目的：应用光相干断层扫描血管成像(OCTA)观察早期年龄相关性黄斑变性(ARMD)患者黄斑区血流密度和形态学结构的改变。

方法：本研究为病例回顾性研究，纳入2018-02于我院眼科被初次明确诊断为单眼湿性年龄相关性黄斑变性(wARMD)且另一眼为早期ARMD患者的35例35眼，并纳入与试验组年龄相匹配的健康眼35例。所有患者早期ARMD眼于初诊时及2a后均行OCTA检查，观察黄斑区3mm×3mm范围内浅层、深层视网膜及脉络膜毛细血管层血流密度，黄斑中心凹面积、周长及非圆指数，及黄斑区全层、内层、外层视网膜和光感受器与Bruch膜之间(ISOS-BRM)厚度变化。

结果：与正常人相比，早期ARMD患者黄斑区3mm×3mm范围内浅层、深层视网膜及脉络膜毛细血管层血流密度降低(P<0.05)，黄斑区全层及内层视网膜厚度降低(P<0.05)，而ISOS-BRM厚度有增加的趋势(P=0.37)，黄斑中心凹无血管区面积、周长及非圆指数无明显变化(P>0.05)； 初次诊断2a后早期ARMD患者深层视网膜及脉络膜毛细血管层血流密度较前进一步降低(P<0.05)，外层视网膜厚度较前增加(P=0.02)，ISOS-BRM厚度较前进一步有增加的表现(P=0.18)，黄斑中心凹无血管区面积、周长及非圆指数较前无明显变化(P>0.05)。此外初次诊断及2a后早期ARMD患者脉络膜毛细血管层血流密度与黄斑区视网膜浅层及深层血流密度均呈正相关(初次诊断组：r_浅层=0.407，r_深层=0.56，均P<0.05； 2a后组：r_浅层=0.57，r_深层=0.628，均P<0.05)。

结论：早期ARMD患者黄斑区浅层、深层视网膜及脉络膜毛细血管层血流密度和内层视网膜厚度较正常人均降低，这对ARMD的早期发现和及早干预具有临床参考意义。

METHODS: The retrospective review included 35 patients(35 eyes)which were first diagnosed with wet age-related macular degeneration(wARMD)in one eye and the fellow eye with early ARMD in our hospital at February 2018. A total of 35(35 subjects)healthy eyes with matched age were enrolled in the control group. All the patients with early ARMD eyes were imaged by OCTA at two points: baseline and 2y later. To obeserve the change of the range of 3mm×3mm macular blood flow density of superficial retinal layer, deep retinal layer and choroidal capillaries layer, foveal avascular zone area, perimeter and acircularity index, and the macular thickness of the full layer, inner layer, outer layer retina and ISOS-BRM.

RESULTS: The range of 3mm×3mm macular blood flow density of superficial retinal layer, deep retinal layer and choroidal capillaries layer in early ARMD patients were lower in early ARMD eyes than controls(P<0.05), and the macular thickness of the full layer and inner layer were reduced(P<0.05), while the thickness of ISOS-BRM increased(P=0.37). There was no significant change in the area of macular foveal, perimeter and acircularity index(P>0.05). Two years after the initial diagnosis, the blood flow density of deep retinal layer and choroidal capillaries layer in early ARMD patients further increased than before(P=0.02), ISOS-BRM thickness increased further than before(P=0.18). There was no significant change in the area of macular foveal, perimeter and acircularity index(P>0.05). In addition, the blood flow density of the choroidal capillary layer in early ARMD patients was positively correlated with the blood flow density in superficial retinal layer and deep retinal layer at baseline and two years after frist definite diagnosis.

CONCLUSION: Compared with the control group, the macular blood flow density of superficial retinal layer, deep retinal layer and choroidal capillary layer, and the thickness of inner layer retina in the patients with early ARMD decreased significantly, it is clinical reference significance for the early detection and intervention of ARMD.