关注OCT血管成像在新生血管性AMD长期治疗和随访中的临床指导作用  

Critical guiding role of OCT angiography in long-term treatment and follow-up of neovascular AMD

作　　者：薄其玉 孙晓东[1] Bo Qiyu;Sun Xiaodong(National Clinical Research Center for Ophthalmic Diseases,Department of Ophthalmology,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国家眼部疾病临床医学研究中心,上海200080

出　　处：《中华实验眼科杂志》2022年第7期604-608,共5页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金面上项目(82171076);上海申康医院发展中心重大临床研究项目(SHDC2020CR2040B、SHDC2020CR5014)。

摘　　要：新生血管性年龄相关性黄斑变性(nAMD)发病机制复杂,黄斑新生血管(MNV)是其关键致病因素,目前抗VEGF药物玻璃体腔注射是nAMD的主要治疗方法。近年来随着眼底影像技术不断发展,具有无创、快速、分层、高清功能的光相干断层扫描血流成像(OCTA)技术在nAMD的诊断、鉴别诊断、疾病动态监测及治疗随访方面呈现出强大的优势,临床医生对OCTA在nAMD等疾病诊断中的重要作用有了一定的认识,OCTA临床应用价值也在不断被认知,但目前对其在nAMD和息肉样脉络膜血管病变(PCV)患者治疗随访中的应用价值尚认识不足。我们通过对近年来OCTA研究大量相关文献的回顾,并结合本研究团队近年来采用OCTA对nAMD和PCV病程监测和治疗效果随访的临床实践,对相关疾病的病理机制产生了新的认识和理解。本文阐述了基于长期OCTA系列研究获得的对AMD诊疗价值的最新认知、AMD应用OCTA影像检查时的新发现及其对眼科临床实践的影响,展望了OCTA影像检查对nAMD复发和对抗VEGF治疗反应的预测作用,以及OCTA影像在nAMD治疗和随访方案制定和优化中的临床价值,希望临床医生关注并重视OCTA在AMD长期治疗监测和随访中的临床价值和指导作用。The pathogenesis of neovascular age-related macular degeneration(nAMD)is complex and macular neovascularization(MNV),a key pathogenic factor in nAMD,is prone to recurrence.Vitreous injection of anti-VEGF drugs is the main therapy of nAMD.In recent years,a lot of progress has been made in fundus imaging techniques and optical coherence tomography angiography(OCTA)with non-invasive,rapid,stratified and high-definition functions has shown strong advantages in diagnosis,differential diagnosis,disease dynamic monitoring and follow-up of nAMD.Clinicians have had a certain understanding of the important role of OCTA in the diagnosis of nAMD and other diseases,and its clinical application value has been recognized gradually.However,its application value in follow-up of patients with nAMD and polypoid choroidal vasculopathy(PCV)is still not well understood.By reviewing a large number of recent relevant literature on OCTA,and combining the clinical practice of our research team in monitoring the course of AMD and PCV disease by OCTA,we have gained new knowledge and understanding of the pathological mechanism of AMD and PCV.In this paper,we elucidated the latest understanding of the diagnostic value of OCTA in AMD based on long-term series of OCTA studies,the new findings of OCTA in AMD management of our team,as well as its impact on ophthalmology clinical practice.Then we forecasted the role of OCTA in the prediction of recurrence and anti-VEGF treatment response,as well as the clinical value of OCTA in the optimization of nAMD treatment and follow-up plan.It is recommended that clinicians pay more attention to the clinical value and guiding role of OCTA in long-term treatment monitoring and follow-up of AMD.

关 键 词：光相干断层扫描 老年 黄斑变性/诊断 脉络膜新生血管/诊断 渗出 监测预测价值 血管内皮生长因子/抑制剂 光相干断层扫描血管成像 

分 类 号：R774.5[医药卫生—眼科]