| 引用本文： |
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陈开传,盛敏杰,李敏,等.OCTA评估抗VEGF治疗老年性黄斑变性患者视网膜血流密度变化[J].同济大学学报（医学版）,2021,42(3):333-342. [点击复制]
- CHEN Kai-chuan,SHENG Min-jie,LI Min,et al.Evaluation of retinal blood flow density with OCTA in patients with age-related macular degeneration undergoing anti-VEGF therapy[J].同济大学学报（医学版）,2021,42(3):333-342. [点击复制]
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| 摘要: |
| 目的采用OCTA方法观察“3+PRN”方案治疗老年性黄斑变性(aged-related macular degeneration, AMD)疗效。方法选取2018年6月～2021年1月间同济大学附属杨浦医院眼科确诊的湿性AMD患者50例（共50只患眼），按照“3+PRN”方案给予玻璃体腔注射雷珠单抗(0.5 mg/0.05 mL)。所有患者分别在治疗前和治疗后的第1、3个月采用国际标准视力表检查、OCTRadial Lines平扫模式和OCTA HD Angio Retina 6.0 mm血流成像模式对黄斑区视网膜进行扫描，比较患者治疗前后最佳矫正视力，黄斑中心凹0.5 mm和1 mm范围视网膜的形态，视网膜毛细血管密度，以及黄斑中心凹无血管区面积间的差异。结果与治疗前相比，患者在治疗后1个月最佳矫正视力显著提高（P<0.05），治疗后3个月无显著改变（P>0.05）；治疗后1个月和3个月的视网膜厚度均明显降低（P<0.001）。通过OCTA检查发现，与治疗前相比，治疗后第1个月视网膜浅层和深层血管密度均有增加（P<0.05），治疗后第3个月均无明显差异（P>0.05）；其中，深层血管丛的所有位点在治疗后1个月均显著改善（P<0.05），术后3个月仍有3个位点保持着血流改善状态；浅层血管丛在术后1个月仅有鼻侧和下方位点的血流密度显著提高（P<0.05），其余的均无明显改善，术后3个月仅下方位点血管密度保持着恢复状态；
面积仅在术后1个月明显减少（P<0.05）；相关性分析发现，治疗前与治疗后1个月视网膜血管密度与最佳矫正视力呈显著正相关（P<0.05）；治疗前与治疗后1个月黄斑中心凹鼻侧0.5 mm和1 mm处视网膜厚度差与深层血管密度差呈显著正相关（P<0.05）；治疗前与治疗后1个月各方位的视网膜厚度差与FAZ面积差呈显著负相关（P<0.05）。结论“3+PRN”方案治疗老年性黄斑变性短期疗效较好，但3个月后需进行严格的主动随访策略以保证患者的预后；OCTA可对湿性AMD患者的疗效进行量化评估，除视网膜厚度指标的评估外，视网膜血流密度和FAZ指标也应在随访中予以重视。 |
| 关键词: 老年性黄斑变性 抗VEGF 视网膜血流密度 OCTA |
| DOI：10.12289/j.issn.1008-0392.20448 |
| 投稿时间：2020-10-22 |
| 基金项目:上海市自然科学基金项目（19ZR1450500）；国家自然科学基金项目（818008859） |
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| Evaluation of retinal blood flow density with OCTA in patients with age-related macular degeneration undergoing anti-VEGF therapy |
| CHEN Kai-chuan,SHENG Min-jie,LI Min,LI Jing,LI Bing |
| (Dept. of Ophthalmology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai 200090, China;Dept. of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China) |
| Abstract: |
| ObjectiveTo evaluate the retinal blood flow density with optical coherence tomography angiography(OCTA) in patients with wet age-related macular degeneration(wAMD) undergoing anti-VEGF therapy. MethodsFifty patients(50 affected eyes) with wAMD admitted in our hospital from June 2018 to January 2021 were enrolled in the study. Patients were treated with intravitreal anti-VEGF ranibizumab(0.5 mg/0.05 mL) with the “3+PRN” regimen. The macular retina was scanned by OCT Radial Lines mode and OCTA HD Angio Retina 6.0 mm flow imaging mode before treatment and at 1 and 3 months after treatment. The best corrected visual acuity, retinal morphology in the foveal 0.5 mm and 1 mm ranges, retinal capillary density, and difference of foveal avascular zone were compared before and after treatment. ResultsCompared with that before treatment, the best corrected visuala acuity was significantly improved at 1 month after treatment(P<0.05), there was no significant change at 3 months after treatment(P>0.05).
The retinal thickness was significantly reduced at 1 and 3 months after treatment(P<0.001). The density of superficial and deep retinal vessels were both increased(P<0.05) at the 1st month after treatment; however, there was no significant difference at 3 months after treatment(P>0.05) by OCTA treatment. All the sites of the deep retinal capillary plexus were significantly improved at 1 month after treatment(P<0.05), and significant improvement was maintained in three sites at 3 months after treatment. The vascular density of the superficial retinal capillary plexus was significantly increased only at the nasal and inferior sites at 1 month after treatment(P<0.05), the others had no significant improvement, and only the vascular density at the inferior site maintained a state of recovery at 3 months after treatment. The FAZ area decreased significantly only at the 1st month after treatment(P<0.05). The macular retinal vascular density was positively correlated with the best corrected visual acuity difference before and 1 month after treatment(P<0.05). There was a significant positive correlation between retinal thickness difference of 0.5 mm and 1 mm nasal macular fovea and deep retinal capillary plexus difference before and 1 month after treatment(P<0.05). There was a significant negative correlation between retinal thickness difference with the FAZ area at all sites before and 1 month after treatment(P<0.05). ConclusionThe anti-VEGF therapy has a good short-term efficacy in the treatment of patients with age-related macular degeneration, but a strict active follow-up strategy is required after 3 months; OCTA can quantitatively evaluate the efficacy of wAMD patients under the therapy. |
| Key words: age-related macular degeneration anti-vascular endothelial growth factor retinal blood flow density optical coherence tomography angiography |
