Chen Li-Ming, Kang Min, Wang Jun-Yi, Xu San-Hua, Chen Cheng, Wei Hong, Ling Qian, He Liang-Qi, Zou Jie, Wang Yi-Xin, Chen Xu, Ying Ping, Huang Hui, Shao Yi, Wu Rui
Department of Rheumatology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China.
Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China.
Int J Ophthalmol. 2024 Oct 18;17(10):1869-1879. doi: 10.18240/ijo.2024.10.14. eCollection 2024.
To examine the disparities in macular retinal vascular density between individuals with connective tissue disease-related interstitial lung disease (CTD-ILD) and healthy controls (HCs) by optical coherence tomography angiography (OCTA) and to investigate the changes in microvascular density in abnormal eyes.
For a retrospective case-control study, a total of 16 patients (32 eyes) diagnosed with CTD-ILD were selected as the ILD group. The 16 healthy volunteers with 32 eyes, matched in terms of age and sex with the patients, were recruited as control group. The macular retina's superficial retinal layer (SRL) and deep retinal layer (DRL) were examined and scanned using OCTA in each individual eye. The densities of retinal microvascular (MIR), macrovascular (MAR), and total microvascular (TMI) were calculated and compared. Changes in retinal vascular density in the macular region were analyzed using three different segmentation methods: central annuli segmentation method (C1-C6), hemispheric segmentation method [uperior right (SR), superior left (SL), inferior left (IL), and inferior right (IR)], and Early Treatment Diabetic Retinopathy Study (ETDRS) methods [superior (S), inferior (I), left (L), and right (R)]. The data were analyzed using Version 9.0 of GraphPad prism and Pearson analysis.
The OCTA data demonstrated a statistically significant difference (<0.05) in macular retinal microvessel density between the two groups. Specifically, in the SRL and DRL analyses, the ILD group exhibited significantly lower surface density of MIR and TMI compared to the HCs group (<0.05). Furthermore, using the hemispheric segmentation method, the ILD group showed notable reductions in SL, SR, and IL in the superficial retina (<0.05), as well as marked decreases in SL and IR in the deep retina (<0.05). Similarly, when employing the ETDRS method, the ILD group displayed substantial drops in superficial retinal S and I (<0.05), along with notable reductions in deep retinal L, I, and R (<0.05). In the central annuli segmentation method, the ILD group exhibited a significant decrease in the superficial retinal C2-4 region (<0.05), whereas the deep retina showed a notable reduction in the C3-5 region (<0.05). Additionally, there was an observed higher positive likelihood ratio in the superficial SR region and deep MIR. Furthermore, there was a negative correlation between conjunctival vascular density and both deep and superficial retinal TMI (<0.001).
Patients with CTD-ILD exhibits a significantly higher conjunctival vascular density compared to the HCs group. Conversely, their fundus retinal microvascular density is significantly lower. Furthermore, CTD-ILD patients display notably lower superficial and deep retinal vascular density in comparison to the HCs group. The inverse correlation between conjunctival vascular density and both superficial and deep retinal TMI suggests that detecting subtle changes in ocular microcirculation could potentially serve as an early diagnostic indicator for connective tissue diseases, thereby enhancing disease management.
通过光学相干断层扫描血管造影（OCTA）检查结缔组织病相关间质性肺病（CTD-ILD）患者与健康对照者（HCs）黄斑区视网膜血管密度的差异，并研究异常眼微血管密度的变化。
进行一项回顾性病例对照研究，共选取16例诊断为CTD-ILD的患者（32只眼）作为ILD组。招募16名年龄和性别与患者匹配的健康志愿者（32只眼）作为对照组。对每只眼睛使用OCTA检查并扫描黄斑区视网膜的浅表视网膜层（SRL）和深层视网膜层（DRL）。计算并比较视网膜微血管（MIR）、大血管（MAR）和总微血管（TMI）的密度。使用三种不同的分割方法分析黄斑区视网膜血管密度的变化：中央环带分割法（C1-C6）、半球分割法[右上（SR）、左上（SL）、左下（IL）和右下（IR）]以及糖尿病视网膜病变早期治疗研究（ETDRS）方法[上（S）、下（I）、左（L）和右（R）]。使用GraphPad prism 9.0版软件和Pearson分析对数据进行分析。
OCTA数据显示两组之间黄斑区视网膜微血管密度存在统计学显著差异（<0.05）。具体而言，在SRL和DRL分析中，ILD组的MIR和TMI表面密度显著低于HCs组（<0.05）。此外，使用半球分割法时，ILD组浅表视网膜的SL、SR和IL显著降低（<0.05），深层视网膜的SL和IR也显著降低（<0.05）。同样，采用ETDRS方法时，ILD组浅表视网膜的S和I大幅下降（<0.05），深层视网膜的L、I和R也显著降低（<0.05）。在中央环带分割法中，ILD组浅表视网膜C2-4区域显著下降（<0.05），而深层视网膜C3-5区域显著降低（<0.05）。此外，在浅表SR区域和深层MIR中观察到较高的阳性似然比。此外，结膜血管密度与深层和浅表视网膜TMI均呈负相关（<0.001）。
与HCs组相比，CTD-ILD患者的结膜血管密度显著更高。相反，他们的眼底视网膜微血管密度显著更低。此外，与HCs组相比，CTD-ILD患者的浅表和深层视网膜血管密度明显更低。结膜血管密度与浅表和深层视网膜TMI之间的负相关表明，检测眼微循环的细微变化可能作为结缔组织病的早期诊断指标，从而改善疾病管理。
