超广角光学相干断层扫描血管成像在视网膜静脉阻塞诊断中的应用

doi:10.3760/cma.j.cn441417-20240528-04018

摘要/Abstract

摘要：

目的　探讨超广角光学相干断层扫描血管成像（OCTA）在视网膜静脉阻塞（RVO）患者诊断中的价值。方法　选取2023年1月至2024年1月在西安爱尔古城眼科医院接受检查并确诊的RVO患者78例（78眼）进行回顾性研究，其中男43例、女35例，年龄（58.7±9.4）岁。所有患者均于2周内分别接受超广角OCTA、荧光素眼底血管造影（FFA）检查，以FFA检查结果作为临床诊断金标准，计算超广角OCTA对视网膜无灌注区的诊断价值。采用配对t检验分析受检者患侧与健侧超广角OCTA检查的视盘区血流密度特征参数差异；采用方差分析法分析FFA与超广角OCTA检查无灌注区面积的差异。结果　超广角OCTA检查视网膜层、浅层血管复合体、深层血管复合体无灌注区面积与FFA检出的无灌注区面积比较，差异均无统计学意义（均P>0.05）。视网膜中央静脉阻塞患者患侧视盘区整个图像血管、视盘周血管、整个图像毛细血管、视盘周毛细血管、下方鼻侧、下方颞侧、颞下、颞上、上方颞侧、下方颞侧血流密度均低于健侧［（50.61±4.82）%比（55.17±5.20）%、（51.40±4.77）%比（57.37±5.00）%、（45.68±5.20）%比（48.93±4.88）%、（45.48±5.50）%比（50.30±6.23）%、（43.83±5.50）%比（48.29±7.23）%、（50.90±7.27）%比（57.34±7.86）%、（48.65±6.61）%比（53.43±6.93）%、（49.50±6.14）%比（54.63±7.22）%、（49.33±7.10）%比（55.38±7.50）%、（45.52±6.14）%比（49.58±6.85）%］，差异均有统计学意义（均P<0.05）。视网膜分支静脉阻塞患者患侧视盘区整个图像血管、视盘周血管、整个图像毛细血管、视盘周毛细血管、下方鼻侧、下方颞侧、颞下、颞上、上方颞侧、下方颞侧血流密度均低于健侧［（52.33±5.14）%比（55.43±4.88）%、（52.30±5.15）%比（57.43±4.86）%、（46.77±4.98）%比（49.54±5.50）%、（46.13±6.62）%比（50.63±5.87）%、（44.18±5.87）%比（48.43±6.61）%、（51.39±6.98）%比（57.92±6.94）%、（49.66±6.21）%比（53.56±6.60）%、（49.50±6.33）%比（54.81±6.87）%、（49.89±7.09）%比（56.12±7.28）%、（45.83±5.81）%比（50.75±6.43）%］，差异均有统计学意义（均P<0.05）。超广角OCTA检查诊断视网膜中央静脉阻塞及视网膜分支静脉阻塞患者无灌注区的灵敏度分别为100.0%（35/35）、81.4%（35/43），特异度分别为86.0%（37/43）、100.0%（35/35）。结论　超广角OCTA可检查RVO患眼视盘区血流密度特征，对RVO无灌注的诊断价值较高，且与FFA相比具有无创优势。

关键词:

视网膜静脉阻塞, 超广角光学相干断层扫描, 荧光素眼底血管造影, 视盘, 血流密度, 诊断

Abstract:

