UWFSS-OCTA检测糖尿病视网膜病变微循环的变化

Assessment of fundus microcirculation changes in diabetic retinopathy using UWFSS-OCTA

摘要

目的 应用超广角扫频源光学相干断层扫描血管成像(ultra-widefield swept-source optical coherence tomography angiography, UWFSS-OCTA)研究不同程度的糖尿病视网膜病变(diabetic retinopathy, DR)视网膜和脉络膜血流密度的变化。方法 横断面研究。观察山东省立医院共159例患者微循环变化情况。根据DR的分期,将患者分为糖尿病无视网膜病变(no diabetic retinopathy, NDR)组69眼,非增殖期糖尿病视网膜病变(non-proliferative diabetic retinopathy, NPDR)组54眼,增殖期糖尿病视网膜病变(proliferative diabetic retinopathy, PDR)组72眼,年龄相匹配的68只健康眼作为对照。使用UWFSS-OCTA在26 mm×21 mm范围内扫描眼底图像,以黄斑为中心分为1~6 mm、6~15 mm、15~21 mm的同心环(分上、下、鼻、颞),分别测量视网膜浅层毛细血管网(superficial capillary plexus, SCP)、视网膜深层毛细血管网(deep capillary plexus, DCP),脉络膜厚度(choroidal thickness, CT)、脉络膜灌注面积(choroidal perfusion area, CPA)。分析视网膜血管密度、最佳矫正视力(BCVA; 以LogMAR表示)及糖尿病病程的关系。结果 与其他组相比,PDR组的SCP和DCP降低,NPDR组部分区域低于对照组。PDR及NPDR组在部分区域CT低于对照组,PDR组在部分区域低于对照组及NDR组。脉络膜血流分析显示,PDR组在多区域CPA低于其他组。糖尿病病程与DCP部分区域负相关,与BCVA(LogMAR)正相关。结论 UWFSS-OCTA能够清晰展示糖尿病视网膜病变不同阶段的微循环损伤,为临床诊断和个性化治疗提供了重要技术支持。

Abstract

Objective To investigate changes in retinal and choroidal blood flow density in diabetic retinopathy (DR) of varying severity using ultra-widefield swept-source optical coherence tomography angiography (UWFSS-OCTA). Methods A total of 159 individuals (263 eyes) recruited from Shandong Provincial Hospital were included. Based on DR staging, patients were categorized into the non-diabetic retinopathy (NDR) group (69 eyes), non-proliferative diabetic retinopathy (NPDR) group (54 eyes), and proliferative diabetic retinopathy (PDR) group (72 eyes). Age-matched healthy controls comprised 68 eyes. Using UWFSS-OCTA to scan fundus images within a 26 mm×21 mm field, the macula was centered and divided into concentric rings of 1-6 mm, 6-15 mm, and 15-21 mm (upper, lower, nasal, and temporal). Measurements were taken for the superficial capillary plexus (SCP), deep capillary plexus (DCP), choroidal thickness (CT), and choroidal perfusion area (CPA). The relationship between retinal vascular density, best-corrected visual acuity (BCVA; expressed as LogMAR), and diabetes duration were analyzed. Results Compared with other groups, the PDR group exhibited reduced SCP and DCP, while the NPDR group showed lower values in certain regions relative to the control group. Both PDR and NPDR groups demonstrated lower CT values than the control group in some regions, with the PDR group also showing lower values than both the control and NDR groups in certain areas. Choroidal blood flow analysis revealed that the PDR group had lower CPA in multiple regions compared to other groups. Diabetes duration was negatively correlated with DCP in some regions and positively correlated with BCVA (LogMAR). Conclusion UWFSS-OCTA clearly demonstrates microcirculatory damage at different stages of diabetic retinopathy, providing crucial technical support for clinical diagnosis and personalized treatment.

关键词

糖尿病视网膜病变 / 超广角扫频源光学相干断层扫描血管成像 / 视网膜血管 / 血流密度 / 脉络膜厚度

Key words

Diabetic retinopathy / UWFSS-OCTA / Retinal vessels / Blood flow density / Choroidal thickness

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基金资助

山东省自然科学基金项目(ZR2019MH111)