| Part1:Quantitative analysis of macular morphology and microcirculation of pathological myopia choroidal neovascularizationPurpose:To quantitatively analyze the changes of macular morphology and microcirculation in patients with myopic choroidal neovascularization(m CNV)by optical coherence tomography(OCTA),and to provide theoretical support for the study of pathogenesis and progression of m CNVMethod:Patients diagnosed as pathological myopia(PM)in the ophthalmology department of Subei People’s Hospital in from May 2020 to December 2020 were selected.There were 30 eyes in 30 patients with combined CNV(m CNV group),27 eyes in 30 patients with PM without combined CNV(PM non-CNV group),and 29 eyes in30 normal control group.Dioptry,axial length(AL),and best corrected visual acuity(BCVA)were examined for all subjects.OCTA was used to measure the area,perimeter,and foveal vessel density(FVD)of the foveal avascular zone(FAZ).Full retinal thickness(FRT),inner retinal thickness(IRT),outer retinal thickness(ORT),superficial capillary plexus vessel density(SCP-VD)and deep capillary plexus vessel density(DCP-VD)of the macular fovea,paracentral fovea and four quadrants of paracentral fovea,subfoveal choroidal thickness(SFCT)and choroid capillaries vessel density(CC-VD).The retinal thickness of each layer,morphology and microcirculation indexes of different quadrants were compared and analyzed among the three groups.Results:1.Retinal thickness:Compared with the control group and PM non-CNV group,the foveal full retinal thickness(FRT)and outer retinal thickness(ORT)of m CNV group were significantly increased(P<0.001,P=0.001,P=0.001,P<0.001);the foveal inner retinal thickness(IRT)was significantly higher in both the m CNV group and the PM non-CNV group compared with the control group(P=0.009,P=0.012).2.Retinal vessel density:Compared with the control group,the superficial capillary plexus vessel density(SCP-VD)in m CNV group and PM non-CNV group was significantly decreased(P=0.031,P=0.012);compared with the control group and PM non-CNV group,the deep capillary plexus vessel density(DCP-VD)in the m CNV group was significantly decreased(P=0.024,P=0.044).The foveal vessel density(FVD)was significantly decreased in the m CNV group and PM non-CNV group compared with the control group(P<0.001,P=0.001).3.The area and perimeter of foveal avascular zone:Compared with the control group,the area and perimeter of FAZ in PM non-CNV group were significantly decreased(P<0.001,P=0.048);compared with the control group and PM non-CNV group,there were no statistically significant differences in FAZ area and FAZ perimeter in the m CNV group(P=0.425,P=0.742,P=0.061,P=0.595).4.Subfoveal choroidal thickness and choroid capillaries vessel density:Compared with the control group,the SFCT in the m CNV group and the PM non-CNV group was significantly decreased(P<0.001);compared with the control group and PM non-CNV group,the CC-VD of the m CNV group was significantly decreased(P=0.039,P=0.003).Conclusions:1.The foveal full retinal thickness and outer retinal thickness of m CNV were significantly higher than those in control group and PM non-CNV group.2.m CNV eyes have an effect on the retinal capillary plexus vessel density in the macular area,resulting in a decrease in the superficial and deep capillary plexus vessel density compared with the normal population.3.The deep capillary plexus vessel density was significantly lower than that in the control group and PM non-CNV group,but the superficial capillary plexus vessel density was not significantly different.4.The subfoveal choroidal thickness of m CNV eyes was lower than that in the control group,and the choroid capillaries vessel density was lower than that of the PM non-CNV group and the control group.Part2:The effect of anti-VEGF agents on macular morphology and microcirculation of m CNVPurpose:To evaluate the efficacy of intravitreal injection of anti-VEGF agents in the treatment of m CNV,and to analyze the effect of intravitreal injection of anti-VEGF agents on macular morphology and microcirculation,so as to provide evidence for the safe and effective treatment of m CNV.Method:A total of 15 eyes of m CNV patients diagnosed from May 2020 to October2020 were enrolled and intravitreal injection of anti-VEGF agents was performed.Among them,9 patients received intravitreal injection of Combercept 0.5mg(10mg/m1)and 6 patients received intravitreal injection of Ranibizumab 0.5mg(10mg/m1).The treatment plan of 1+PRN was adopted and follow-up every month.Best corrected vis-ual acuity(BCVA),CNV lesion area,CNV flow area,retinal thickness of each layer,retinal blood Flow density,subfoveal choroidal thickness and choroid capillaries vessel density were compared and analyzed at baseline and 1,2,3 months after treatment.Results:1.Changes in BCVA after treatment:The Log MAR BCVA of m CNV patients was(0.72±0.29)before treatment,and(0.55±0.17),(0.46±0.15),and(0.41±0.17)at 1,2,and3 months after treatment.The results showed that there were statistically significant differences in the Log MAR BCVA of m CNV patients before treatment and at 1,2,and 3months after treatment(P=0.003).2.Changes of CNV area and Flow area after treatment:The CNV area of m CNV patients was(0.53±0.50)mm~2 before treatment,and(0.48±0.42)mm~2,(0.37±0.32)mm~2and(0.44±0.43)mm~2 at 1,2 and 3 months after treatment.The CNV area of m CNV patients at 1,2 and 3 months after treatment decreased compared with that before treatment,but the differences were not statistically significant(P=0.122).The Flow area of m CNV patients was(0.38±0.39)mm~2before treatment,and(0.32±0.35)mm~2,(0.28±0.35)mm~2,and(0.30±0.35)mm~2 in 1,2 and 3 months after treatment.The Flow area of m CNV patients at 1,2 and 3 months after treatment decreased compared with that before treatment,with no statistical significance(P=0.097).3.There was no statistical significance in the changes of FAZ area and FAZ perimeter in m CNV patients after treatment(P=0.997,P=1.142).4.Changes in macular fovea retinal thickness after treatment:the FRT of m CNV patients in the 1st,2nd and 3rd months after treatment was significantly lower than that before treatment,with statistical significance(P<0.001);There was no significant difference in foveal IRT between m CNV patients before treatment and 1st,2nd and 3rd months after treatment(P=0.760).ORT of m CNV patients at 2nd and 3rd months after treatment was significantly lower than that before treatment,the difference was statistically significant(P=0.001)5.Changes in retinal vessel density after treatment:DCP-VD of m CNV patients after treatment was significantly higher than that before treatment,with statistical signify-cance(P=0.006);There were no significant differences in SCP-VD and FVD in m CNV patients before and after treatment(P>0.05).6.Changes in subfoveal choroidal thickness and choroid capillaries vessel density after treatment:SFCT and CC-VD of m CNV patients before treatment and 1st,2nd and 3rd months after treatment showed no statistically significant differences(P=0.845,P=0.200);Conclusions:1.Intravitreal injection of anti-VEGF agents in the treatment of m CNV showed significant short-term efficacy and improved visual acuity.2.The fovea thickness of the outer retinal in the macular area decreased significantly,and the deep capillary plexus vessel density in the macular fovea increased significantly.m CNV lesions may mainly affect the outer retinal.3.Anti-VEGF agents had no significant effects on retinal thickness in macular fovea,superficial capillary plexus vessel density,FAZ perimeter and area,subfoveal choroidal thickness and choroid capillaries vessel density in m CNV eyes. |
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