| Objective:OCTA was used to observe the changes of microvascular in the macular area of DME after anti-VEGF treatment,and combining with CRT and BCVA to explore the relationship between the observed parameters.Methods:1.Prospective case-control study methods.27 patients(41eyes)with DME who admitted to the ophthalmology department of the First Affiliated Hospital of Chongqing Medical University from Sept.2019to Jan.2021 were included in the study,including 13 males(19 eyes)and 14females(22 eyes),14 eyes in NPDR group and 27 eyes in PDR group.2.The patient’s BCVA,CRT,and the FAZ area,perimeter of FAZ,circularity index of FAZ,VD,PD in OCTA 3mm*3mm mode were recorded before and 1 month and 2 months after injection.3.SPSS 22.0 software was used for statistical analysis.Measurement data were expressed as mean±standard deviation(X±s).T test was used for normal data,nonparametric test was used for non-normal data and Spearman analysis was used for correlation analysis,and P<0.05 was considered statistically significant.Results:A month after anti-VEGF treatment,The improvement in vision was not significant in the NPDR group(P>0.05),but which significantly improved in the PDR group(P=0.009).After 2 months,visual acuity was significantly improved in both groups(P=0.032,0.007,P<0.05).The visual acuity of PDR group after 2 months was significantly lower than that of NPDR group(P=0.025,P<0.05).A month after injection,the CRT of the NPDR group was not significantly decreased from baseline(P>0.05),but the CRT of the PDR group was significantly decreased(P<0.001).Two months latter,CRT in both groups decreased significantly from baseline(P=0.074,P<0.001).There was no significant difference in CRT between the two groups before and after injection(P>0.05.After treatment,there were no significant differences in the area of FAZ,perimeter of FAZ and circularity index of FAZ between the two groups compared with the baseline(P>0.05).The area of FAZ,perimeter of FAZ and circularity index of FAZ between the two groups were no difference before and after injection(P>0.05).In the NPDR group,the VD and PD of foveal,parafoveal and full area was not significantly changed after 1month compared to baseline(P>0.05),while the VD and PD of parafoveal and full area were significantly decreased from the baseline after 2 months(P<0.05).In PDR group,the VD and PD of foveal,parafoveal and full area were significantly decreased after 1 month compared with the baseline(P<0.05),and the VD and PD in the foveal and full area were significantly decreased after 2 months compared with the baseline(P<0.05).The VD of parafoveal area in PDR group was obviously lower than which in NPDR group at the baseline(P=0.040),and there was no difference in PD of each regions between the two groups(P>0.05).The VD and PD of parafoveal and full area in PDR group were significantly lower than those in NPDR group after 1 month(P<0.05).There was no statistical difference in VD and PD between the two groups after 2 months(P>0.05).There was a lower correlation between the BCVA(Log MAR)and CRT at the baseline(rs=0.312,P=0.047),after 2months,BCVA(Log MAR)was only negatively correlated with parafoveal VD(rs=-0.338,P=0.030),but there was no correlation between vision improvement and the changes of CRT(rs=0.92,P>0.05).Baseline CRT and VD of parafoveal and full area,and PD of foveal,parafoveal and full area were positively related(P<0.05).After 2 months,CRT was positively correlated with the VD and PD in foveal and full area(P<0.05).The baseline FAZ area was negatively correlated with the VD and PD of the foveal and full area(P<0.05).After 2 months,FAZ area was negatively correlated with CRT(P=0.010),which was also negatively correlated with the VD and PD of foveal area,and VD of full area(P<0.05).The perimeter of FAZ was negatively correlated with the VD and PD in the foveal and full area(P<0.05)at the baseline,and there was a negative correlation between the perimeter of FAZ and VD and PD of foveal area,and VD of full area(P<0.05)after 2 months.There was a highly positive correlation between the perimeter of FAZ and FAZ area before and after injection.(rs>0.8,P<0.05).A multiple regression model found that the baseline visual acuity was a strong predictor of patients’postoperative visual acuity(adjusted R~2=0.382,intercept=-0.017,β=0.549).Conclusion:After anti-VEGF treatment,the CRT of DME patients decreased and the visual acuity improved,but they were not parallel.And baseline visual acuity had a strong predictive effect on postoperative visual acuity.The vascular density reduced after anti-VEGF,and large sample prospective randomized controlled studies were needed to further verify and explain.It was found that the changes of visual acuity,CRT and vascular density in the NPDR group lagged behind that in the PDR group,and it was speculated that the inflammatory was more serious in the PDR,and the response of anti-VEGF therapy was more effective in the early stage.Besides,it was also found that CRT was positively correlated with vascular density,especially in the fovea,this may reveal the significance of macular microvascular dilation in the occurrence and development of DME.OCTA can quantify and follow up microvascular changes dynamically,which plays an important role in exploring vascular factors in DME. |
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