鞍区占位视交叉压迫患者黄斑区与视盘周围视网膜结构厚度、血管密度的OCTA定量分析

Optical coherence tomography angiography for quantitative analysis of retinal structure thickness and vessel density alterations in patients with chiasmal compression due to sellar region mass

目的探讨基于光学相干断层扫描血管成像(OCTA)的鞍区占位视交叉压迫患者黄斑区和视盘周围视网膜结构厚度和血管密度的定量变化及其临床意义。方法回顾性病例对照研究。纳入2020年12月—2022年4月安徽医科大学第一附属医院眼科鞍区占位视交叉压迫患者42例为观察组,其中男21例、女21例,年龄21~75(49.7±11.4)岁;观察组中,发生视野缺损者纳入视野缺损组24例24眼(将视野缺损更大的一侧眼纳入观察),未发生视野缺损者纳入视野正常组18例18眼。在安徽医科大学第一附属医院眼科机器数据库中挑选同期性别、年龄与观察组相匹配的健康者42例为健康对照组,将其右眼纳入分析。对所有研究对象进行视力、视野和OCTA检查,并采用OCTA对黄斑区视网膜神经节细胞复合体(mGCC)和视盘周围视网膜神经纤维层(pRNFL)的厚度,以及视网膜浅层毛细血管丛(SRCP)和视盘周围放射状毛细血管(RPC)的血管密度进行定量评估。采用协方差分析和多重比较方法将视野缺损组、视野正常组和健康对照组的视网膜结构厚度和血管密度进行比较。采用Spearman相关分析评估鞍区占位患者视网膜血管密度与视网膜结构厚度和视功能损伤程度之间的相关性。采用多因素线性回归方法分析鞍区占位患者视网膜血管密度的影响因素。采用ROC曲线评估视网膜结构厚度和血管密度对鞍区占位视交叉压迫病变的诊断效能。结果与健康对照组相比,视野缺损组患者的mGCC和pRNFL厚度、RPC和SRCP血管密度均减低,差异均有统计学意义(P值均<0.05)。观察组患者的视网膜血管密度(RPC和SRCP)与视网膜结构厚度(mGCC和pRNFL)呈正相关(P值均<0.05),与视野缺损程度呈负相关(P值均<0.05)。观察组患者不同的视网膜结构厚度对血管密度的影响差异均有统计学意义(P值均<0.05)。pRNFL厚度、mGCC厚度、RPC血管密度、SRCP血管密度诊断鞍区占位视交叉压迫病变的AUC值分别为0.767、0.756、0.707、0.702。结论鞍区占位视交叉压迫患者的黄斑区和视盘周围视网膜结构厚度和视网膜血管密度明显降低,且与患者视野缺损程度呈负相关;OCTA检测可定量评估视网膜微血管密度及结构厚度,在鞍区占位视交叉压迫病变的诊断和病情评估中具有一定的价值。

Objective To analyze changes in retinal structure thickness and vessel density in macular and peripapillary areas in patients with chiasmal compression due to sellar region mass using optical coherence tomography angiography(OCTA),as well as their clinical implications.Methods This is a retrospective case-control study,42 patients with chiasmal compression due to sellar region mass were enrolled at the Department of Ophthalmology of the First Affiliated Hospital of Anhui Medical University from December 2020 to April 2022 as the observation group.Among the patients,21 were male,and 21 were female.Their ages were in the range of 21-75(49.7±11.4)years.In the observation group,24 eyes from 24 patients who had visual field defects were included in the visual field defect group(the eye with the greater visual field defect was selected),and 18 right eyes from 18 patients who did not have visual field defects were included in the normal visual field group.In addition,42 healthy subjects whose gender and age matched those of the patients in the observation group were selected from the machine database of the Department of Ophthalmology of the First Affiliated Hospital of Anhui Medical University,and the right eyes were included in the analysis.Visual acuity,visual field,and OCTA were examined.The thicknesses of the macular retinal ganglion cell complex(mGCC)and peripapillary retinal nerve fiber layer(pRNFL)and the vessel densities of the superficial retinal capillary plexus(SRCP)and radial peripapillary capillary(RPC)were assessed using OCTA.Retinal structure thickness and retinal vessel density were compared among patients with visual field defects,patients with normal visual fields,and healthy controls using covariance analysis and multiple comparisons.Spearman's correlation analysis was used to investigate the relationship among retinal vessel density,retinal structural thickness,and visual function in patients with sellar region mass.Multiple linear regression was used to investigate the factors influencing retinal vessel density in patients with sellar region mass.Receiver operating characteristic(ROC)curves were used to assess the diagnostic efficacies of retinal structure thickness and vessel density for chiasmal compression due to sellar region mass.Results Compared with healthy controls,the patients with chiasmal compression due to sellar region mass who had visual field defects showed significantly reduced mGCC thickness,pRNFL thickness,RPC vessel density,and SRCP vessel density(all P values<0.05).In the observation group,a positive correlation between vessel density and retinal structure thickness was observed(all P values<0.05),and a negative correlation between vessel density and the degree of visual field defects was found(all P values<0.05).The effect of different retinal structure thickness on retinal vessel density was statistically different in the observation group(all P values<0.05).The areas under the ROC curves of pRNFL thickness,mGCC thickness,RPC vessel density,and SRCP vessel density for the diagnosis of chiasmal compression due to sellar region mass were 0.767,0.756,0.707,and 0.702,respectively.Conclusions Retinal structure thickness and retinal vessel density in macular and peripapillary areas are significantly reduced in patients with chiasmal compression due to sellar region mass and negatively correlated with the degree of visual field defects.OCTA allows the quantitative assessment of retinal vessel density and structural thickness and can be valuable in the diagnosis and assessment of disease progression in optic chiasmal compression lesions.