Objective　To explore the value of ultra wide angle optical coherence tomography (OCTA) in the diagnosis of patients with retinal vein occlusion (RVO). Methods　Seventy-eight ( 78 eyes ) patients with RVO taking examination and diagnosed at Xi'an Ai'er Ancient City Eye Hospital from January 2023 to January 2024 were selected for the retrospective study, including 43 males and 35 females who were (58.7±9.4) years old. All the patients underwent ultra wide angle OCTA and fluorescein angiography (FFA) within 2 weeks. The FFA results were set as the gold standard for clinical diagnosis. The value of ultra wide angle OCTA in the diagnosis of non-perfusion retinal areas was evaluated. The paired t test was used to analyze the differences in blood flow density characteristic parameters of the optic disc area between the affected and healthy sides of the subjects undergoing ultra wide angle OCTA. The analysis of variance was used to analyze the difference in non-perfusion areas between FFA and ultra wide angle OCTA. Results　There were no statistical differences in the areas of retinal layer, superficial vascular complex, and deep vascular complex between ultra wide angle OCTA and FFA (all P>0.05). The blood flow densities of the entire image of the optic disc area, the peripheral vessels of the optic disc, the capillaries of the entire image, the peripheral capillaries of the optic disc, the nasal side below, the temporal side below, the below temporal side, the above temporal side, the temporal side above, and the temporal side below on the affected sides of the patients with central retinal vein occlusion were lower than those on the healthy sides [(50.61±4.82)% vs. (55.17±5.20)%, (51.40±4.77)% vs. (57.37±5.00)%, (45.68±5.20)% vs. (48.93±4.88)%, (45.48±5.50)% vs. (50.30±6.23)%, (43.83±5.50)% vs. (48.29±7.23)%, (50.90±7.27)% vs. (57.34±7.86)%, (48.65±6.61)% vs. (53.43±6.93)%, (49.50±6.14)% vs. (54.63±7.22)%, (49.33±7.10)% vs. (55.38±7.50)%, (45.52±6.14)% vs. (49.58±6.85)%], with statistical differences (all P<0.05). The blood flow densities of the entire image of the optic disc area, the peripheral vessels of the optic disc, the capillaries of the entire image, the peripheral capillaries of the optic disc, the nasal side below, the temporal side below, the below temporal side, the above temporal side, the temporal side above, and the temporal side below on the affected sides of the patients with branch retinal vein occlusion were lower than those on the healthy sides [(52.33±5.14)% vs. (55.43±4.88)%, (52.30±5.15)% vs. (57.43±4.86)%, (46.77±4.98)% vs. (49.54±5.50)%, (46.13±6.62)% vs. (50.63±5.87)%, (44.18±5.87)% vs. (48.43±6.61)%, (51.39±6.98)% vs. (57.92±6.94)%, (49.66±6.21)% vs. (53.56±6.60)%, (49.50±6.33)% vs. (54.81±6.87)%, (49.89±7.09)% vs. (56.12±7.28)%, and (45.83±5.81)% vs. (50.75±6.43)%], with statistical differences (all P<0.05). The sensitivities of ultra wide angle OCTA for diagnosing non-perfusion areas in the patients with central retinal vein occlusion and branch retinal vein occlusion were 100.0% (35/35) and 81.4% (35/43), respectively; the specificities were 86.0% (37/43) and 100.0% (35/35), respectively. Conclusions　Ultra wide angle OCTA can examine the blood flow density characteristics of the optic disc areas in patients with RVO, and has high diagnostic value for non-perfusion of RVO. Moreover, ultra wide angle OCTA has non-invasive advantages over FFA.

Key words:

Retinal vein occlusion, Ultra wide angle optical coherence tomography, Fluorescein fundus angiography, Optic disk, Blood flow density, Diagnosis

姜旭光苏争宏.

超广角光学相干断层扫描血管成像在视网膜静脉阻塞诊断中的应用 [J]. 国际医药卫生导报, 2025, 31(4): 612-617.

Jiang Xuguang, Su Zhenghong.

Ultra wide angle optical coherence tomography in diagnosis of retinal vein occlusion [J]. International Medicine and Health Guidance News, 2025, 31(4): 612-617.

