白内障术后黄斑囊样水肿的OCTA研究

An Optical Coherence Tomography Angiography Study of Pseudophakic Cystoid Macular Edema

摘要: 目的：使用光学相干断层扫描血管造影术(Optical Coherence Tomography Angiography, OCTA)对白内障术后黄斑囊样水肿患者的黄斑区视网膜厚度及血流情况进行研究。材料：本研究为前瞻性研究，收集2017年4月到2018年2月期间就诊于青岛大学附属医院眼科的白内障术后黄斑囊样水肿患者20例20只眼，正常白内障术后患者20例20只眼，利用OCTA测量白内障术后黄斑囊样水肿患者治疗前后、正常白内障术后患者的黄斑区视网膜厚度，黄斑的灌注、血管密度并进行分析。结果：正常组黄斑血管密度为19.23 ± 1.88，灌注密度为0.429 ± 0.039，黄斑区视网膜厚度为254.12 ± 22.02 μm，白内障术后黄斑囊样水肿组黄斑血管密度为18.66 ± 2.911，灌注密度为0.408 ± 0.045，黄斑区视网膜厚度为482.15 ± 19.23 μm，黄斑囊样水肿组黄斑血管、灌注密度较正常组减少(P < 0.05)，黄斑区视网膜厚度增加(P < 0.01)。经过曲安奈德治疗后，白内障术后黄斑囊样水肿组黄斑血管密度为19.06 ± 2.911，灌注密度为0.418 ± 0.031，黄斑区视网膜厚度为268.34 ± 17.14 μm，较治疗前血管密度、灌注密度增加(P < 0.05)，黄斑区视网膜厚度减少(P < 0.01)。结论：白内障术后黄斑水肿患者黄斑区视网膜厚度增加，血流密度及灌注密度减少。经曲安奈德治疗后，白内障术后黄斑水肿患者黄斑区视网膜厚度较治疗前减少，血管密度及灌注密度较治疗前增加。

Abstract: Objective: To study the central foveal thickness (CFT) and macular vascular density in pseudo-phakic cystoid macular edema (PCME) patients using optical coherence tomography angiography (OCTA). Materials: This study was a prospective study. 20 eyes 20 patients with PCME and 20 eyes of 20 normal patients after cataract surgery in the affiliated hospital of Qingdao University from April 2017 to February 2018 were enrolled. The CFT, macular vascular density, macular perfusion density of normal patients after cataract surgery, patients before and after triamcinolone acetonide injection in patients with PCME were measured by OCTA, and we analyzed the material. Results: The macular vascular density in normal group was 19.23 ± 1.88, the macular perfusion density was 0.429 ± 0.039, the CFT was 254.12 ± 22.02 μm. The macular density of PCME group was 18.66 ± 2.911, the perfusion density was 0.408 ± 0.045, the CFT was 482.15 ± 19.23 μm. The macular vascular density and the macular perfusion density of PCME group were lower than those in normal group (P < 0.05). The CFT was increased (P < 0.01). After triamcinolone acetonide treatment, the macular vascular density of PCME group was 19.06 ± 2.911, the perfusion density was 0.418 ± 0.031, and the CFT was 268.34 ± 17.14 μm, which was higher than the pre-treatment vascular density and perfusion density (P < 0.05), and CFT in macular was decreased (P < 0.01). Conclusion: The macular vascular density and perfusion density were decreased in PCME patients, and the CFT was increased. After triamcinolone acetonide treatment, the CFT of PCME patients was reduced than pre-treatment, and the macular vascular density and perfusion density were increased than pre-treatment.

文章引用：李晓晓, 张丽娜, 冷林, 齐莹莹, 王艳萍. 白内障术后黄斑囊样水肿的OCTA研究[J]. 眼科学, 2018, 7(1): 66-72. https://doi.org/10.12677/HJO.2018.71010

