光学相干断层扫描血管成像技术评估孔源性视网膜脱离患者行玻璃体切割联合气体或硅油填充术后的黄斑区血流变化
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摘要
目的·探讨经玻璃体切割术后不同的玻璃体填充物对孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)患者黄斑区血流的影响,以及黄斑区血流与最佳矫正视力的相关性。方法·回顾性分析2017年12月—2018年6月于上海交通大学附属第一人民医院眼科行玻璃体切割术的单眼初发RRD患者74例。根据玻璃体切割术后填充物的不同,将患者分为气体填充组(气体组)和硅油填充组(硅油组)。利用光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)技术行黄斑区3 mm×3 mm区域扫描。记录黄斑区中心凹及旁中心凹处浅层视网膜毛细血管丛(superficial capillary plexus,SCP)血流密度、深层视网膜毛细血管丛(deep capillary plexus,DCP)血流密度,黄斑区中心凹无血管区(foveal avascular zone,FAZ)面积、周长。分析2组患者黄斑区血流参数与最佳矫正视力的相关性。结果·与硅油组相比,气体组患者术后6个月的总3 mm×3 mm区域SCP血流密度及DCP血流密度均较高(均P=0.000)。偏相关分析显示,患者的最佳矫正视力变化与FAZ面积的变化呈负相关性(r=-0.216,P=0.015)。结论·RRD患者行玻璃体切割术联合气体填充术后对其黄斑区血流的恢复更为有利。使用OCTA技术评估视网膜脱离患者玻璃体切割术后患眼的黄斑区血流密度变化,对于监测视网膜结构和功能的变化有重要意义。
Objective·To investigate the effect of different vitreous fillers on the macular blood flow of patients with rhegmatogenous retinal detachment(RRD), and the correlation between the macular blood flow and the best corrected visual acuity(BCVA). Methods·In this retrospective study, 74 eyes in 74 patients with RRD for first time underwent pars plana vitrectomy in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from Dec. 2017 to Jun. 2018 were included. According to different vitreous fillers, the patients were divided into two group, i.e. pars plana vitrectomy with gas tamponade group(gas group) and pars plana vitrectomy with silicone oil tamponade group(silicone oil group). The blood flow in 3 mm×3 mm macular area was detected by optical coherence tomography angiography(OCTA). The blood flow densities of superficial capillary plexus(SCP) and deep capillary plexus(DCP) at foveal and parafoveal area, and the areas and perimeters of foveal avascular zone(FAZ) were calculated. The correlations between the macular blood flow parameters and BCVA were analyzed by partial correlation. Results·Compared with the silicone oil group, the blood flow densities of SCP and DCP in the whole 3 mm×3 mm regions in the gas group were higher at 6 months after surgery(both P=0.000). The partial correlation showed that the improvement of visual acuity was negatively correlated with the change of FAZ area(r=-0.216, P=0.015). Conclusion·Gas is an advantageous tamponade for the patients with RRD in improvement of blood flow density in the macular area. Meanwhile, assessing the macular blood flow density of the patients with retinal detachment by using OCTA after vitrectomy is significant to monitor the changes of structure and function of retina.
Objective·To investigate the effect of different vitreous fillers on the macular blood flow of patients with rhegmatogenous retinal detachment(RRD), and the correlation between the macular blood flow and the best corrected visual acuity(BCVA). Methods·In this retrospective study, 74 eyes in 74 patients with RRD for first time underwent pars plana vitrectomy in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from Dec. 2017 to Jun. 2018 were included. According to different vitreous fillers, the patients were divided into two group, i.e. pars plana vitrectomy with gas tamponade group(gas group) and pars plana vitrectomy with silicone oil tamponade group(silicone oil group). The blood flow in 3 mm×3 mm macular area was detected by optical coherence tomography angiography(OCTA). The blood flow densities of superficial capillary plexus(SCP) and deep capillary plexus(DCP) at foveal and parafoveal area, and the areas and perimeters of foveal avascular zone(FAZ) were calculated. The correlations between the macular blood flow parameters and BCVA were analyzed by partial correlation. Results·Compared with the silicone oil group, the blood flow densities of SCP and DCP in the whole 3 mm×3 mm regions in the gas group were higher at 6 months after surgery(both P=0.000). The partial correlation showed that the improvement of visual acuity was negatively correlated with the change of FAZ area(r=-0.216, P=0.015). Conclusion·Gas is an advantageous tamponade for the patients with RRD in improvement of blood flow density in the macular area. Meanwhile, assessing the macular blood flow density of the patients with retinal detachment by using OCTA after vitrectomy is significant to monitor the changes of structure and function of retina.
引文
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[8]Nesper PL,Roberts PK,Onishi AC,et al.Quantifying microvascular abnormalities with increasing severity of diabetic retinopathy using optical coherence tomography angiography[J].Invest Ophthalmol Vis Sci,2017,58(6):BIO307-BIO315.
