恒定性外斜视视网膜微血流及厚度初步分析

doi:10.3969/j.issn.1674-8115.2021.08.012

摘要/Abstract

摘要：

目的·应用光学相干断层扫描血管成像（optical coherence tomography angiography，OCTA）设备评估成年恒定性外斜视患者的视网膜微血流及厚度变化，并探讨OCTA在成年恒定性外斜视患者中的应用价值。方法·纳入2019年1月—12月于上海交通大学附属第一人民医院眼科就诊的成年恒定性外斜视患者29名作为试验组，同期纳入27例健康志愿者的27只眼作为对照组。所有患者初诊时进行全面的眼科综合检查，包括主觉验光、眼压、眼球运动及眼位检查、远近遮盖检查、眼轴测量、裂隙灯检查。由同一位经验丰富的医师使用OCTA设备对全部研究对象的黄斑区行3 mm×3 mm扫描，由软件自动计算浅层视网膜毛细血管丛（superficial capillary plexus，SCP）和深层视网膜毛细血管丛（deep capillary plexus，DCP）的血流密度、黄斑中心凹无灌注区（foveal avascular zone，FAZ）面积，以及内层和全层视网膜厚度。分类资料采用χ²检验比较各组间差异。主导眼、非主导眼和对照眼之间OCTA参数差异采用t检验或Mann-Whitney U检验。采用Littmann’s公式调整屈光不正及眼轴对OCTA数据的影响。P<0.05表示差异有统计学意义。结果·试验组与对照组的年龄、性别之间差异无统计学意义。所有参与者眼球运动正常，眼前段和眼后段检查亦均正常。主导眼、非主导眼以及正常眼的等效球镜度数（spherical equivalent，SE）、最佳矫正视力（best corrected visual acuity， BCVA）、眼压、眼轴等参数之间差异无统计学意义。在3 mm×3 mm黄斑扫描中，恒定性外斜视患者主导眼、非主导眼和对照眼SCP、DCP的血流平均密度以及FAZ面积之间差异无明显统计学意义。非主导眼中心凹和颞侧全层视网膜厚度分别为（248.61±19.84）μm和（320.44±17.05）μm，与主导眼［分别为（251.61±19.37）μm和（323.44±15.82）μm］相比变薄，差异有统计学意义（P=0.018，P=0.018）。结论·OCTA可作为量化分析恒定性外斜视患者的血流密度、FAZ面积和黄斑厚度的有效工具。成年恒定性外斜视患者黄斑区SCP、DCP的血流密度和FAZ面积均无明显变化；非主导眼黄斑区微结构发生的特异性改变，中心凹及颞侧全层视网膜厚度显著变薄。

关键词: 恒定性外斜视, 光学相干断层扫描血管成像, 视网膜微血管, 视网膜厚度

Abstract:

Objective·To investigate the retinal microvascular and thickness abnormalities in adult patients with constant exotropia using OCTA (optical coherence tomography angiography) device, and explore the clinical application value of OCTA in constant exotropic adults.

Methods·A total of 29 adult patients with constant exotropia who visited the Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University from January to December 2019 were recruited as the experimental group. Twenty-seven eyes of 27 healthy volunteers who visited the hospital during the same period were included as the control group. All participants underwent a comprehensive ophthalmologic examination at the first visit, which included subjective refraction, intraocular pressure measurement, ocular motility and position test, cover test at distance and near, axial length, and slit-lamp examination. Pearson's chi-squared test was used to compare categorical variants. The vessel and thickness in 3 mm×3 mm macular area were detected by OCTA device by a single experienced technician. The average vessel density of superficial capillary plexus (SCP), deep capillary plexus (DCP), foveal avascular zone (FAZ) area and inner and full retina thickness were automatically calculated by software. The differences in OCTA parameters between the dominant eyes, non-dominant eyes and control eyes were compared by using t-test or Mann-Whitney U test. The OCTA data was corrected for axial length and refractive error using Littmann's formula. A value of P<0.05 was considered statistically significant.

Results·There was no significant difference in age and gender between the experimental group and the control group. All participants had normal eye movements and normal anterior and posterior segments of the ocular. There were no statistically significant differences in SE, BCVA, intraocular pressure, and axial length of the dominant, non-dominant and normal eyes. In the 3 mm×3 mm macular region, there was no significant difference in the average blood flow density of SCP, DCP and FAZ area in the dominant, non-dominant and control eyes. The fovea and temporal regions of full macular thickness of the non-dominant eyes were (248.61±19.84) μm and (320.44±17.05) μm respectively, significantly (P=0.018, P=0.018) thinner when compared with the dominant eyes [(251.61±19.37) μm, (323.44±15.82) μm].