参考文献

[1]	Belair, M.L., Kim, S.J., Thorne, J.E., et al. (2009) Incidence of Cystoid Macular Edema after Cataract Surgery in Patients with and without Uveitis Using Optical Coherence Tomography. American Journal of Ophthalmology, 148, 128. [Google Scholar] [CrossRef] [PubMed]
[2]	Specialist, S.S. and Van, S. (2001) Non-Steroidal Anti-Inflammatory Agents for Treating Cystoid Macular Oedema Following Cataract Surgery. John Wiley & Sons, Ltd., Hoboken, CD004239.
[3]	Şahin, M., Cingü, A.K. and Gözüm, N. (2013) Evaluation of Cystoid Macular Edema Using Optical Coherence Tomography and Fundus Au-tofluorescence after Uncomplicated Phacoemulsification Surgery. Journal of Ophthalmology, 2013, 376013-376013. [Google Scholar] [CrossRef] [PubMed]
[4]	万敏婕, 杨先凤. SD-OCT及FFA在白内障术后黄斑囊样水肿研究中的应用[J]. 眼科新进展, 2015, 35(1): 55-59.
[5]	陈青山, 彭云, 余宝花, 李志, 谢秀英. 黄斑囊样水肿的OCT与FFA对比观察[J]. 中国实用眼科杂志, 2008, 26(10): 1075-1076.
[6]	Jiao, S., Knighton, R., Huang, X., Gregori, G. and Puliafito, C. (2005) Simultaneous Acquisition of Sectional and Fundus Ophthalmic Images with Spectral-Domain Optical Coherence Tomography. Optics Express, 13, 444-452. [Google Scholar] [CrossRef]
[7]	Jia, Y., Tan, O., Jason, T., et al. (2012) Split-Spectrμm Amplitude-Decorrelation Angiography with Optical Coherence Tomography. Optics Express, 20, 4710-4725. [Google Scholar] [CrossRef]
[8]	Henderson, B.A., Kim, J.Y., Ament, C.S., Ferrufinoponce, Z.K., Grabowska, A. and Cremers, S.L. (2007) Clinical Pseudophakic Cystoid Macular Edema. Risk Factors for Development and Duration after Treatment. Journal of Cataract & Refractive Surgery, 33, 1550-1558. [Google Scholar] [CrossRef] [PubMed]
[9]	蔡蕾, 杨晋, 卢奕. 白内障术后黄斑囊样水肿诊断与治疗进展[J]. 国际眼科纵览, 2013, 37(4): 234-238.
[10]	Ji, W.J., Chung, B.H., Kim, E.K., Seo, K.Y. and Kim, T.I. (2015) The Effects of Two Non-Steroidal Anti-Inflammatory Drugs, Bromfenac 0.1% and Ketorolac 0.45%, on Cataract Surgery. Yonsei Medical Journal, 56, 1671-1677. [Google Scholar] [CrossRef] [PubMed]
[11]	Rho, D.S., Soll, S.M. and Markovitz, B.J. (2006) Bromfenac 0.09% versus Diclofenac Sodium 0.1% versus Ketorolac Tromethamine 0.5% in the Treatment of Acute Pseudophakic Cystoid Macular Edema.
[12]	唐瑞雪. 玻璃体腔内注射曲安奈德与贝伐单抗治疗白内障术后黄斑水肿的疗效[J]. 国际眼科杂志, 2016(1): 135-137.
[13]	Lobo, C.L., Faria, P.M., Soares, M.A., Bernardes, R.C. and Cunha-Vaz, J.G. (2004) Macular Alterations after Small-Incision Cataract Surgery. Journal of Cataract & Refractive Surgery, 30, 752-760. [Google Scholar] [CrossRef]
[14]	龚晋, 王平, 岳军, 等. 玻璃体腔注射曲安奈德联合黄斑格栅样激光光凝治疗黄斑水肿的效果[J]. 广东医学, 2013, 34(20): 3172-3175.
[15]	乔宝笛, 戴涛, 帖彪, 陈鹏. 曲安奈德玻璃体腔注射联合黄斑格栅样光凝治疗黄斑水肿的临床研究[J]. 中华实验眼科杂志, 2012, 30(8): 734-738.
[16]	梅海峰, 邢怡桥, 江双红, 郭颖. 曲安奈德玻璃体腔内注射治疗白内障术后慢性黄斑囊样水肿[J]. 眼科新进展, 2006, 26(6): 450-451.
[17]	Jia, Y., Wei, E., Wang, X., et al. (2014) Optical Coherence Tomography Angiography of Optic Disc Perfusion in Glaucoma. Ophthalmology, 121, 1322-1332. [Google Scholar] [CrossRef] [PubMed]
[18]	Liu, L., Jia, Y., Takusagawa, H.L., et al. (2015) Optical Coherence Tomography Angiography of the Peripapillary Retina in Glaucoma. Jama Ophthalmology, 133, 1045. [Google Scholar] [CrossRef] [PubMed]
[19]	Kwon, J., Choi, J., Shin, J.W., Lee, J. and Kook, M.S. (2017) Altera-tions of the Foveal Avascular Zone Measured by Optical Coherence Tomography Angiography in Glaucoma Patients with Central Visual Field Defects. Investigative Ophthalmology & Visual Science, 58, 1637-1645. [Google Scholar] [CrossRef] [PubMed]