阿柏西普治疗视网膜静脉阻塞继发黄斑水肿的视网膜微血管改变及视力预后分析  

Changes of retinal microvasculature and visual acuity prognostic of aflibercept treatment in macular edema secondary to retinal vein occlusion

作　　者：吴冠男 张笑天 何广辉[1,2,3] 董蒙 高翔[2,3] 王梦 陈松 Wu Guannan;Zhang Xiaotian;He Guanghui;Dong Meng;Gao Xiang;Wang Meng;Chen Song(Clinical College of Ophthalmology of Tianjin Medical University,Tianjin 300020,China;Tianjin Eye Hospital,Tianjin Key Lab of Ophthalmology and Visual Science,Tianjin Eye Institute,Tianjin 300020,China;Nankai University Affiliated Eye Hospital,Tianjin 300020,China)

机构地区：[1]天津医科大学眼科临床学院,300020 [2]天津市眼科医院,天津市眼科学与视觉科学重点实验室,天津市眼科研究所,300020 [3]南开大学附属眼科医院,天津300020

出　　处：《中华眼底病杂志》2021年第4期290-297,共8页Chinese Journal of Ocular Fundus Diseases

基　　金：天津市眼科医院科技基金(YKZD1901)。

摘　　要：目的观察视网膜静脉阻塞(RVO)伴黄斑水肿(ME)患者玻璃体腔注射阿柏西普(IVA)治疗后黄斑区微血管变化,初步分析其与最佳矫正视力(BCVA)的相关性。方法回顾性临床研究。2019年4月至2020年2月于天津市眼科医院临床检查确诊的单眼RVO伴ME(RVO-ME)患者30例30只眼纳入研究。其中,男性12例12只眼,女性18例18只眼;平均年龄(54.30±13.17)岁;平均病程(3.43±1.97)个月。双眼均行BCVA、光相干断层扫描血管成像(OCTA)检查。IVA治疗方案采用首次注射后按需注射。采用OCTA仪对双眼黄斑区6 mm×6 mm范围进行扫描,测量基线时及治疗后1、3、6个月黄斑中心凹无血管区(FAZ)面积、FAZ周长(PERIM)、非圆度指数(AI)、FAZ范围300μm宽度内的血流密度(FD-300)、黄斑中心凹视网膜厚度(CMT)以及视网膜浅层毛细血管丛(SCP)、视网膜深层毛细血管丛(DCP)血流密度。基线时患眼与对侧健康眼各定量参数比较采用配对t检验;基线时及治疗后1、3、6个月各定量参数变化采用重复测量方差分析。IVA治疗后6个月BCVA与视网膜灌注、黄斑区血液供应参数的相关性分析采用Pearson相关分析。结果基线时,与对侧健康眼比较,RVO-ME患眼FAZ面积(t=-4.091)、PERIM(t=-5.098)、AI(t=-9.093)扩大,FD-300(t=7.237)及整体SCP、DCP血流密度(t=8.735、9.897)降低,差异均有统计学意义(P<0.001)。治疗后6个月,RVO-ME患眼BCVA明显提高,CMT降低,FAZ面积扩大,AI降低(t=8.566、16.739、-6.469、9.719,P<0.001),差异均有统计学意义;FD-300及整体SCP、DCP血流密度均无明显变化,差异无统计学意义(t=1.017、1.197、0.987,P>0.05)。与基线时比较,治疗后3、6个月RVO-ME患眼FAZ面积逐渐扩大,差异有统计学意义(F=21.979,P<0.001)。相关性分析结果显示,治疗后6个月BCVA与基线时、治疗后6个月整体SCP、DCP血流密度呈正相关(r=-0.538、-0.484、-0.879、-0.854,P<0.05),与治疗后6个月FAZ面积呈负相关(r=0.544,P=0.001)。ME�Objective To observe the changes of macular microvessels in patients with retinal vein occlusion(RVO)and macular edema(ME)after intravitreal injection of aflibercept(IVA),and analyze its correlation with best corrected visual acuity(BCVA).Methods A retrospective case study.Thirty patients(30 eyes)with monocular RVO with ME(RVO-ME)who were diagnosed in the clinical examination of Tianjin Eye Hospital from April 2019 to February 2020 were included in the study.Among them,there were 12 males(12 eyes)and 18 females(18 eyes);the average age was 54.30±13.17 years.The average course of disease was3.43±1.97 months.Both eyes were examined by BCVA and optical coherence tomography(OCTA).The on-demand injection was adopted after the first injection in IVA treatment regimen.The macular area 6 mm×6 mm in both eyes was scanned with an OCTA instrument,and the area of the foveal avascular area(FAZ),FAZ circumference(PERIM),and out-of-roundness were measured at baseline and 1,3,and 6 months after treatment.Index(AI),blood flow density within 300μm width of FAZ(FD-300),foveal retinal thickness(CMT),superficial retinal capillary plexus(SCP),deep retinal capillary plexus(DCP)blood flow density.The paired t test was used to compare the quantitative parameters of the affected eye and the contralateral healthy eye at baseline;the changes of the quantitative parameters at baseline and 1,3,and 6 months after treatment were analyzed by repeated measures analysis of variance.Pearson correlation analysis was used to analyze the correlation between BCVA,retinal perfusion,and macular blood supply parameters at 6 months after IVA treatment.Results At baseline,compared with the contralateral healthy eye,the FAZ area(t=-4.091),PERIM(t=-5.098)and AI(t=-9.093)of the RVO-ME eye were enlarged,and FD-300(t=7.237)and overall SCP and DCP blood flow density(t=8.735,9.897)decreased,the difference was statistically significant(P<0.001).Six months after treatment,the BCVA of RVO-ME eyes was significantly increased,CMT decreased,FAZ area expanded,and AI

关 键 词：视网膜静脉闭塞 黄斑水肿 血管生成抑制剂 局部血流 

分 类 号：R774.1[医药卫生—眼科]