Conclusion·OCTA is an effective tool to quantitatively analyze the blood flow density, FAZ area and macular thickness of patients with constant exotropia. There are no significant differences in the average blood flow density of SCP, DCP and FAZ area in adult patients with constant exotropia; there are specific changes in the macular microstructure of the non-dominant eyes. The fovea and temporal regions of full macular thickness of the non-dominant eyes are significantly decreased.

Key words: constant exotropia, optical coherence tomography angiography (OCTA), retinal microvasculature, retinal thickness

中图分类号:

R777.4

罗丽颖, 唐敏, 项潇琼, 傅扬. 恒定性外斜视视网膜微血流及厚度初步分析[J]. 上海交通大学学报(医学版), 2021, 41(8): 1068-1073.

Li-ying LUO, Min TANG, Xiao-qiong XIANG, Yang FU. Preliminary analysis of retinal microvasculature and thickness in constant exotropia adults[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(8): 1068-1073.

图/表 5

参考文献 17

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Item	SE/ D	BCVA/logMAR	IOP/mmHg	AXL/mm
P value	0.489	NA	0.834	0.290
NDE	-1.56±2.08	0.1	14.5	23.12±1.20
DE	-0.30±1.53	0.1	12.3	22.91±1.58
CE	-0.35±2.84	0.1	16.0	22.97±1.87

Item	SE/ D	BCVA/logMAR	IOP/mmHg	AXL/mm
P value	0.489	NA	0.834	0.290
NDE	-1.56±2.08	0.1	14.5	23.12±1.20
DE	-0.30±1.53	0.1	12.3	22.91±1.58
CE	-0.35±2.84	0.1	16.0	22.97±1.87

Retinal region	Strabismus （n=29）		CE （n=27）		P value
Retinal region	NDE	DE	CE （n=27）	NDE vs DE	NDE vs CE	DE vs CE
SCP （vessel density）/%
Whole image	49.71±2.85	49.36±2.25	49.95±2.63	0.415	0.327	0.730
Fovea	21.02±5.57	20.88±6.28	23.13±6.81	0.829	0.272	0.284
Para fovea	51.39±4.43	51.93±2.61	52.22±3.44	0.562	0.784	0.542
DCP （vessel density）/%
Whole image	50.87±4.81	51.34±3.69	50.14±4.31	0.657	0.341	0.602
Fovea	36.11±6.67	36.07±6.52	38.97±7.92	0.968	0.208	0.216
Para fovea	54.67±2.99	54.13±3.75	55.82±2.70	0.343	0.165	0.271
FAZ/mm²	0.277±0.109	0.280±0.112	0.279±0.096	0.639	0.939	0.977

Retinal region	Strabismus （n=29）		CE （n=27）		P value
Retinal region	NDE	DE	CE （n=27）	NDE vs DE	NDE vs CE	DE vs CE
SCP （vessel density）/%
Whole image	49.71±2.85	49.36±2.25	49.95±2.63	0.415	0.327	0.730
Fovea	21.02±5.57	20.88±6.28	23.13±6.81	0.829	0.272	0.284
Para fovea	51.39±4.43	51.93±2.61	52.22±3.44	0.562	0.784	0.542
DCP （vessel density）/%
Whole image	50.87±4.81	51.34±3.69	50.14±4.31	0.657	0.341	0.602
Fovea	36.11±6.67	36.07±6.52	38.97±7.92	0.968	0.208	0.216
Para fovea	54.67±2.99	54.13±3.75	55.82±2.70	0.343	0.165	0.271
FAZ/mm²	0.277±0.109	0.280±0.112	0.279±0.096	0.639	0.939	0.977

Retinal region	Strabismus （n=29）		CE （n=27）		P value
Retinal region	NDE	DE	CE （n=27）	NDE vs DE	NDE vs CE	DE vs CE
Inner thickness/μm
Fovea	52.01±10.39	51.89±9.99	51.41±10.96	0.756	0.573	0.648
Tempo	106.39±7.59	106.89±6.83	107.23±5.67	0.343	0.594	0.342
Superior	117.22±6.14	117.56±6.86	116.42±7.32	0.560	0.372	0.410
Nasal	113.39±6.13	114.28±6.11	114.19±6.48	0.076	0.236	0.162
Inferior	118.39±8.60	118.56±7.17	116.76±9.19	0.852	0.717	0.869
Full thickness/μm
Fovea	248.61±19.84	251.61±19.37	251.85±19.51	0.018	0.594	0.837
Tempo	320.44±17.05	323.44±15.82	323.75±15.05	0.018	0.250	0.145
Superior	334.83±13.83	337.28±14.92	339.54±12.50	0.075	0.272	0.260
Nasal	331.05±13.34	333.11±13.23	336.23±11.49	0.069	0.520	0.439
Inferior	331.66±16.60	333.06±15.12	332.23±12.63	0.372	0.105	0.083