摘要
目的 应用OCTA观察湿性老年性黄斑变性(nAMD)合并视网膜色素上皮脱离(PED)患者雷珠单抗治疗前后黄斑区新生血管(MNV)的形态和主要指标变化,并与最佳矫正视力(BCVA)比较,分析OCTA在nAMD合并PED患者抗新生血管治疗中的价值.方法 收集2021年1月～2022年6月在我院就诊的nAMD患者30例(31眼),所有患者按照"3+PRN"方案行玻璃体腔注射雷珠单抗,应用OCTA检测患者治疗前及治疗后(1周、1个月、6个月、12个月)的MNV流动面积、MNV最大直线长度、黄斑中心凹视网膜厚度(CMT)、PED宽度(PEDW)和PED高度值(PEDH),分析各项指标治疗前后的变化及其与患者初始BCVA和治疗后BCVA的相关性.结果 与治疗前相比,患者雷珠单抗治疗后BCVA明显提高,注射后1周、1个月、6个月、12个月与治疗前比较,差异均有统计学意义(P＜0.05);OCTA显示患者MNV流动面积、MNV最大线性尺寸、PEDW、PEDH及CMT值在治疗后1周、1个月、6个月、12个月均明显减小,与治疗前相比,差异均有统计学意义(P＜0.05).患者初始MNV流动面积、MNV最大线性尺寸、PEDW、PEDH及CMT值与患者治疗前BCVA值和治疗后BCVA值比较,治疗前、后BCVA均与最初MNV血流面积、MNV最大长度值存在正向相关性,而与PEDW、PEDH及CMT值无相关性.结论 OCTA可以通过对MNV血流面积、MNV最大长度值的动态检测对nAMD合并PED患者的抗新生血管治疗预后提供帮助,具有临床指导价值;PED高度和宽度可能对nAMD合并PED患者抗新生血管治疗的视力预后影响不大.
Abstract
Objective OCTA was applied to observe the changes in the morphology and major indexes of macular neovascularization(MNV)in patients with neovascular age-related macular degeneration combined with retinal pigment epithelial detachment(PED)before and after treatment with ranibizumab,and to compare it with the best-cor-rected visual acuity(BCVA),in order to analyze the value of OCTA in the anti-neovascular treatment of patients with nAMD combined with PED.Methods Thirty patients(31 eyes)with nAMD were collected from January 2021 to June 2022,and all of them underwent vitreous injection of ranibizumab according to the"3+PRN"protocol,and OCTA was ap-plied to detect the MNV flow area,MNV maximum linear length,macular central recess retinal thickness(CMT),and PED width(PEDW)and PED height values(PEDH)of the patients before and after treatment(1 week,1 month,6 months and 12 months),to analyze the changes of each index before and after treatment,and to analyze its correlation with the patients'initial BCVA and post-treatment BCVA.Results Compared with pre-treatment,BCVA increased sig-nificantly after treatment,and the difference between 1 week,1 month,6 months and 12 months after injection and pre-treatment was statistically significant(P＜0.05).OCTA showed that patients'MNV flow area,MNV maximum linear di-mension,PEDW,PEDH,and CMT values were significantly reduced at 1 week,1 month,and 6 months after treatment,and the differences were all statistically significant compared with those before treatment(P＜0.05).Comparison of pa-tients'initial MNV flow area,MNV maximum linear dimension,PEDW,PEDH,and CMT values with patients'pre-treat-ment BCVA values and post-treatment BCVA values showed that there was a positive correlation between pre-treatment and post-treatment BCVA and the initial MNV flow area and MNV maximum length values,whereas there was no correla-tion with PEDW,PEDH,and CMT values.Conclusion OCTA can help the prognosis of antineovascular therapy in pa-tients with nAMD combined with PED by the dynamic detection of MNV flow area and MNV maximum length value,which has clinical guidance value;PED height and width may have little effect on visual prognosis in patients with nAMD combined with PED on antineovascular therapy.
基金项目
潍坊市科技局项目(2021YX029)
潍坊医学院附属医院博士基金(2020BSQD02)
潍医附院种子基金(2022wyfyzzjj10)
NETL
NSTL
万方数据