OCTA评估糖尿病视网膜病变患者全视网膜激光光凝后黄斑区血流情况

目的:使用光学相干断层血流成像技术(OCTA)评估重度非增殖性糖尿病视网膜病变(S-NPDR)患者和健康受试者黄斑区血管网的区别以及S-NPDR患者全视网膜激光光凝(PRP)前后指标的变化。方法:前瞻性研究。共纳入18例31眼S-NPDR患者和健康受试者31眼。使用OCTA检测黄斑血流密度以及中心凹无血管区(FAZ)的面积和体积。结果:与正常对照组相比,S-NPDR患者的浅层视网膜毛细血管丛(SCP)中,除了中心凹血流密度外其余的黄斑区血流密度均下降。在深层视网膜毛细血管丛(DCP)中,S-NPDR患者的黄斑血流密度也有所下降。此外,S-NPDR患者FAZ面积和体积扩大。S-NPDR患者接受PRP 6mo后,中心凹SCP和DCP密度明显增加,而FAZ面积和体积缩小。接受PRP 3mo后,只有中心凹的DCP增加。S-NPDR患者接受PRP 1mo后,中心凹SCP和DCP密度以及FAZ面积和体积的变化比较无差异。结论:OCTA检测显示S-NPDR患者的黄斑毛细血管网受损。尽管OCTA的这些指标在S-NPDR患者接受PRP 1、3mo后没有明显变化,但是在6mo的随访后这些指标发生变化,在临床上具有参考意义。

Assessment of macular vascular network after panretinal photocoagulation in the patients with diabetic retinopathy by OCTA

AIM: To evaluate the differences of macular vascular network measured by optical coherence tomography angiography(OCTA)between severe non-proliferative diabetic retinopathy(S-NPDR)eyes and health eyes, and explore the changes of these OCTA characteristics in patients with S-NPDR before and after panretinal photocoagulation(PRP).

METHODS: This was a prospective study including 31 eyes from 18 consecutive patients with S-NPDR and 31 eyes of healthy subjects. We measured macular vascular density and foveal avascular zone(FAZ)area and volume by an OCTA device.

RESULTS: Compared to the normal control group, in superficial retinal capillary plexus(SCP), macular vascular density decreased in S-NPDR group, except foveal vascular density unchanged. Consistently, in deep retinal capillary plexus(DCP), macular vascular density was also lower in S-NPDR group. In addition, FAZ area and volume expanded in S-NPDR eyes. At 6mo post-PRP in S-NPDR eyes, foveal SCP and DCP densities increased significantly, while FAZ area and volume decreased. At 3mo post-PRP, only foveal vascular density in DCP increased. The changes of foveal SCP and DCP densities as well as FAZ area and volume were not statically significant at 1mo post-PRP.

CONCLUSION: Macular vascular network was impaired in S-NPDR assessed by OCTA. Although OCTA parameters were not significantly affected by PRP in 1 and 3mo period, at 6mo follow-up parameters became significant after PRP.