目的：比较分谱振幅去相关算法(SSADA)的频域光学相干断层扫描血管成像仪(FD-OCTA)、光学微血管成像算法(OMAG)的FD-OCTA、扫频光源光学相干断层扫描血管成像仪(SS-OCTA)三种仪器测量因类风湿关节炎(RA)长期服用羟氯喹(HCQ)患者视网膜黄斑区微血管参数的一致性。

方法：前瞻性研究。选取2022年1月至2025年11月在我院眼科行眼底检查的因RA服用羟氯喹5 a的患者。分别采用三种OCTA仪器对所有患者行黄斑区6 mm×6 mm扫描(检查的顺序随机化，每种仪器检查间隔5 min)，采集浅层毛细血管丛(SCP)、深层毛细血管丛(DCP)图像，比较黄斑中心凹浅层毛细血管丛血管密度(F-SCP VD)、黄斑旁中心凹浅层毛细血管丛血管密度(PF-SCP VD)、黄斑中心凹深层毛细血管丛血管密度(F-DCP VD)、黄斑旁中心凹深层毛细血管丛血管密度(PF-DCP VD)及黄斑中心凹无血管区(FAZ)面积。

结果：本研究共纳入因RA服用羟氯喹 5 a的患者34例68眼，均为女性，年龄38-58(平均49.3±5.05)岁。SS-OCTA与SSADA算法的FD-OCTA、OMAG算法的FD-OCTA测量的F-SCP VD、PF-SCP VD、F-DCP VD、PF-DCP VD、FAZ面积比较均有差异(P<0.05)，而SSADA算法的FD-OCTA 与OMAG算法的FD-OCTA测量值比较均无差异(P>0.05)。三种仪器测量的FAZ面积均呈高度正相关性(|r|≥0.8，P<0.01)，SSADA算法的FD-OCTA与OMAG算法的FD-OCTA 测量的F-SCP VD、PF-SCP VD、F-DCP VD、PF-DCP VD值均呈高度正相关性(|r|≥0.8，P<0.01)，SS-OCTA与SSADA算法的FD-OCTA、OMAG算法的FD-OCTA测量的PF-SCP VD、PF-DCP VD值均呈中度正相关性(0.5≤|r|<0.8，P<0.01)，SS-OCTA与SSADA算法的FD-OCTA、OMAG算法的FD-OCTA测量的F-SCP VD、F-DCP VD值均呈低度正相关性(0.3≤|r|<0.5，P<0.05)。Bland-Altman散点图中，显示SSADA算法的FD-OCTA与OMAG算法的FD-OCTA在测量F-SCP VD、PF-SCP VD、F-DCP VD、PF-DCP VD值时一致性较好，而SS-OCTA与SSADA算法的FD-OCTA、OMAG算法的FD-OCTA在测量F-SCP VD、PF-SCP VD、F-DCP VD、PF-DCP VD值时一致性较差，三种OCTA仪器测量FAZ面积时一致性良好。

结论：SSADA算法的FD-OCTA与OMAG算法的FD-OCTA在测量服用羟氯喹患者黄斑区血流密度方面具有较好的一致性和相关性，在临床随访中可谨慎互换； SS-OCTA与SSADA算法的FD-OCTA、OMAG算法的FD-OCTA测量的血流密度参数差异较大，不宜直接互换； FAZ面积测量在三种仪器间具有较好的跨设备一致性，使用中需结合临床实际情况相互替换。

METHODS:This prospective study enrolled patients treated with HCQ for 5 y due to RA who visited the Department of Ophthalmology of the hospital from January 2022 to November 2025. All subjects underwent a 6 mm×6 mm macular scan with three OCTA devices in random order, with a 5-minute interval between examinations by different devices. Images of the superficial capillary plexus(SCP)and deep capillary plexus(DCP)were acquired. The following microvascular parameters were compared: foveal superficial capillary plexus vessel density(F-SCP VD), parafoveal superficial capillary plexus vessel density(PF-SCP VD), foveal deep capillary plexus vessel density(F-DCP VD), parafoveal deep capillary plexus vessel density(PF-DCP VD), and the area of the foveal avascular zone(FAZ).

RESULTS:A total of 34 female patients(68 eyes)treated with HCQ for 5 y due to RA were enrolled in this study, aged 38-58 y with a mean age of 49.3±5.05 y. Statistically significant differences were found in F-SCP VD, PF-SCP VD, F-DCP VD, PF-DCP VD, and FAZ area among measurements obtained by SS-OCTA, SSADA-based FD-OCTA, and OMAG-based FD-OCTA(all P<0.05). No statistically significant differences in all above parameters were observed between SSADA-based FD-OCTA and OMAG-based FD-OCTA(all P>0.05). FAZ areas measured by the three devices were highly positively correlated(|r|≥0.8, P<0.01). The F-SCP VD, PF-SCP VD, F-DCP VD, and PF-DCP VD values obtained by SSADA-based FD-OCTA and OMAG-based FD-OCTA were all highly positively correlated(|r|≥0.8, P<0.01). The PF-SCP VD and PF-DCP VD values measured by SS-OCTA versus SSADA-based FD-OCTA and OMAG-based FD-OCTA showed moderate positive correlations(0.5≤|r|<0.8, P<0.01). The F-SCP VD and F-DCP VD values measured by SS-OCTA versus SSADA-based FD-OCTA and OMAG-based FD-OCTA exhibited low positive correlations(0.3≤|r|<0.5, P<0.05). Bland-Altman plots demonstrated good agreement between SSADA-based FD-OCTA and OMAG-based FD-OCTA for the measurements of F-SCP VD, PF-SCP VD, F-DCP VD and PF-DCP VD. By contrast, poor agreement was observed when comparing SS-OCTA with SSADA-based FD-OCTA or OMAG-based FD-OCTA for measurements of F-SCP VD, PF-SCP VD, F-DCP VD and PF-DCP VD.Satisfactory agreement was found among the three OCTA devices for FAZ area measurements.

CONCLUSION:SSADA-based FD-OCTA and OMAG-based FD-OCTA show favorable correlation and agreement in measuring macular vessel density of patients receiving HCQ, which allows cautious interchangeable use during clinical follow-up. The vessel density parameters measured by SS-OCTA were markedly different from those obtained by SSADA-based FD-OCTA and OMAG-based FD-OCTA; therefore, these devices cannot be directly interchanged.FAZ area measurements exhibit favorable inter-device agreement among the three systems, and interchangeability should be considered in the context of clinical practice.