摘要
目的观察视网膜分支静脉阻塞继发黄斑水肿(BRVO-ME)患眼玻璃体腔注射康柏西普治疗后黄斑微血管结构改变,分析其与视功能及黄斑中心凹视网膜厚度(CRT)的关系。方法前瞻性临床研究。2018年7月至2019年6月于北京协和医院眼科检查确诊的单颞侧BRVO-ME患者21例21只眼纳入研究。其中,男性14例14只眼,女性7例7只眼;平均年龄(58.0±8.3)岁。视网膜静脉颞上、颞下分支阻塞分别为13、8只眼。将静脉阻塞侧定义为受累区。所有患眼均行玻璃体腔注射康柏西普治疗,每一个月1次,连续3个月,其后按需治疗。治疗前后患眼均行最佳矫正视力(BCVA)、光相干断层扫描血管成像(OCTA)检查。BCVA检查采用国际标准对数视力表进行,统计时换算为最小分辨角对数(logMAR)视力。采用OCTA仪对患眼黄斑区3 mm×3 mm范围进行扫描,测量其视网膜浅层毛细血管丛(SCP)、深层毛细血管丛(DCP)整体、中心凹、受累区血管密度,黄斑中心凹无血管区(FAZ)面积、周长(PERIM)、非圆度指数(AI),FAZ范围300 μm宽度内的血管密度(FD-300)以及CRT。治疗后随访时间6个月。治疗前后黄斑区血管密度、FAZ参数比较行配对t检验;治疗后6个月BCVA、CRT与血管密度、FAZ面积及其与各参数之间的相关性采用线性回归分析。结果治疗前,患眼logMAR BCVA为0.506±0.159,CRT为(375.4±81.3)μm;治疗后6个月,患眼logMAR BCVA为0.294±0.097,CRT为(266.3±46.7)μm。患眼治疗前后logMAR BCVA、CRT比较,差异均有统计学意义(t=8.503、9.843,P<0.05)。与治疗前比较,治疗后6个月患眼SCP、DCP整体血管密度差异无统计学意义(t=-0.091、-0.320,P>0.05);中心凹血管密度下降,差异有统计学意义(t=8.801、3.936,P<0.05);DCP受累区血管密度显著增加,差异有统计学意义(t=-2.198,P<0.05)。与治疗前比较,患眼FAZ面积、PERIM有增加趋势,AI、FD-300有降低趋势,差异均有统计学意义(t=-18.071、-12.835、2.555、8.610,P<0.05)。线性回归分析结果显示,治疗后6个月BCVA与FAZ面积显著相关(t=2.532,P=0.024)。结论 BRVO-ME患眼玻璃体腔注射康柏西普治疗后CRT降低,BCVA提高;SCP中心凹血管密度下降,DCP受累区血管密度增加,FAZ面积逐渐扩大,PERIM和AI逐渐降低。患眼治疗后BCVA与FAZ面积显著相关。
Objective To observe the changes of macular microvascular structure in eyes with macular edema secondary to branch retinal vein occlusion(BRVO-ME)after intravitreal injection of conbercept and analyze its relationship with visual function and central retinal thickness(CRT).Methods A prospective clinical study.From July 2018 to June 2019,21 eyes of 21 patients with unilateral temporal BRVO-ME diagnosed in the Department of Ophthalmology of Peking Union Medical College Hospital were included in the study.Among them,there were 14 eyes of 14 males and 7 eyes of 7 females;the average age was 58.0±8.3 years.There were 13 eyes and 8 eyes with occlusion of the superior temporal and inferior temporal branches of the retinal vein,respectively.The affected area was defined as the side of the venous obstruction.All the affected eyes underwent best-corrected visual acuity(BCVA)and optical coherence tomography angiography(OCTA)examination.The BCVA was tested using the international standard logarithmic visual acuity chart,which was converted into the logarithmic minimum angle of resolution(logMAR)visual acuity during statistical analysis.All the eyes were treated with intravitreal injection of conbercept once a month for 3 months,and then treated as needed.A 3 mm × 3 mm scan centered on fovea was obtained and the vascular density of superficial capillary plexus(SCP)and deep capillary plexus(DCP),fovea avascular zone(FAZ)area,perimeter of FAZ(PERIM),acircularity index(AI),foveal vascular density in a 300 jim wide region around FAZ(FD-300)and central retinal thickness(CRT)were measured.The follow-up time after treatment was 6 months.The vascular density and FAZ parameters were compared before and after treatment by paired t test.The correlations of BCVA,CRT and vascular density,FAZ area and the other parameters at 6 months after treatment were analyzed by linear regression analysis.Results Before treatment,the logMAR BCVA of the eyes was 0.506±0.159,and the CRT was 375.4±81.3 μm;6 months after treatment,the logMAR BCVA of the eyes was 0.294±0.097,and the CRT was 266.3±46.7 μm.There was a statistically significant difference of logMAR BCVA and CRT between the eyes before and after treatment(t=8.503,9.843;P<0.05).There was no statistically significant difference in the overall vascular density of SCP and DCP before and 6 months after treatment(t=-0.091,-0.320;P>0.05).The foveal vascular density decreased,and the difference was statistically significant(t=8.801,3.936;P<0.05).The vascular density of DCP of the affected area increased,and the difference was statistically significant(r=-2.198,P<0.05).Compared with those before treatment,the FAZ area and PERIM of the affected eyes had an increasing trend,while AI and FD-300 had a decreasing trend,and the differences were statistically significant(t=-18.071,-12.835,2.555,8.610;P<0.05).The linear regression analysis showed that BCVA and FAZ area 6 months after treatment have significant correlation(t=2.532,P=0.024).Conclusion CRT decreased and BCVA increased after intravitreal injection of conbercept in BRVO-ME eyes.After treatment,the foveal vascular density of SCP and DCP decreased while the vascular density of DCP of the affected area increased.The FAZ increased and the PERIM and AI decreased during follow-up.The BCVA was significantly correlated with the FAZ area 6 months after treatment.
作者
杨治坤
于伟泓
陈有信
Yang Zhikun;Yu Weihong;Chen Youxin(Department of Ophthalmology,State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Key Laboratory of Ocular Fundus Diseases,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2021年第9期675-680,共6页
Chinese Journal of Ocular Fundus Diseases
基金
白求恩•朗沐中青年眼科科研基金(BJ-LM2016005L)。
作者简介
通信作者:陈有信,Email:chenyouxinpumch@163.com。