[9]D′Amico AG,Maugeri G,Bucolo C,et al.Nap interferes with hypoxiainducible factors and VEGF expression in retina of diabetic rats[J].J Mol Neurosci,2017,61(2):256-266.
[10]Yang B,Xu Y,Hu Y,et al.Madecassic acid protects against hypoxia-induced oxidative stress in retinal microvascular endothelial cells via ROS-mediated endoplasmic reticulum stress[J].Biomed Pharmacother,2016,84:845-852.
[11]Quintyn JC,Brasseur G.Subretinal fluid in primary rhegmatogenous retinal detachment:physiopathology and composition[J].Surv Ophthalmol,2004,49(1):96-108.
[12]Ohkubo H.Fluorescein angiographic findings in the detached and reattached retina[J].Jpn J Ophthalmol,1988,32(4):423-428.
[13]Scheerlinck LM,Schellekens PA,Liem AT,et al.Incidence,risk factors,and clinical characteristics of unexplained visual loss after intraocular silicone oil for macula-on retinal detachment[J].Retina,2016,36(2):342-350.
[14]Pastor JC,Del Nozal MJ,Marinero P,et al.Cholesterol,α-tocopherol,and retinoid concentrations in silicone oil used as a vitreous substitute[J].Arch Soc Esp Oftalmol,2006,81(1):13-19.
[15]Winter M,Eberhardt W,Scholz C,et al.Failure of potassium siphoning by Muller cells:a new hypothesis of perfluorocarbon liquid-induced retinopathy[J].Invest Ophthalmol Vis Sci,2000,41(1):256-261.
[2]Akkoyun I,Yilmaz G.Optical coherence tomography:anatomic and functional outcome after scleral buckling surgery in macula-off rhegmatogenous retinal detachment[J].Klin Monbl Augenheilkd,2013,230(8):814-819.
[3]Lumi X,Lu?nik Z,Petrovski G,et al.Anatomical success rate of pars plana vitrectomy for treatment of complex rhegmatogenous retinal detachment[J].BMC Ophthalmol,2016,16(1):216.
[4]Eshita T,Shinoda K,Kimura I,et al.Retinal blood flow in the macular area before and after scleral buckling procedures for rhegmatogenous retinal detachment without macular involvement[J].Jpn J Ophthalmol,2004,48(4):358-363.
[5]Murakami Y,Funatsu J,Nakatake S,et al.Relations among foveal blood flow,retinal-choroidal structure,and visual function in retinitis pigmentosa[J].Invest Ophthalmol Vis Sci,2018,59(2):1134-1143.
[6]Choi W,Moult EM,Waheed NK,et al.Ultrahigh-speed,swept-source optical coherence tomography angiography in nonexudative age-related macular degeneration with geographic atrophy[J].Ophthalmology,2015,122(12):2532-2544.
[7]Chen YC,Chen YT,Chen SN.Foveal microvascular anomalies on optical coherence tomography angiography and the correlation with foveal thickness and visual acuity in retinopathy of prematurity[J].Graefes Arch Clin Exp Ophthalmol,2019,257(1):23-30.
[8]Nesper PL,Roberts PK,Onishi AC,et al.Quantifying microvascular abnormalities with increasing severity of diabetic retinopathy using optical coherence tomography angiography[J].Invest Ophthalmol Vis Sci,2017,58(6):BIO307-BIO315.
[9]D′Amico AG,Maugeri G,Bucolo C,et al.Nap interferes with hypoxiainducible factors and VEGF expression in retina of diabetic rats[J].J Mol Neurosci,2017,61(2):256-266.
[10]Yang B,Xu Y,Hu Y,et al.Madecassic acid protects against hypoxia-induced oxidative stress in retinal microvascular endothelial cells via ROS-mediated endoplasmic reticulum stress[J].Biomed Pharmacother,2016,84:845-852.
[11]Quintyn JC,Brasseur G.Subretinal fluid in primary rhegmatogenous retinal detachment:physiopathology and composition[J].Surv Ophthalmol,2004,49(1):96-108.
[12]Ohkubo H.Fluorescein angiographic findings in the detached and reattached retina[J].Jpn J Ophthalmol,1988,32(4):423-428.
[13]Scheerlinck LM,Schellekens PA,Liem AT,et al.Incidence,risk factors,and clinical characteristics of unexplained visual loss after intraocular silicone oil for macula-on retinal detachment[J].Retina,2016,36(2):342-350.
[14]Pastor JC,Del Nozal MJ,Marinero P,et al.Cholesterol,α-tocopherol,and retinoid concentrations in silicone oil used as a vitreous substitute[J].Arch Soc Esp Oftalmol,2006,81(1):13-19.
[15]Winter M,Eberhardt W,Scholz C,et al.Failure of potassium siphoning by Muller cells:a new hypothesis of perfluorocarbon liquid-induced retinopathy[J].Invest Ophthalmol Vis Sci,2000,41(1):256-261.