不同眼底影像检查方法对PDR患眼视盘及其他部位视网膜新生血管的检出率和检测时间成本比较

Comparison of detection rates and time costs of different fundus imaging techniques for retinal neovascularization in optic disc and other area of proliferative diabetic retinopathy

目的比较不同眼底成像方式对增生性糖尿病视网膜病变(PDR)患眼视网膜及视盘新生血管的检出率和检测时间。方法采用横断面研究方法,纳入2019年10月至2021年2月于河南省立眼科医院确诊的PDR患者38例48眼,其中男22例28眼,女16例20眼;平均(51.08±13.35)岁。所有患者均行超广角眼底成像(UWFI)、荧光素眼底血管造影(FFA)、光学相干断层扫描血管成像(OCTA)、en face OCT、近红外眼底成像(IR)联合频域OCT(SD-OCT),因相关原因无法行FFA的患者接受超广角扫频源OCTA(WF-SS-OCTA)检查。记录单眼每项检查所需的时间、各种检查方法对视盘新生血管(NVD)及视网膜其他部位新生血管(NVE)的检出率。结果 UWFI的单眼检查时间平均为(0.51±0.13)min,NVE检出率为52.1%(25/48),NVD检出率为12.5%(6/48);IR联合SD-OCT的单眼平均检查时间为(2.08±0.57)min,NVE检出率为81.3%(39/48),NVD检出率为20.8%(10/48);OCTA和en face OCT的单眼平均检查时间为(5.79±0.68)min,NVD检出率为83.3%(40/48),NVE检出率为27.1%(13/48);FFA平均检查时间为(17.66±1.83)min,WF-SS-OCT为(13.38±1.23)min,FFA联合WF-SS-OCT的NVE检出率为93.8%(45/48),NVD检出率为29.2%(14/48)。5种不同影像模式单眼检查花费时间总体比较,差异有统计学意义(F=2 077.960,P<0.001)。各不同影像模式间NVE检出率比较差异有统计学意义(χ2=26.460,P<0.001),NVD检出率差异无统计学意义(χ2=4.645,P=0.200)。OCTA在3例患眼中检出新生血管芽5处,而该新生血管芽未在FFA检测出。结论 UWFI和IR联合SD-OCT筛查PDR患眼NVD及NVE用时短且无创。OCTA和en face OCT较FFA可清晰显示新生血管形态。FFA检查范围较大,但用时较长且有创。WF-SS-OCTA检查扩大了OCTA的扫描范围、无创且检查时间较FFA短。

Objective To compare the detection rate and time cost of different imaging methods for retinal and optic disc neovascularization in proliferative diabetic retinopathy(PDR).Methods A cross-sectional study was conducted.Thirty-eight patients(48 eyes)with PDR were enrolled in Henan Eye Hospital from October 2019 to February 2021,including 22 males(28 eyes)and 16 females(20 eyes).The average age of the patients was(51.08±13.35)years.All patients underwent ultra-widefield imaging(UWFI),fundus fluorescein angiography(FFA),optical coherence tomography angiography(OCTA),en face optical coherence tomography(OCT),near-infrared fundus imaging(IR)combined with spectral domain OCT(SD-OCT).Wide field swept-source OCTA(WF-SS-OCTA)was performed in the patients who were unsuitable for FFA.The time required for each examination in one eye and the detection rate of neovascularization at the optic disc(NVD)and retinal neovascularization elsewhere(NVE)were recorded.This study adhered to the Declaration of Helsinki.The study protocol was approved by Henan Eye Hospital(No.HNEECKY-2021[22]).All patients were informed about the method and purpose of the study and voluntarily signed the informed consent form.Results The mean monocular examination time costs of UWFI,IR+SD-OCT,OCTA+en face OCT,FFA and WF-SS-OCT was(0.51±0.13),(2.08±0.57),(5.79±0.68),(17.66±1.83)and(13.38±1.23)min,respectively.There was a significant overall difference in the mean monocular examination time among the five methods(F=2077.960,P<0.001).The detection rates of UWFI,IR+SD-OCT,OCTA+en face OCT,FFA+WF-SS-OCT for NVE and NVD were 52.1%(25/48)and 12.5%(6/48),81.3%(39/48)and 20.8%(10/48),83.3%(40/48)and 27.1%(13/48),93.8%(45/48)and 29.2%(14/48),respectively.There were significant differences in the detection rates of NVE(χ2=26.460,P<0.001)but not in the detection rates of NVD(χ2=4.645,P=0.200)among the various methods.Five neovascular buds were detected by OCTA in 3 eyes,but not by FFA.Conclusions UWFI and IR+SD-OCT are faster and non-invasive methods for the screening of NVD and NVE in PDR eyes.Compared with FFA,OCTA and en face OCT can show the shape of neovascularization more clearly.FFA provides a wide-range retinal image,but it is time-consuming and invasive.WF-SS-OCTA extends the examination range of OCTA and detects neovascularization non-invasively and faster than FFA.