光相干断层扫描血管成像观察新生血管性ARMD的临床研究

Study of optical coherence tomography angiography for neovascular age-related macular degeneration

摘要:

目的：利用光相干断层扫描血管成像(optical coherence tomography angiography，OCTA)观察新生血管性年龄相关性黄斑变性(neovascular age-related macular degeneration，nARMD)患者的脉络膜新生血管(choroidal neovascularization，CNV)及接受抗血管内皮生长因子(vascular endothelial growth factor，VEGF)治疗前后的变化。

方法：本研究为病例系列分析研究。纳入2017-05/12就诊于我院眼科的nARMD患者29例37眼。所有患者玻璃体腔注射抗VEGF治疗前和治疗后1d，1wk，1mo及每月随访时均行OCTA检查，共随访3～6mo，观察抗VEGF治疗前后CNV病灶形态和大小、中心凹旁浅层视网膜血管密度和血流灌注的变化。

结果：nARMD患者CNV病灶的组织结构中不成熟的结构、小分支血管和毛细血管对抗VEGF的治疗应答反应较好； 术前基线病灶面积为1.27±1.88mm²，术后第1d病灶面积为1.13±1.79mm²，CNV病灶在抗VEGF治疗后1d即可缩小，最终病灶大小稳定在1mo时的病灶面积水平，与治疗前比较差异有统计学意义(P=0.001)； 抗VEGF治疗后3mo，中心凹旁浅层视网膜血管密度和血流灌注明显降低，差异有统计学意义(P=0.003、0.015)。

结论：OCTA能够无创、清晰地显示nARMD患者CNV病灶的细微结构变化和定量分析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nARMD患者的病情监测和指导治疗方面有重要的临床应用价值。

Abstract:

AIM: To analyze the characteristics of choroidal neovascularization(CNV)in neovascular age-related macular degeneration(nARMD)patients and the outcome of intravitreal anti-vascular endothelial growth factor(VEGF)treatment by using optical coherence tomography angiography(OCTA).

METHODS: A prospective cohort study was carried out, which included 37 eyes of 29 patients with nARMD in West China Hospital during May to December 2017. OCTA scans was conducted to all patients before treatment, 1d, 1wk, 1mo and 3-6mo after treatment. The analysis was performed to evaluate the morphological characteristics, lesion area, parafoveal superficial vessel density and perfusion area of CNV before and after treatment.

RESULTS: Among all the subjects, immature structure, small branches, and capillaries responded well to anti-VEGF treatment. Compared with the mean lesion area in nARMD patients before treatment(1.27±1.88mm²), there was significant reduction(1.13±1.79 mm²)1d after treatment, which meant CNV lesion decreased 1d after treatment, and stabilized 1mo later(P=0.001). Obvious decrease was observed both in parafoveal superficial vessel density(P=0.003)and perfusion area(P=0.015)3mo after treatment in nARMD patients.

CONCLUSION: OCTA, a non-invasive diagnostic examination, clearly identified tiny structures of CNV, quantified the lesion area and displayed specific vasculature in nARMD patients. Furthermore, retinal microcirculation can be detected using OCTA, which provides an effective approach of monitoring the progression and treatment effect of nARMD.