OCTA观察高度近视眼ICL植入术后视网膜血流密度的变化

目的：利用光学相干断层扫描血管成像技术（OCTA）观察高度近视眼行有晶状体眼后房型人工晶状 体（ICL）植入术对黄斑区视网膜血流密度、视网膜厚度的影响。方法：前瞻性临床研究。选取2019年 12月至2020年5月于南京医科大学附属眼科医院行ICL植入术的高度近视患者25例（43眼），术眼 等效球镜度（SE）>-6.00 D。观察患者术前，术后1周、1个月、3个月的视力、眼压、拱高及黄斑区 视网膜血流密度、视网膜厚度的变化。数据采用方差分析进行统计分析。结果：患者手术前后各时 间点裸眼视力和最佳矫正视力总体差异均有统计学意义（F=500.975，P<0.001；F=16.032，P<0.001）， 术后各时间点指标均较术前明显提高（均P<0.001）。术后各时间点黄斑中心凹无血管区（FAZ）面积 均较术前减少（均P<0.001），术后黄斑中心凹视网膜厚度（CRT）无明显改变。患者手术前后黄斑中 心凹、黄斑旁中心凹、颞侧、上方、鼻侧及下方各区域浅层视网膜血流密度差异均无统计学意义。 与术前相比，术后1周、1个月、3个月黄斑中心凹、颞侧、上方及下方各区域深层视网膜血流密度差 异均无统计学意义，而术后黄斑旁中心凹、鼻侧深层视网膜血流密度较术前均有所降低（均P<0.05）。 结论：OCTA观察显示高度近视眼行ICL植入术对鼻侧深层视网膜血流密度有影响，同时FAZ面积降 低，但对其余视网膜血流密度及视网膜厚度无影响。

Evaluation of the Correlation between Vessel Density and Visual Field Loss in High Myopic Patients with Primary Open-Angle Glaucoma Using OCTA

Objective: To evaluate the vessel density and optic disc morphological characteristics in high myopic (HM) patients with primary open-angle glaucoma (POAG), and to investigate the association between vessel density and visual field loss. Methods: This was a cross-sectional study. A total of 24 HM patients (44 eyes) with POAG and 37 HM patients (50 eyes) without POAG (control group) were enrolled in this study. The glaucoma patients were additionally classified into a mild POAG group (13 patients, 20 eyes) and moderate and severe POAG group (15 patients, 24 eyes) according to the visual field mean deviation (MD). All patients underwent imaging using optical coherence tomography angiography (OCTA) to measure vessel density and structural parameters of the optic disc and macula, fudus photography to calculate the optic disc ovality index, and standard automated perimetry. The differences in vessel density, structural parameters and visual field variables between the groups were compared by one-way analysis and the correlation between MD and the optic disc ovality index was performed by Pearson correlation or Spearman correlation analysis. Results: Compared with the control group, the HM patients with POAG showed reduced peripapillary capillary density, deep foveal vessel density and superficial parafoveal vessel density (F=86.340, 18.620, 42.757, all P<0.001), which aggravated the progression of glaucoma. There was no significant difference in the optic disc ovality index between the mild POAG group and control group (P=0.077), while the moderate and severe POAG group showed a decreased optic disc ovality compared to the control group and mild POAG group, and the difference was significant (P<0.001, P=0.028 respectively). The parameter with the highest correlation coefficient to visual field MD was average retinal nerve fiber layer (RNFL) thickness (r=0.782, P<0.001), followed by average ganglion cell complex (GCC) thickness (r=0.621, P<0.001), superficial parafoveal vessel density (r=0.621, P<0.001), peripapillary capillary density (r=0.599, P<0.001) and deep parafoveal vessel density (r=0.420, P=0.002). The disc ovality index was positively associated with the peripapillary capillary density (r=0.318, P=0.002), disc area (r=0.405, P<0.001), average RNFL thickness (r=0.476, P<0.001) and average GCC thickness (r=0.375, P<0.001). Conclusions: In contrast to average RNFL thickness and GCC thickness, decreased vessel density in HM patients with POAG is associated less with visual field loss. The disc ovality index is correlated with a decrease in vessel density and structural damage. The OCTA can be used for early diagnosis of HM with POAG.