Ⅲ级高血压性视网膜病变黄斑区OCT及血管成像特征  

Morphological Characteristics of Macular Optical Coherence Tomography and Angiography in GradeⅢHypertensive Retinopathy

作　　者：刘银和[1] 蒋自培[1] 董海曙[1] 徐思思[1] 尹世平 林竹[1] 潘建 Yinhe Liu;Zipei Jiang;Haishu Dong;Sisi Xu;Shiping Yin;Zhu Lin;Jian Pan(Department of Ophthalmology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou Zhejiang 325000,China)

机构地区：[1]温州医科大学附属第一医院眼科,325000

出　　处：《中华眼视光学与视觉科学杂志》2021年第10期736-744,共9页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：温州市科技局基础性医疗卫生科技项目(Y20190631)。

摘　　要：目的: 通过光学相干断层扫描(OCT)及血管成像(OCTA)观察Ⅲ级高血压性视网膜病变(HRP)患者黄斑区图像特征。方法: 系列病例研究。分析2018年5月至2020年5月在温州医科大学附属第一医院眼科确诊的79例(129眼)Ⅲ级(KWB分级)HRP患者, 对所有患者进行双眼眼底照相、OCT及OCTA检查, 分析其黄斑区OCT及OCTA图像特征, 二者检查异常比较采用χ^(2)检验分析。结果: 79例Ⅲ级HRP患者中, 29例为单眼Ⅲ级HRP改变(对侧眼均为Ⅱ级HRP改变), 50例为双眼Ⅲ级HRP改变。在总计129眼的Ⅲ级HRP中, OCT检查发现异常病变48眼(37%), OCTA检查发现异常病变93眼(72%), OCTA发现异常病变的敏感性要高于OCT(χ^(2)=28.04, P<0.001)。OCT黄斑区异常图像特征主要表现为视网膜神经上皮层外丛状层反射不平整, 局部变薄抬高(35眼, 27%), 神经上皮层间散在强反射光点(30眼, 23%), 神经上皮层内局部强反射团块(18眼, 14%), 神经上皮层内层厚度变薄(18眼, 14%), 神经上皮层局部浆液性隆起(11眼, 9%), 神经上皮层弥漫水肿增厚(6眼, 5%)。OCTA黄斑区异常图像特征主要有浅、深层视网膜拱环局部破坏和扩大(66眼, 51%), 散在毛细血管稀疏灶(43眼, 33%), 散在毛细血管瘤样扩张(27眼, 21%), 深层视网膜散在条片状强反射灶(12眼, 9%), 毛细血管无灌注区(9眼, 7%), 且深层视网膜病变重于浅层视网膜。结论: OCT联合OCTA能够早期及时评估HRP患者视网膜黄斑区结构及血流成像特征, OCTA检查对视网膜微血管异常的表现更直观和敏感, 这些发现有助于更好地理解HRP病理生理机制及指导有效的随访和治疗策略。Objective:To observe the image characteristics of the macular area in patients with gradeⅢhypertensive retinopathy(HRP)using optical coherence tomography(OCT)and angiography(OCTA).Methods:This was a case series study.Seventy-nine patients(129 eyes)with gradeⅢ(KWB)HRP were examined and analyzed by fundus photography,OCT and OCTA from May 2018 to May 2020 in the First Affiliated Hospital of Wenzhou Medical University.Morphological characteristics of macular OCT and OCTA were analyzed.The abnormality rate of OCT and OCTA was analyzed byχ^(2) text.Results:Twenty-nine patients had gradeⅢHRP changes in one eye(all the contralateral eyes had gradeⅡHRP changes),and 50 patients had gradeⅢHRP changes in both eyes among the 79 patients with gradeⅢHRP.Abnormal lesions were found in 48 eyes(37%)by OCT and in 93 eyes(72%)by OCTA among the 129 eyes with gradeⅢHRP.The sensitivity of abnormal lesions was higher with OCTA than with OCT(χ^(2)=28.04,P<0.001).The abnormal image features of OCT in the macula were as follows:The reflection from the outer plexiform layer of the retina was uneven,local thinning and elevation(35 eyes,27%),scattered strong reflective light spots between the neuroepithelial layers(30 eyes,23%),local strong reflection masses within the neuroepithelial layer(18 eyes,14%),thinning of the inner layer of the neuroepithelial layer(18 eyes,14%),local serous uplift in the neuroepithelial layer(11 eyes,9%),diffuse edema and thickening in the neuroepithelial layer(6 eyes,5%).The main abnormal image features of the macula in OCTA were local destruction and enlargement of the arch ring(66 eyes,51%),sparsely scattered capillary foci(43 eyes,33%),scattered microangioma(27 eyes,21%),and focal capillary nonperfusion(9 eyes,7%)at the levels of the superficial and deep vascular networks.Scattered strips of strong reflexive foci(12 eyes,9%)were at the level of the deep vascular networks.The lesions at the levels of the deep vascular networks were more serious than those at the level of the superficial vascular

关 键 词：高血压性视网膜病变 光学相干断层扫描 血管成像 成像特征 

分 类 号：R544.1[医药卫生—心血管疾病] R774.1[医药卫生—内科学]