参考文献

[1] Hwang BE, Kim JY, Kim RY, et al. Alteration of perivascular reflectivity on optical coherence tomography of branched retinal vein obstruction[J].Sci Rep,2023,13(1):15847.DOI:10.1038/s41598-023-41691-4.
[2] Romano F, Lamanna F, Gabrielle PH, et al. Update on retinal vein occlusion[J].Asia Pac J Ophthalmol (Phila),2023,12(2):196-210.DOI:10.1097/APO.0000000000000598.
[3] 李水,杨华静,代家乐,等. 视网膜静脉阻塞机制及危险因素研究进展[J].国际眼科杂志,2024,24(1):72-76.DOI:10.3980/j.issn.1672-5123.2024.1.14.
[4] Liao D, Zhou Z, Wang F, et al. Changes in foveal avascular zone area and retinal vein diameter in patients with retinal vein occlusion detected by fundus fluorescein angiography[J].Front Med (Lausanne),2023,10:1267492.DOI:10.3389/fmed.2023.1267492.
[5] Zhao X, Lin Z, Yu S, et al. An artificial intelligence system for the whole process from diagnosis to treatment suggestion of ischemic retinal diseases[J].Cell Rep Med,2023,4(10):101197.DOI:10.1016/j.xcrm.2023.101197.
[6] An W, Han J. Research progress of UWFFA and OCTA in retinal vein occlusion: a review[J].Eur J Ophthalmol,2021,31(6):2850-2855.DOI:10.1177/11206721211027411.
[7] 李都吉雅,张景馨,韩珊,等. OCT和OCTA影像学特征在视网膜静脉阻塞中的研究进展[J].眼科学,2023,12(3):112-119.DOI:10.12677/HJO.2023.123016.
[8] An W, Zhao Q, Yu R, et al. The role of optical coherence tomography angiography in distinguishing ischemic versus non-ischemic central retinal vein occlusion[J].BMC Ophthalmol,2022,22(1):413.DOI:10.1186/s12886-022-02637-y.
[9] 中华医学会眼科学分会眼底病学组,中国医师协会眼科医师分会眼底病专业委员会. 中国视网膜静脉阻塞临床诊疗路径专家共识[J].中华眼底病杂志,2024,40(3):175-185.DOI:10.3760/cma.j.cn511434-20240201-00056.
[10] Rudnick ND, Vingopoulos F, Wang JC, et al. Characterising collateral vessels in eyes with branch retinal vein occlusions using widefield swept-source optical coherence tomography angiography[J].Br J Ophthalmol,2023,107(12):1887-1891.DOI:10.1136/bjo-2021-320356.
[11] Cavalleri M, Sacconi R, Parravano M, et al. Optical coherence tomography angiography in central retinal vein occlusion: macular changes and their correlation with peripheral nonperfusion at ultra-widefield fluorescein angiography[J].Ophthalmologica,2022,245(3):275-284.DOI:10.1159/000522503.
[12] 张碧磊,陈有信. 广角光相干断层扫描血管成像对临床前期糖尿病视网膜病变的定量评估[J].影像研究与医学应用,2023,7(18):32-34.DOI:10.3969/j.issn.2096-3807. 2023.18.011.
[13] Siying L, Qiaozhu Z, Xinyao H, et al. Comparison of widefield swept-source optical coherence tomography angiography with ultra-widefield fluorescein angiography for the evaluation of lesions in retinal vein occlusion[J].BMC Ophthalmol,2022,22(1):422.DOI:10.1186/s12886-022-02642-1.
[14] 孙梅,郝晓凤,谢立科,等. 视网膜静脉阻塞继发黄斑水肿的OCT影像指标研究进展[J].国际眼科杂志,2023,23(1):58-61.DOI:10.3980/j.issn.1672-5123.2023.1.11.
[15] 董文韬,刘三梅,李杰,等.增生早期糖尿病视网膜病变患者视网膜及视盘新生血管的超广角OCTA与FFA检测结果对比分析[J].眼科新进展,2023,43(4):294-297.DOI:10.13389/j.cnki.rao.20230060.
