目的:本研究旨在分析光学相干断层扫描血管造影(OCTA)对糖尿病性黄斑水肿(DME)分期的影响,并评估激光光凝的疗效。
方法:选择2019年8月至2022年3月在我院就诊的86例(141只眼)疑似DME患者,行眼底血管造影和OCTA检查。比较两种检查方法在黄斑水肿分期中的疗效。随后,灵敏度,特异性,准确度,正预测值,以眼底血管造影作为金标准评估OCTA诊断DME的阴性预测值。在使用激光光凝治疗的具有临床意义的黄斑水肿(CSME)的患者中,中央凹形非灌注区(FAZ),血管密度(VD),黄斑中心视网膜厚度(CRT),全视网膜血流密度(FD-300),浅表毛细血管丛(SCP),治疗前使用OCTA3mm×3mm模式测量深毛细血管丛(DCP),治疗后3个月,治疗后6个月。SCP,深毛细血管丛(DCP),血流密度(VD),最佳矫正视力(BCVA),治疗前记录中央视网膜厚度(CRT),治疗后3个月,治疗后6个月。采用Pearson相关性分析治疗后6个月BCVA与治疗前OCTA参数的相关性。
结果:对86例(141只眼)疑似DME患者行眼底血管造影。141只眼睛中,44没有泄漏,52例弥漫性水肿,40例有局灶性黄斑水肿,5只眼缺血。共有97只眼眼底血管造影显示CSME。以眼底血管造影作为金标准,OCTA的灵敏度为97.94%,特异性为63.64%,诊断CSME的准确率为87.23%。OCTA与眼底血管造影的Kappa值为0.674。受试者工作特征曲线显示,OCTA诊断CSME的曲线下面积(AUC)为0.808(95%置信区间:0.717-0.899)。BCVA更高,CSME患者在治疗后3个月和6个月的CRT降低(P<0.05)。CSME患者治疗后3个月的OCTA参数与治疗前比较差异无统计学意义(P>0.05)。同样,CSME患者治疗后6个月的FD300与治疗前比较差异无统计学意义(P>0.05)。然而,FAZ地区,DCP-VD(总体上,中央凹面,和准中央凹),和SCP-VD(总体而言,中央凹面,与治疗前相比,CSME患者在治疗后6个月和旁中心凹)较高(P<0.05)。Pearson相关显示BCVA与治疗前FAZ面积呈正相关,DCP-VD,和SCP-VD(r>0,P<0.05),与CRT呈负相关(r<0,P<0.05)。
结论:OCTA对DME的诊断和分期具有较高的敏感性和特异性。它能巧妙地捕捉到激光光凝治疗前后黄斑中央隐窝的微血管和视觉变化,定量指导DME的后续治疗。
OBJECTIVE: This study aimed to analyze the effect of optical coherence tomography angiography (OCTA) on diabetic macular edema (DME) staging and assess the efficacy of laser photocoagulation.
METHODS: Eighty-six patients (141 eyes) with suspected DME who visited our hospital from August 2019 to March 2022 were selected and underwent fundus angiography and OCTA. The two examination methods were compared in terms of their efficacy in macular edema staging. Subsequently, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of OCTA in diagnosing DME were assessed using fundus angiography as the gold standard. In patients with clinically significant macular edema (CSME) treated with laser photocoagulation, the central concave non-perfused zone (FAZ), vascular density (VD), central macular retinal thickness (CRT), whole retinal blood flow density (FD-300), superficial capillary plexus (SCP), and deep capillary plexus (DCP) were measured using the OCTA 3 mm × 3 mm mode before treatment, at 3 months after treatment, and at 6 months after treatment. SCP, deep capillary plexus (DCP), blood flow density (VD), best corrected visual acuity (BCVA), and central retinal thickness (CRT) were recorded before treatment, 3 months after treatment, and 6 months after treatment. The correlation between BCVA and pre-treatment OCTA parameters at 6 months after treatment was analyzed using Pearson\'s correlation.
RESULTS: Fundus angiography was performed in 86 patients (141 eyes) with suspected DME. Of the 141 eyes, 44 had no leakage, 52 had diffuse edema, 40 had focal macular edema, and 5 had eyes ischemia. A total of 97 eyes showed CSME on fundus angiography. Using fundus angiography as the gold standard, OCTA exhibited a sensitivity of 97.94 %, a specificity of 63.64 %, and an accuracy of 87.23 % in diagnosing CSME. The Kappa value between OCTA and fundus angiography was 0.674. The receiver operating characteristic curve revealed that the area under the curve (AUC) of OCTA in diagnosing CSME was 0.808 (95 % confidence interval: 0.717-0.899). The BCVA was higher, while the CRT was lower in CSME patients at 3 and 6 months after treatment (P<0.05). No significant difference was observed in the OCTA parameters in CSME patients at 3 months after treatment compared with that before treatment (P>0.05). Similarly, no significant difference was found in the FD300 of CSME patients at 6 months after treatment compared with that before treatment (P>0.05). However, the FAZ area, DCP-VD (overall, central concave, and paracentral concave), and SCP-VD (overall, central concave, and paracentral concave) were higher in CSME patients at 6 months after treatment compared with that before treatment (P<0.05). Pearson\'s correlation showed that BCVA was positively correlated with pre-treatment FAZ area, DCP-VD, and SCP-VD (r>0, P<0.05), and negatively associated with CRT (r<0, P<0.05).
CONCLUSIONS: OCTA exhibited high sensitivity and specificity in diagnosis and staging DME. It adeptly captures the microvascular and visual changes in the central macular recess before and after laser photocoagulation therapy, which can quantitatively guide the follow-up treatment of DME.