超广域SS-OCTA联合超广角激光扫描眼底成像对糖尿病视网膜病变的诊断价值

Diagnostic value of ultra-wide field swept-source optical coherence tomography angiography combined with ultra-wide field scanning laser ophthalmoscopy in diabetic retinopathy

目的 超广域扫频源光学相干断层扫描血管成像(UWF SS-OCTA)联合超广角激光扫描眼底成像(UWF SLO)对糖尿病视网膜病变(DR)患者病变的检出率以及对DR分级诊断价值的研究。方法 横断面研究。招募在四川省人民医院眼科就诊的糖尿病患者。所有参与者都接受了UWF SS-OCTA、UWF SLO和荧光素眼底血管造影(FFA)检查,用于检测DR病变,包括微动脉瘤(MA)、视网膜内出血(IRH)、视网膜无灌注区(NPAs)、视网膜内微血管异常(IRMAs)、视网膜静脉串珠(VB)、视网膜新生血管(NVE)、视盘新生血管(NVD)及玻璃体积血(VH)。联合三类影像检查(以下简称三联影像)结果作为标准对照,对比不同影像两两联合对DR病变的检出率及对DR严重度分级的一致性。结果 共纳入101例175眼。与三联影像结果相比,UWF SS-OCTA联合UWF SLO对MA、IRH、NPAs、IRMAs、NVE、NVD及VH的检出率分别为91%、83%、77%、69%、27%、10%及12%,Kappa依次为0.812、1.000、1.000、1.000、0.986、0.970及1.000。与三联影像结果相比,UWF SS-OCTA联合UWF SLO对DR的严重度分级具有优异一致性(Kappa=0.943)。结论 UWF SS-OCTA联合UWF SLO能准确识别MA、IRH、NPAs、IRMAs、NVE、NVD及VH,对DR筛查及分级诊断准确性高,适用于临床上对DR的大规模筛查与管理。

Objective To investigate the detection rate and grading diagnostic value of ultra-wide field swept-source optical coherence tomography angiography(UWF SS-OCTA)combined with ultra-wide field scanning laser ophthalmoscopy(UWF SLO)in diabetic retinopathy(DR)lesions.Methods In this cross-sectional study,diabetic patients attending the Ophthalmology Department of Sichuan Provincial People's Hospital were recruited.All participants underwent UWF SS-OCTA,UWF SLO and fundus fluorescein angiography to detect DR lesions,including microaneurysms(MA),intraretinal hemorrhages(IRH),nonperfusion areas(NPAs),intraretinal microvascular abnormalities(IRMAs),venous beading(VB),neovascularization elsewhere(NVE),neovascularization of the optic disc(NVD),and vitreous hemorrhage(VH).The results of the combination of three imaging examinations(triple imaging)were used as the standards,evaluating the detection rate and severity grading consistency in DR lesions of pairwise combinations of different imaging modalities.Results A total of 101 patients(175 eyes)were included.Compared with the triple imaging results,the detection rates of UWF SS-OCTA combined with UWF SLO for MA,IRH,NPAs,IRMAs,NVE,NVD and VH were 91%,83%,77%,69%,27%,10%and 12%,respectively,with Kappa values of 0.812,1.000,1.000,1.000,0.986,0.970 and 1.000.Compared with the triple imaging results,the combination of UWF SS-OCTA and UWF SLO demonstrated excellent consistency in grading the severity of DR(Kappa=0.943).Conclusion UWF SS-OCTA combined with UWF SLO can accurately identify MA,IRH,NPAs,IRMAs,NVE,NVD and VH,demonstrating high accuracy in DR screening and grading diagnosis,making it suitable for large-scale screening and management of DR in clinical practice.