0.75±0.20) vs.(0.49±0.24),(1 416.08±489.54) vs.(2 385.56±746.32)](t=8.322,10.862,P<0.05);compared with before treatment, there was no significant difference in paraoptic blood flow density, FAZ area and CMT in the amblyopic eye group after 3 months of treatment [(52.31±2.27) % vs.(52.18±2.33) %,(0.38±0.06) mm^(2) vs.(0.37±0.07) mm^(2),(261.43±15.24) μm vs.(262.35±17.02) μm](t=0.400,1.085,0.403,all P>0.05), SCP, DCP and optic disc blood flow density all increased, and the difference was statistically significant [(27.32±4.25) % vs.(24.88±5.72) %,(29.48±2.86) % vs.(27.65±4.09) %,(53.71±3.45) % vs.(48.85±4.14) %](t=3.424,3.667,9.018,all P<0.05);Pearson analysis showed that BCVA was positively correlated with SCP, DCP and optic disc blood flow density(r=0.531, 0.526, 0.541,all P< 0.05), and the stereoscopic difference was moderately and highly negatively correlated with SCP, DCP and optic disc blood flow density(r=-0.571,-0.513,-0.565,all P<0.05).Conclusion The micro-blood flow state of the amblyopic eyes in children with anisometropic amblyopia is abnormal, and the observation of the micro-blood flow state changes can reflect the clinical treatment effect to a certain extent.