华西医学

华西医学

光相干断层扫描血管成像观察近视性脉络膜新生血管病变的研究

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目的 利用光相干断层扫描血管成像(optical coherence tomography angiography,OCTA)观察近视性脉络膜新生血管(myopic choroidal neovascularization,mCNV)及接受抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗的变化。 方法 前瞻性纳入 2017 年 5 月—12 月就诊于四川大学华西医院眼科的 mCNV 患者 31 例(34 只眼),所有患者玻璃体腔注射抗 VEGF 治疗前、抗 VEGF 治疗后 1 d、1 周、1 个月及每月随访时均行 OCTA 检查,共随访 3~6 个月,观察抗 VEGF 治疗前后脉络膜新生血管(choroidal neovascularization,CNV)病灶形态、CNV 病灶大小、中心凹旁浅层视网膜血管密度及血流灌注的变化。 结果 mCNV 患者 CNV 病灶中小圆形的团块状病灶、小分支血管和毛细血管抗 VEGF 治疗应答反应较好;术前基线病灶面积为(0.082±0.013) mm2,术后 1 d及 1 周的病灶面积分别为(0.064±0.013)、(0.046±0.011) mm2,CNV 病灶在抗 VEGF 治疗后 1 d 即可缩小,在抗 VEGF 治疗后 1 周明显降低(P<0.05);术前基线中心凹旁浅层视网膜血管密度及血流灌注分别为(15.2±0.5)% 及(32.6±1.5)%,抗 VEGF 治疗后 1 d,即可观察到中心凹旁浅层视网膜血管密度[(12.1±0.9)%]及血流灌注[(27.4±2.0)%]降低(P<0.05),1 个月时有所回升。 结论 OCTA 能够无创、清晰地显示 mCNV 患者 CNV 病灶的细微结构变化及进行定量分析 CNV 病灶面积的变化;OCTA 还能够对视网膜血管进行分层显示,定量分析视网膜微循环的变化,在 mCNV 患者的病情监测及指导治疗方面有重要的临床应用价值。

Objective To analyze the characteristics of myopic choroidal neovascularization (mCNV) and the outcome of intravitreal anti-vascular endothelial growth factor (VEGF) treatment by using optical coherence tomography angiography (OCTA). Methods A prospective study was carried out, which included 34 eyes of 31 patients with mCNV in West China Hospital of Sichuan University between May and December 2017. OCTA scans were conducted to all patients before treatment, 1 day, 1 week, 1 month and 3–6 months after treatment. The analysis was performed to evaluate the morphological characteristics, lesion area, parafoveal superficial vessel density and perfusion area of choroidal neovascularization before and after treatment. Results Among mCNV patients, small round crumby lesions, small branches, and capillaries responded well to anti-VEGF treatment. Compared with the mean lesion area in mCNV patients before treatment [(0.082±0.013) mm2], there was instant reduction 1 day after treatment [(0.064±0.013) mm2] and obviously decreased after 1 week [(0.046±0.011) mm2]. The parafoveal superficial vessel density and perfusion area before treatment were (15.2±0.5)% and (32.6±1.5)%, respectively, and obvious decrease was observed both in parafoveal superficial vessel density [(12.1±0.9)%] and perfusion area [(27.4±2.0)%] 1 day after treatment in mCNV patients, which began to recover 1 month after treatment. Conclusions OCTA is a non-invasive diagnostic examination, which can clearly identify tiny structures of mCNV, quantify the lesion area and display specific vasculature in mCNV patients. Furthermore, retinal microcirculation can be detected by using OCTA, which provides an effective approach of monitoring the progression and treatment effect of mCNV.

关键词: 光相干断层扫描血管成像; 近视性脉络膜新生血管; 血管内皮生长因子

Key words: Optical coherence tomography angiography; Myopic choroidal neovascularization; Vascular endothelial growth factor

引用本文: 闵晓雪, 周思睿, 牟佳, 刘依琳, 张明. 光相干断层扫描血管成像观察近视性脉络膜新生血管病变的研究. 华西医学, 2018, 33(11): 1382-1387. doi: 10.7507/1002-0179.201806022 复制

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