目的：应用光学相干断层血管成像(OCTA)观察康柏西普和阿柏西普治疗糖尿病性黄斑水肿(DME)时，黄斑无血管区面积(FAZ)、形态以及血流密度的短期变化。

方法：选择26例DME患者进行玻璃体腔注射康柏西普或阿柏西普，利用OCTA观察注药前、注药后1、7、30d的FAZ、黄斑无血管弓周长(PERIM)、非圆指数(AI)，及中心凹300μm宽度内的血管密度(FD-300)的变化，分析抗VEGF药物对黄斑区微循环的影响。同时观察患者最佳矫正视力(BCVA)和黄斑区中心厚度(CFT)，BCVA记录时转换为最小分辨角对数(LogMAR)视力。使用重复测量资料方差分析方法，比较注药前、注药后1、7、30d FAZ、PERIM、AI、FD-300、BCVA、CFT的情况； 采用Bonferroni分析不同时间点差异的两两比较。通过Pearson相关分析用来评估BCVA(LogMAR)的变化与FAZ、CFT相关性。

结果：注射抗VEGF药前FAZ为0.296±0.022mm²，注药后1d检测到FAZ增大到0.339±0.024mm²(P=0.015)，术后7、30d FAZ与术前无差异(P=0.084、0.224)。与治疗前比较，术后BCVA有明显变化，CFT下降，抗VEGF治疗有效。PERIM、AI及FD-300在注药前后不同时间差异均不显著(F=2.598，P=0.059； F=0.438，P=0.726； F=0.594，P=0.621)。BCVA(LogMAR)与FAZ、CFT正相关(r=0.273，P=0.005； r=0.200，P=0.042)，二者均影响BCVA。

结论：糖尿病性黄斑水肿患者玻璃体腔注射抗VEGF药后1d内FAZ可能短暂变大。注药1wk后FAZ减少，并伴有视力提高。选择适当的OCTA参数能提供可靠的客观测定方法。

AIM: To evaluate the effect of Conbercept or Aflibercept on macular perfusion status in patients with diabetic macular edema(DME), and the changes in foveal avascular zone(FAZ)areas and capillary density in macular regions were measured quantitatively by optical coherence tomography angiography(OCTA).

METHODS: Twenty-six patients with DME received intravitreal injections of Conbercept or Alfibercept. The changes of FAZ areas, PERIM, AI, and macular vessel density in fovea of 300μm width(FD-300)were measured by OCTA in baseline 1, 7, and 30d after injection, and the effect of anti-VEGF drugs on blood circulation in macular area was analyzed. The best-corrected visual acuity(BCVA), central foveal thickness(CFT)were observed, the BCVA was converted to LogMAR. The changes of BCVA, CFT, FAZ, FD-300, PERIM, AI treated with anti-VEGF by methods repetitive measure analysis of variance on 1, 7, 30d after treatment were compared. Bonferroni was used to analyze the differences at different time points in pairwise comparison. Pearson correlation analysis was used to evaluate the correlation between changes in BCVA(LogMAR)and FAZ, CFT.

RESULTS: The FAZ area was 0.296±0.022mm² in baseline. After 1d drug injection, the FAZ increased to 0.339±0.024mm² (P=0.015). There was no significant difference in FAZ on the 7 and 30d after surgery(P=0.084, P=0.224). Compared with before treatment, BCVA and CFT decreased significantly, the anti-VEGF therapy was effective. The changes in PERIM, AI, and FD-300 did not reach significant level(F=2.598, P=0.059; F=0.438, P=0.726; F=0.594, P=0.621). The results of correlation analysis showed that BCVA(LogMAR)was positively correlated with FAZ and CFT(r=0.273, P=0.005; r=0.200, P=0.042)which had influence on BCVA.

CONCLUSION: With an increase in the avascular area of macular fovea was detected within 1d after intravitreal injection of anti-VEGF drug in patients with DME, and decrease in the area of avascular area in macular fovea after 1wk, accompanied by improved visual acuity. The selected appropriate index of OCTA can provide a reliable means to measure retinal circulation.