【摘要】 目的 研究糖尿病性黄斑水肿(DME)患者视网膜深层毛细血管丛(DCP)的血流密度(VD)与康柏西普治疗预后的关系。方法 回顾性分析2020年1月至2021年7月就诊于潍坊医学院附属医院眼科中心的46例非增生型糖尿病视网膜病变(NPDR)期DME患者(DME组)和同期37例无DME的NPDR患者(对照组)资料。DME组患者连续3次玻璃体内注射康柏西普，根据3次治疗后黄斑中心视网膜厚度(CRT)的降低程度分为有效组(>50μm)和疗效欠佳组(≤50μm)。OCTA测量患者治疗前及治疗后1个月、3个月的视网膜浅层毛细血管丛VD(SCP-VD)、DCP-VD、CRT、黄斑中心凹无血管区(FAZ)面积、FAZ旁300μm的血流密度(FD300)等参数，分析各参数的差异及相关性。结果 DME组患者整体、中心凹和旁中心凹SCP-VD、DCP-VD均较对照组低，差异均有统计学意义(均为P<0.05);除CRT外，DME组患者治疗后1个月、3个月的OCTA参数与治疗前比较差异均无统计学意义(均为P>0.05);DME组患者治疗后1个月、3个月BCVA(logMAR)(0.38±0.28、0.37±0.29)均较治疗前(0.54±0.39)显著提高，治疗后1个月CRT[(327.457±73.684)μm]、治疗后3个月CRT[(304.761±58.537)μm]均较治疗前[(380.065±82.685)μm]显著降低(均为P<0.05);有效组患者中心凹DCP-VD(36.258%±13.187%)较疗效欠佳组(28.564%±8.855%)大(P=0.024),两组患者间其余OCTA参数(FAZ面积、FD300、整体SCP-VD、中心凹SCP-VD、旁中心凹SCP-VD、整体DCP-VD、旁中心凹DCP-VD、CRT)差异均无统计学意义(均为P>0.05);DME组患者治疗前中心凹DCP-VD与治疗后3个月CRT下降值呈正相关(P=0.040),患者治疗前整体DCP-VD和旁中心凹DCP-VD与治疗后3个月BCVA提高值均呈正相关(P=0.033、0.036),余参数间均无明显相关性(均为P>0.05)。结论 DME患者DCP-VD与黄斑水肿的发展密切相关，DCP-VD可能可以作为预测DME患者抗VEGF治疗预后的指标。更多还原

【Abstract】 Objective To investigate the correlation between the vessel density(VD) in retinal deep capillary plexus(DCP) and the prognosis of patients with diabetic macular edema(DME) treated with Conbercept. Methods This was a retrospective study. A total of 46 DME patients with non-proliferative diabetic retinopathy(NPDR) were selected into the DME group, and 37 NPDR patients without DME were selected into the control group. Patients in the DME group were subdivided into the effective group(>50 μm) and ineffective group(≤50 μm) according to the reduction of central retinal thickness(CRT) after three consecutive intravitreal injections of Conbercept. The vessel density in superficial capillary plexus(SCP-VD), vessel density in deep capillary plexus(DCP-VD), CRT, foveal avascular zone(FAZ), VD in a 300-μm-wide region around the FAZ(FD300) and other parameters were measured by optical coherence tomography angiography(OCTA) before, 1 month and 3 months after treatment with Conbercept, and their correlations were analyzed. Results Compared with the control group, the global, foveal and parafoveal SCP-VD and DCP-VD in the DME group were significantly lower(all P<0.05). Except CRT, OCTA parameters in the DME group at 1 month and 3 months after treatment had no significant difference compared with those before treatment(all P>0.05). The BCVA(logMAR) in the DME group was 0.38±0.28 at 1 month after treatment and 0.37±0.29 at 3 months after treatment, significantly better than that before treatment(0.54±0.39)(both P<0.05). The CRT in the DME group was(327.457±73.684)μm at 1 month after treatment and(304.761±58.537)μm at 3 months after treatment, significantly lower than that before treatment [(380.065±82.685)μm](both P<0.05). The foveal DCP-VD in the effective group [(36.258±13.187) %] was higher than that in the ineffective group [(28.564±8.855) %](P=0.024), while other OCTA parameters(FAZ, FD300, global SCP-VD, foveal and parafoveal SCP-VD, global and parafoveal DCP-VD, CRT) had no significant difference between the two groups(all P>0.05). The preoperative foveal DCP-VD was positively correlated with the CRT decrease at 3 months after treatment(P=0.040). The global and parafoveal DCP-VD at baseline were positively correlated with the BCVA recovery at 3 months after treatment(P=0.033, 0.036). There was no correlation between the rest parameters(all P>0.05). Conclusion DCP-VD is closely related to the development of macular edema in DME patients. It may be used as an indicator to predict the prognosis of anti-vascular endothelial growth factor therapy in DME patients.更多还原