【摘要】 目的观察特发性黄斑前膜(IMEM)患者微视野和光学相干断层扫描血管成像(OCTA)的微血管变化及与视力的相关性。方法横断面研究。选择2019年10月至2020年10月来我院就诊的IMEM患者37例(72眼),根据Gass分期分为A组(2期IMEM 23眼)和B组(0期、1期IMEM 25眼)及C组(健康对侧眼24眼)。另选择健康对照组13人26眼为D组。利用OCTA检测所有受试者视网膜厚度、黄斑区中心凹视网膜浅层血流密度(FSVD)、黄斑中心凹视网膜厚度(CMT)、黄斑中心凹脉络膜厚度、黄斑中心凹无血管区(FAZ)面积和FAZ 300μm宽度内血流密度(FD-300)。微视野计检查各组受检眼黄斑中心6°范围的视觉敏感度(MS),分析不同组别受检眼OCTA检测指标、MS与视力的相关性。结果 A组患眼BCVA大于B组、C组和D组,B组大于D组;A组患眼CMT大于B组,B组大于C组、D组;5个方位视网膜厚度中央视网膜厚度A组大于B组、C组和D组,B组大于D组,上方、下方、鼻侧、颞侧视网膜厚度A组大于B组、C组和D组。5个方位MS A组小于D组。A组FSVD大于B组;各组间黄斑中心凹下脉络膜厚度无显著差异;FAZ面积A组、B组小于C组、D组;A组FD-300大于B组、C组和D组,B组大于D组。BCVA(logMAR)与视网膜中央厚度和FD-300均呈正相关(r=0.719,P<0.01;r=0.407,P<0.01),与视网膜中央MS呈负相关(r=-0.564,P<0.01),与FSVD不相关(r=0.267,P=0.066),与FAZ面积不相关(r=-0.004,P=0.978)。IMEM患眼中央、上方、颞侧、下方、鼻侧视网膜厚度与其所对应的MS均呈负相关(均为P<0.05)。结论 IMEM引起的黄斑区视网膜厚度和血流改变会导致患者视力和MS的改变。更多还原

【Abstract】 Objective To explore the microvascular changes of patients with idiopathic macular epiretinal membrane(IMEM) based on microperimetry and optical coherence tomography angiography(OCTA) and their correlation with visual acuity. Methods This study was a cross-sectional study. Totally 37 patients(72 eyes) treated in our hospital from October 2019 to October 2020 and 13 healthy individuals(26 eyes) were included. All eyes were divided into group A(23 eyes of IMEM in stage 2), group B(25 eyes of IMEM in stage 0 and 1), group C(24 healthy fellow eyes), and group D(26 normal eyes of controls). The retinal thickness, foveal superficial vessel density(FSVD), central macular thickness(CMT), subfoveal choroidal thickness(SFCT), foveal avascular zone(FAZ), and vessel density within a 300 μm-wide annulus surrounding FAZ(FD-300) were measured by OCTA. The mean sensitivity(MS) within the central 6° was measured by microperimetry. Based on these results, the correlations between the OCTA measurements, MS and the visual acuity were analyzed. Results BCVA in group A was higher than groups B, C, and D, and that in group B was higher than group D. CMT in group A was higher than group B, and that in group B was higher than groups C and D. The retinal thickness in the central, superior, inferior, nasal, and temporal sides in group A was higher than groups B, C, and D, and that in the central side in group B was higher than group D. The retinal MS in the central, superior, inferior, nasal, and temporal sides in group A was lower than group D. FSVD in group A was increased compared with group B. SFCT showed no statistically significant difference among these groups. FAZ areas in group A and B were smaller than group C and D. FD-300 in group A was higher than groups B, C, and D, and that in group B was higher than group D. The logMAR BCVA was positively correlated with CMT and FD-300(r=0.719, P<0.01; r=0.407, P<0.01), and was negatively correlated with MS in the center of retina(r=-0.564, P<0.01). It was not correlated with FSVD(r=0.267, P=0.066) and FAZ area(r=-0.004, P=0.978). The retinal thickness in the central, superior, temporal, inferior, and nasal sides was negatively correlated with their corresponding MS(all P<0.05).Conclusion Changes in the macular retinal thickness and blood flow induced by IMEM affect patients’ visual acuity and MS.更多还原