Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea; Yeungnam Eye Center, Yeungnam University Hospital, Daegu, South Korea.
Optos PLC, Dunfermline, United Kingdom.
Am J Ophthalmol. 2021 May;225:57-68. doi: 10.1016/j.ajo.2020.12.026. Epub 2021 Jan 4.
To investigate the correlation between macular microvascular alterations on optical coherence tomography angiography (OCTA) and retinal ischemia on ultra-widefield fluorescein angiography (UWF FA) in eyes with branch retinal vein occlusion (BRVO).
Cross-sectional study.
This prospective study was performed from September 2019 to June 2020 at Yeungnam University Medical Center. We included 60 patients with treatment-naïve BRVO. Two independent, masked graders analyzed OCTA parameters, including vessel density, skeletal density, and fractal dimension (FD), and UWF FA parameters, including retinal nonperfusion area (NPA) and ischemic index (ISI), from various concentric regions (perimacular region, 0.5-3 mm radius; near-peripheral region, 3-10 mm; midperipheral region, 10-15 mm; far-peripheral region, >15 mm). A repeated-measures analysis of variance test and a paired t test were performed for inter-visit and inter-regional comparisons, and Pearson correlation coefficient and multivariate regression analyses were performed to examine the correlation between UWF FA and OCTA parameters.
The OCTA parameters from both the superficial and deep capillary plexuses (DCP) were significantly correlated with NPA and ISI in all concentric regions. Even after adjusting for several covariates, all OCTA parameters revealed a significant association with ISI on UWF FA. Moreover, OCTA parameters from DCP were significantly correlated with concentrations of placental growth factor and vascular endothelial growth factor. Although all OCTA parameters achieved excellent results of area under the curve (AUC) > 0.9 for detecting severe retinal ischemia, defined as ISI >10%, FD reduction in DCP was the most reliable parameter (AUC = 0.948, P < .001), and 5.39% was the best cut-off point for predicting ISI > 10%.
OCTA is a useful noninvasive tool not only for evaluation of macular microvasculature but for supposition of peripheral nonperfusion in eyes with BRVO.
探讨光学相干断层扫描血管造影（OCTA）黄斑微血管改变与分支静脉阻塞（BRVO）患者超广角荧光素血管造影（UWF FA）视网膜缺血之间的相关性。
横断面研究。
本前瞻性研究于 2019 年 9 月至 2020 年 6 月在延世大学医疗中心进行。我们纳入了 60 例未经治疗的 BRVO 患者。两名独立的、盲法评估者分析 OCTA 参数，包括血管密度、骨架密度和分形维数（FD），以及 UWF FA 参数，包括视网膜无灌注区（NPA）和缺血指数（ISI），来自不同的同心区域（黄斑区，0.5-3mm 半径；近周边区，3-10mm；中周边区，10-15mm；远周边区，>15mm）。采用重复测量方差分析和配对 t 检验进行组内和组间比较，采用 Pearson 相关系数和多元回归分析检验 UWF FA 与 OCTA 参数的相关性。
浅层和深层毛细血管丛（DCP）的 OCTA 参数与所有同心区域的 NPA 和 ISI 均呈显著相关。即使在调整了几个协变量后，所有 OCTA 参数与 UWF FA 上的 ISI 仍存在显著相关性。此外，DCP 的 OCTA 参数与胎盘生长因子和血管内皮生长因子的浓度显著相关。尽管所有 OCTA 参数在检测严重视网膜缺血（定义为 ISI>10%）方面的曲线下面积（AUC）均>0.9，但 DCP 中 FD 降低是最可靠的参数（AUC=0.948，P<0.001），5.39%是预测 ISI>10%的最佳截断点。
OCTA 不仅是评估黄斑微血管的有用非侵入性工具，而且可以推测 BRVO 患者的外周无灌注。