[16] Tanaka S, Tanaka Y, Inoue T, et al. Retinal haemorrhages on ultra-widefield red channel images and perfusion status in central retinal vein occlusion[J].Eye (Lond),2023,37(11):2305-2309.DOI:10.1038/s41433-022-02337-3.
[17] Ong CJT, Wong MYZ, Cheong KX, et al. Optical coherence tomography angiography in retinal vascular disorders[J].Diagnostics (Basel),2023,13(9):1620.DOI:10.3390/diagnostics13091620.
[18] Cheng BT, Mishra S, Bryan JM, et al. Retinal vessel density and treatment intensity among adults with retinal vein occlusion: a swept-source optical coherence tomography angiography study[J].J Clin Med,2022,11(10):2892.DOI:10.3390/jcm11102892.
[19] Miao J, Yu J, Zou W, et al. Deep learning models for segmenting non-perfusion area of color fundus photographs in patients with branch retinal vein occlusion[J].Front Med (Lausanne),2022,9:794045.DOI:10.3389/fmed.2022.794045.
[20] Ertop M, Yaylacıoğlu Tuncay F, Arıbaş YK, et al. Evaluation of central and peripheral retinal vascular changes in the fellow eyes of patients with unilateral retinal vein occlusions[J].Turk J Ophthalmol,2023,53(6):349-355.DOI:10.4274/tjo.galenos.2023.94389.
[21] 彭金英,赵桂玲. 影响视网膜中央静脉阻塞预后的相关因素研究现状[J].国际眼科杂志,2022,22(7):1127-1132.DOI:10.3980/j.issn.1672-5123.2022.7.12.
[22] 鲁鑫,赵星星,伊恩晖,等. OCTA定量分析糖尿病视网膜病变患者黄斑区微循环变化[J].国际眼科杂志,2023,23(6):1033-1039.DOI:10.3980/j.issn.1672-5123.2023.6.30.
[23] Rudnick ND, Vingopoulos F, Wang JC, et al. Characterising collateral vessels in eyes with branch retinal vein occlusions using widefield swept-source optical coherence tomography angiography[J].Br J Ophthalmol,2023,107(12):1887-1891.DOI:10.1136/bjo-2021- 320356.
[24] 肖亚星,李秀娟,崔璨,等. OCTA联合微视野计在视网膜静脉阻塞黄斑水肿中的应用[J].国际眼科杂志,2022,22(2):287-292.DOI:10.3980/j.issn.1672-5123.2022.2.22.
[25] Śpiewak D, Witek K, Drzyzga Ł, et al. An analysis of optical coherence tomography angiography (OCT-A) perfusion density maps in patients treated for retinal vein occlusion with intravitreal aflibercept[J].Diagnostics (Basel),2023,13(19):3100.DOI:10.3390/diagnostics13193100.
[26] 董文韬,刘三梅,李杰,等.超广角OCTA对视网膜静脉阻塞眼视网膜无灌注区的检出效果分析[J].眼科新进展,2023,43(1):40-43.DOI:10.13389/j.cnki.rao.2023.0008.
[27] Çalışkan NE, Doğan M, Çalışkan A, et al. Optical coherence tomography angiography evaluation of retinal and optic disc microvascular morphological characteristics in retinal vein occlusion[J].Photodiagnosis Photodyn Ther,2023,41:103244.DOI:10.1016/j.pdpdt.2022.103244.
[28] 夏颖,施梅,张铭. 糖尿病视网膜病变患者视网膜微循环障碍光学相干断层扫描血管成像早期筛查价值[J]. 中国医药导报,2022,19(28):144-146,150.DOI:10.20047/j.issn1673-7210.2022.28.32.
[29] Hein M, Mehnert A, Freund KB, et al. Variability in capillary perfusion is increased in regions of retinal ischemia due to branch retinal vein occlusion[J].Invest Ophthalmol Vis Sci,2023,64(13):30.DOI:10.1167/iovs.64.13.30.
[30] Mautuit T, Cunnac P, Truffer F, et al. Absolute retinal blood flow in healthy eyes and in eyes with retinal vein occlusion[J].Microvasc Res,2024,152:104648.DOI:10.1016/j.mvr.2023.104648.