无明确高血压视网膜病变患者黄斑区血流密度观察

目的观察无明确高血压视网膜病变(HRP)患者黄斑区血流密度变化。方法2019年1~4月于武汉大学人民医院心内科检查确诊的2级或3级原发性高血压病患者23例(高血压组)纳入研究。其中,男性13例,女性10例;平均年龄(61.6±5.6)岁,平均BCVA 0.74±0.16。高血压病程>7年;Keith-Wagener(K-W)分级0级或1级。选取同期无高血压病史的正常人15名作为正常对照组。其中,男性8名,女性7名;平均年龄(59.7±4.4)岁,平均BCVA 0.79±0.17.K-W分级0级。两组患者年龄(t=1.739)、性别构成比(χ2=0.036)、BCVA(t=0.585)比较,差异均无统计学意义(P=0.265、1.000、0.563)。受检者均行BCVA、彩色眼底照相、OCT血管成像(OCTA)检查。采用OCTA仪对黄斑区3 mm×3 mm范围进行扫描。软件自动将其划分为以黄斑中心凹为中心的2个同心圆,分别是直径为1 mm的内环(中心凹区),1~3 mm的外环。测量黄斑区3 mm范围内总体及颞侧、上方、鼻侧、下方浅层毛细血管层血流密度以及黄斑中心凹无血管区(FAZ)面积、中心凹视网膜厚度(CFT)。结果高血压组、正常对照组受检眼之间黄斑区总体血流密度以及颞侧、鼻侧、下方血流密度比较,差异有统计学意义(t=2.188、2.472、5.105、2.734,P=0.037、0.020、0.000、0.010);上方、黄斑中心凹区血流密度比较,差异无统计学意义(t=0.575、0.140,P=0.570、0.889)。两组受检眼FAZ面积、CFT比较,差异无统计学意义(t=0.367、0.753,P=0.714、0.457)。高血压组患者黄斑拱环结构均完整。结论无明确HRP患者黄斑区总体及颞侧、鼻侧、下方血流密度降低;FAZ面积无扩大;黄斑拱环结构正常。

The macular vascular density in hypertensive patients without obvious hypertensive retinopathy

Objective To observe the changes of macular vascular density of hypertensive patients without obvious hypertensive retinopathy(HRP).Methods Twenty-three patients(hypertension group)diagnosed as grade 2 or grade 3 essential hypertension in Cardiology Department of Renmin Hospital of Wuhan University from January to April 2019 were enrolled in the study.Among them,there were 13 males and 10 females.The mean age was 61.6±5.6 years,and the mean BCVA was 0.74±0.16.The course of hypertension was more than 7 years;Keith Wagener(K-W)grade was 0 or 1.Fifteen age-matched people without hypertension were selected as the control group,among which included 8 males and 7 females.Their average age was 59.7±4.4 years and the average BCVA was 0.79±0.17,the K-W grades were 0.There was no significant difference(P=0.265,1.000,0.563)between the two groups in age(t=1.739),sex ratio(χ2=0.036)or BCVA(t=0.585).All subjects were examined by BCVA,fundus photography and OCTA.OCTA scanned the macular area in the range of 3 mm×3 mm.The software automatically divided the image into two concentric circles with the macular fovea as the center,which are the inner ring with a diameter of 1 mm(foveal area)and the outer ring with a diameter of 1-3 mm.The blood flow density of the whole,temporal,upper,nasal and lower capillary layers within 3 mm of the macular area,and foveal avascular zone(FAZ)area,central foveal retinal thickness(CFT)were measured.Results Significant differences were observed in the vascular densities of total,temporal,nasal and inferior area of maculas(t=2.188,2.472,5.105,2.734;P=0.037,0.020,0.000,0.010)between the two groups,while no significant differences were evidenced in foveal vascular densities and superior vascular densities(t=0.575,0.140;P=0.570,0.889).There was no significant difference in FAZ area or CFT between the two groups(t=0.367,0.753;P=0.714,0.457).Macular arches were intact in all hypertension patients.Conclusions The vascular densities of total,temporal,nasal and inferior area of maculas in the hypertension patients without HRP decreased.The area of FAZ did not expand,and the structures of macular arch ring were normal.