光学相干断层扫描血管成像技术评估孔源性视网膜脱离患者行玻璃体切割联合气体或硅油填充术后的黄斑区血流变化  

Macular blood flow changes assessed by optical coherence tomography angiography after pars plana vitrectomy with gas or silicone oil tamponade for the patients with rhegmatogenous retinal detachment

作　　者：陈钰虹 项潇琼 朱鸿[1,2] 孙涛 李宪辰[3] 王泓 CHEN Yu-hong;XIANG Xiao-qiong;ZHU Hong;SUN Tao;LI Xian-Chen;WANG Hong(Department of Ophthalmology,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China;Shanghai Engineering Center for Visual Science and Photomedicine,Department of Ophthalmology,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China;Scientific Research Department,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China)

机构地区：[1]上海交通大学附属第一人民医院眼科,上海200080 [2]上海交通大学附属第一人民医院眼科,上海眼视觉与光医学工程技术研究中心,上海200080 [3]上海交通大学附属第一人民医院科研处,上海200080

出　　处：《上海交通大学学报（医学版）》2019年第6期605-612,605,共8页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家重点研发计划(2016YFC0904800);上海市卫生和计划生育委员会项目(0503N15005);上海市转化医学协同创新中心资助(TM201817)~~

摘　　要：目的·探讨经玻璃体切割术后不同的玻璃体填充物对孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)患者黄斑区血流的影响,以及黄斑区血流与最佳矫正视力的相关性。方法·回顾性分析2017年12月—2018年6月于上海交通大学附属第一人民医院眼科行玻璃体切割术的单眼初发RRD患者74例。根据玻璃体切割术后填充物的不同,将患者分为气体填充组(气体组)和硅油填充组(硅油组)。利用光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)技术行黄斑区3mm×3mm区域扫描。记录黄斑区中心凹及旁中心凹处浅层视网膜毛细血管丛(superficial capillary plexus,SCP)血流密度、深层视网膜毛细血管丛(deep capillary plexus,DCP)血流密度,黄斑区中心凹无血管区(foveal avascular zone,FAZ)面积、周长。分析2组患者黄斑区血流参数与最佳矫正视力的相关性。结果·与硅油组相比,气体组患者术后6个月的总3mm×3mm区域SCP血流密度及DCP血流密度均较高(均P=0.000)。偏相关分析显示,患者的最佳矫正视力变化与FAZ面积的变化呈负相关性(r=-0.216,P=0.015)。结论·RRD患者行玻璃体切割术联合气体填充术后对其黄斑区血流的恢复更为有利。使用OCTA技术评估视网膜脱离患者玻璃体切割术后患眼的黄斑区血流密度变化,对于监测视网膜结构和功能的变化有重要意义。Objective·To investigate the effect of different vitreous fillers on the macular blood flow of patients with rhegmatogenous retinal detachment (RRD),and the correlation between the macular blood flow and the best corrected visual acuity (BCVA).Methods·In this retrospective study,74 eyes in 74 patients with RRD for first time underwent pars plana vitrectomy in Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine from Dec.2017 to Jun.2018 were included.According to different vitreous fillers,the patients were divided into two group,i.e.pars plana vitrectomy with gas tamponade group (gas group) and pars plana vitrectomy with silicone oil tamponade group (silicone oil group).The blood flow in 3 mm×3 mm macular area was detected by optical coherence tomography angiography (OCTA).The blood flow densities of superficial capillary plexus (SCP) and deep capillary plexus (DCP) at foveal and parafoveal area,and the areas and perimeters of foveal avascular zone (FAZ) were calculated.The correlations between the macular blood flow parameters and BCVA were analyzed by partial correlation.Results·Compared with the silicone oil group,the blood flow densities of SCP and DCP in the whole 3 mm×3 mm regions in the gas group were higher at 6 months after surgery (both P=0.000).The partial correlation showed that the improvement of visual acuity was negatively correlated with the change of FAZ area (r=-0.216,P=0.015).Conclusion·Gas is an advantageous tamponade for the patients with RRD in improvement of blood flow density in the macular area.Meanwhile,assessing the macular blood flow density of the patients with retinal detachment by using OCTA after vitrectomy is significant to monitor the changes of structure and function of retina.

关 键 词：孔源性视网膜脱离 硅油 光学相干断层扫描血管成像 黄斑区毛细血管丛血流密度 

分 类 号：R774.12[医药卫生—眼科]