超高度近视眼行有晶状体眼人工晶体植入术前后视网膜和脉络膜厚度及血流参数变化

Changes of retinal choroidal thickness and retinal blood flow density before and after ICL-V4c implantation in ultra-high myopic eyes

目的通过光学相干断层扫描血管成像技术(OCTA)观察超高度近视眼行中央有孔型有晶状体眼后房型人工晶体前植入术(ICL-V4c)前后视网膜和脉络膜厚度、黄斑区及视盘旁视网膜血流密度的变化。方法选取2020年4月-2021年5月于首都医科大学附属北京同仁医院就诊且双眼等效球镜度(SE)≥±10.0 D的患者15例(30眼),所有眼均行ICL-V4c治疗。观察并比较患者术前及术后2 h、1周、1个月、9个月时视力、眼压的变化,并采用OCTA监测黄斑区视网膜和脉络膜厚度、黄斑区及视盘旁视网膜血流密度的变化。结果患者术后各时间点裸眼视力与术前最佳矫正视力比较差异无统计学意义(P>0.05);术后眼压呈下降趋势,但与术前比较差异无统计学意义(P>0.05);术后9个月拱高较术后1周降低,差异有统计学意义(P=0.002)。手术前后各时间点深层视网膜血流密度、黄斑区视网膜厚度、黄斑区脉络膜厚度、视盘旁放射状毛细血管网血流密度、神经纤维层厚度差异均无统计学意义(P>0.05),而术后2 h时,上下鼻颞4个方向的浅层视网膜血流密度均较术前明显下降,差异有统计学意义(P<0.05)。术后其余时间点各区域血流密度与术前比较差异均无统计学意义(P>0.05)。结论超高度近视眼行ICL-V4c植入术早期对浅层视网膜血流密度有影响,随时间延长可恢复至术前水平,对于黄斑部视网膜脉络膜厚度及深层视网膜血流密度、视盘旁毛细血管网血流密度和神经纤维层厚度无影响。

Objective To investigate the changes of posterior chamber intraocular lens(ICL-V4c)implantation on retinal and choroid thickness,retinal blood flow density in the macular area,and optic disc in ultra-high myopia using optical coherence tomography angiography(OCTA).Methods From April 2020 to May 2021,15 patients(30 eyes)with binocular equivalent spherical lens(SE)≥–10.00 D in Beijing Tongren Hospital Affiliated to Capital Medical University were enrolled.All eyes had undergone the ICL-V4c treatment.We observed the visual acuity and intraocular pressure at the following time points:before the operation,2-hour,1-week,1-month,and 9-month post-operation.OCTA was used to monitor the changes in retinal and choroid thickness in the macular area as well as retinal blood flow density around the macular area and optic disc.Results There was no statistically significant difference between uncorrected viusal acuity postoperative and best corrected viusal acuity preoperative at each time point after surgery(P>0.05).The postoperative intraocular pressure showed a downward trend,but the difference was not statistically significant.The vault at 9-month post-surgery was significantly lower than that at 1-week post-surgery,the difference was statistically significant(P=0.002).There were no statistically significant differences in deep retinal blood flow density,retinal thickness or choroid thickness in the macular area,blood flow density in the radial capillary network around the optic disc,and nerve fiber layer thickness at each postoperative time point(P>0.05).The superficial retinal blood flow density in the four directions of upper,lower,nasal,and temporal decreased significantly 2-hour after surgery,with statistical significance(P<0.05).With the extension of time,the blood flow density in each area increased significantly,and there was no statistical difference compared with that before surgery(P>0.05).Conclusion OCTA observation showed that ICL-V4c implantation had an effect on the superficial retinal blood flow density in the early stage of ultra-high myopia but would restored to the preoperative level during the time,and had no effect on the retinal choroid thickness in the remnant macular area,the blood flow density of the capillary network around the optic disc and the thickness of the nerve fiber layer.