Zhang Yu, Weng Huan, Li Qingjian, Wang Zhiliang
Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China.
Clin Exp Optom. 2018 Sep;101(5):674-679. doi: 10.1111/cxo.12660. Epub 2018 Jan 22.
Reports of choroidal and retinal changes before and after haemodialysis are few and have been controversial. Traditional imaging modalities are insufficient for quantitative assessment. This study aims to use optical coherence tomography angiography to monitor the short-term vascular density and thickness changes in retina and choroid before and after haemodialysis.
Seventy-seven eyes of 77 patients with end-stage kidney disease undergoing haemodialysis were included. Ophthalmologic examinations including optical coherence tomography angiography were performed one hour before and after haemodialysis. The vascular density of retina and choroid were measured and calculated by optical coherence tomography angiography. The retinal thickness and subfoveal choroidal thickness were measured manually using Image J software. The relationships between the changes in ocular and systemic parameters after haemodialysis were evaluated.
The systolic blood pressure decreased from 123.7 ± 19.7 to 116.9 ± 24.6 mmHg (p < 0.05) in all patients. The mean ocular perfusion pressure decreased significantly after haemodialysis in both diabetic and non-diabetic groups (p < 0.05). Mean retinal thickness decreased from 204.7 ± 22.4 μm to 200.8 ± 22.8 μm (p < 0.05) after haemodialysis in all patients. The vascular density of outer retina was decreased from 38.8 ± 5.5 per cent to 37.5 ± 3.4 per cent (p < 0.05) after haemodialysis in all patients. The changes in diastolic blood pressure, intraocular pressure, subfoveal choroidal thickness, vascular density of the superficial capillary plexus, deep capillary plexus and choriocapillaris were insignificant. There was no significant correlation between systolic blood pressure and the vascular density of the outer retina.
In optical coherence tomography angiography, the retinal thickness became thinner and the vascular density in the outer retina decreased after haemodialysis in patients with end-stage kidney disease. The change of subfoveal choroidal thickness showed no significance after haemodialysis. The decreased volume in the retinal vascular bed and deficient choroidal autoregulatory control of ocular blood flow might be involved in the mechanism of these changes.
关于血液透析前后脉络膜和视网膜变化的报道较少，且存在争议。传统成像方式不足以进行定量评估。本研究旨在使用光学相干断层扫描血管造影术监测血液透析前后视网膜和脉络膜的短期血管密度及厚度变化。
纳入77例接受血液透析的终末期肾病患者的77只眼。在血液透析前后1小时进行眼科检查，包括光学相干断层扫描血管造影术。通过光学相干断层扫描血管造影术测量并计算视网膜和脉络膜的血管密度。使用Image J软件手动测量视网膜厚度和黄斑下脉络膜厚度。评估血液透析后眼部和全身参数变化之间的关系。
所有患者的收缩压从123.7±19.7 mmHg降至116.9±24.6 mmHg（p<0.05）。糖尿病组和非糖尿病组血液透析后平均眼灌注压均显著降低（p<0.05）。所有患者血液透析后平均视网膜厚度从204.7±22.4μm降至200.8±22.8μm（p<0.05）。所有患者血液透析后外层视网膜血管密度从38.8±5.5%降至37.5±3.4%（p<0.05）。舒张压、眼压、黄斑下脉络膜厚度、浅表毛细血管丛、深层毛细血管丛和脉络膜毛细血管的血管密度变化不显著。收缩压与外层视网膜血管密度之间无显著相关性。
在光学相干断层扫描血管造影术中，终末期肾病患者血液透析后视网膜厚度变薄，外层视网膜血管密度降低。血液透析后黄斑下脉络膜厚度变化不显著。视网膜血管床容积减少和脉络膜对眼血流的自身调节控制不足可能参与了这些变化的机制。
