增殖性糖尿病视网膜病变患者全视网膜光凝前后的黄斑血管密度
Macular vessel density before and after panretinal photocoagulation in patients with proliferative diabetic retinopathy.
作者信息
Abdelhalim Ahmed Shawkat, Abdelkader Mohamed Farouk Sayed Othman, Mahmoud Mohamed Salah El-Din, Mohamed Mohamed Asmaa Anwar
机构信息
Ophthalmology Department, Faculty of Medicine, Minia University Hospital, Minia University, El-Minia, 61519, Egypt.
出版信息
Int J Retina Vitreous. 2022 Mar 14;8(1):21. doi: 10.1186/s40942-022-00369-1.
INTRODUCTION
Diabetic retinopathy (DR) is microangiopathy causing ischemia leading to proliferative diabetic retinopathy and macular edema. Panretinal photocoagulation (PRP) reverses the ischemia leading to regression of neovessels. Most previous studies showed the large vessel effects of PRP, while optical coherence tomography angiography (OCTA) allowed noninvasive quantification of microvascular retinal changes.
AIM
To study the effect of PRP on microvascular retinal vessels in a detailed manner at different retinal and choroidal levels using OCTA.
PATIENTS AND METHODS
This study was a prospective interventional study. 30 eyes of 18 diabetic patients with PDR were included. All patients were evaluated clinically and with OCTA (Avanti RTVue-XR system, Optovue) to evaluate superficial and deep vessels density (VDs), choroidal flow, and FAZ area before PRP (base line) and 1 month and 6 months after PRP.
RESULTS
PRP improved vessels density at superficial (SCP), deep (DCP), and choriocapillaris levels. Foveal vessel density at SCP and DCP were statistically significantly increased. SCP was 28.76 ± 2.56 at base line and was increased to 29.84 ± 2.47 and 30.89 ± 2.20 after 1 month and after 6 months, respectively. DCP was 34.08 ± 5.59 at base line and was increased to 34.93 ± 5.66 and 36.09 ± 5.62 after 1 month and after 6 months, respectively. Foveal choriocapillaris was statistically significantly increased from 63.04 ± 2.66 at base line to 63.48 ± 2.65 and 63.98 ± 2.78 after 1 month and 6 months, respectively. Choroidal flow was increased from 1.74 ± 0.07 at base line to 1.75 ± 0.09 at 1 month which was nonsignificant (P = 0.72), but it was significantly increased to 1.87 ± 0.27 6 months after PRP (P = 0.009). FAZ area was significantly improved after PRP. FAZ area was decreased from 0.56 ± 0.27 at base line to 0.50 ± 0.21 after 1 month and to 0.46 ± 0.21 after 6 months.
CONCLUSION
OCTA parameters were significantly improved by PRP in PDR patients, possibly due to redistribution of blood in occluded capillary plexuses.
TRIALS REGISTRY
NCT04976361.
引言
糖尿病性视网膜病变（DR）是一种微血管病变，可导致缺血，进而引发增殖性糖尿病性视网膜病变和黄斑水肿。全视网膜光凝（PRP）可逆转缺血，使新生血管消退。此前大多数研究显示了PRP对大血管的影响，而光学相干断层扫描血管造影（OCTA）能够对视网膜微血管变化进行无创定量分析。
目的
使用OCTA在不同视网膜和脉络膜层面详细研究PRP对视网膜微血管的影响。
患者与方法
本研究为前瞻性干预性研究。纳入18例患有增殖性糖尿病性视网膜病变（PDR）的糖尿病患者的30只眼。所有患者在PRP治疗前（基线）、PRP治疗后1个月和6个月均接受临床评估及OCTA（Optovue公司的Avanti RTVue-XR系统）检查，以评估浅表和深层血管密度（VDs）、脉络膜血流及黄斑无血管区（FAZ）面积。
结果
PRP改善了浅表（SCP）、深层（DCP）和脉络膜毛细血管层的血管密度。SCP和DCP层面的黄斑区血管密度在统计学上显著增加。SCP在基线时为28.76±2.56，1个月后增加至29.84±2.47，6个月后增加至30.89±2.20。DCP在基线时为34.08±5.59，1个月后增加至34.93±5.66，6个月后增加至36.09±5.62。黄斑区脉络膜毛细血管在统计学上显著增加，从基线时的63.04±2.66分别增加至1个月后的63.48±2.65和6个月后的63.98±2.78。脉络膜血流从基线时的1.74±0.07增加至1个月后的1.75±0.09，差异无统计学意义（P = 0.72），但在PRP治疗6个月后显著增加至1.87±0.27（P = 0.009）。PRP治疗后FAZ面积显著改善。FAZ面积从基线时的0.56±0.27降至1个月后的0.50±0.21，6个月后降至0.46±0.21。
结论
PRP使PDR患者的OCTA参数显著改善，可能是由于闭塞的毛细血管丛中血液重新分布所致。
试验注册
NCT04976361。
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