目的：通过光学相干断层扫描血管成像(OCTA)技术，评估糖尿病视网膜病变(DR)患者黄斑区微循环变化，并对可能影响黄斑区微循环的危险因素进行分析，为DR早期筛查、诊断及治疗干预提供临床依据。

方法：回顾性研究。收集2022-05/10于西安市中心医院眼科门诊及病房就诊的2型糖尿病患者75例75眼，分为无DR(NDR)组28眼、非增殖型DR(NPDR)组25眼、增殖型DR(PDR)组22眼。应用OCTA对黄斑区视网膜行3mm×3mm血流成像扫描，自动获得浅层视网膜黄斑中心凹区、黄斑旁中心凹区(1～3mm)以及黄斑区3mm×3mm的血管密度(VD)和黄斑中心凹无血管区(FAZ)面积，分析黄斑区各参数在不同程度DR患者中的变化。

结果：与NDR组相比，PDR组和NPDR组患者黄斑区3mm×3mm浅层视网膜毛细血管(SCP)的VD降低(均P<0.017)，并且黄斑旁中心凹VD在各象限均降低(P<0.017)，以PDR组降低最为显著。PDR组和NPDR组患者FAZ面积明显大于NDR组(P<0.017)。DR患者的年龄、同型半胱氨酸、最佳矫正视力(LogMAR)、眼轴、糖化血红蛋白(HbA1c)与黄斑中心凹区VD呈负相关(P<0.05)，同型半胱氨酸、最佳矫正视力(LogMAR)、眼轴、糖尿病病程与黄斑区3mm×3mm VD呈负相关(P<0.05)，甘油三酯、最佳矫正视力(LogMAR)、HbA1c与黄斑旁中心凹区VD呈负相关(P<0.05)，总胆固醇、CMT与VD无明显相关(P>0.05)。

结论： OCTA可以监测到DR患者黄斑区微循环变化，DR患者的全身情况与黄斑区微循环密切相关。

METHODS: Retrospective study. A total of 75 patients(75 eyes)with type 2 diabetes mellitus(DM)who came to the ophthalmology outpatient clinic and ward of Xi'an Central Hospital from May to October 2022 were collected, and the DM patients were further divided into non-DR(NDR)group, non-proliferative DR(NPDR)group and proliferative DR(PDR)group, with 28 eyes, 25 eyes and 22 eyes in each group respectively. OCTA was applied to perform a 3mm×3mm blood flow imaging scan of the macular retina to automatically obtain the vascular density(VD)of the superficial retinal macular foveal, the parafoveal(1～3mm), as well as the macular 3mm×3mm and the area of macular foveal avascular zone(FAZ). Furthermore, the alteration of these parameters in patients with different degrees of DR was analyzed.

RESULTS: Compared with the NDR group, the VD of the 3mm×3mm superficial retinal capillary(SCP)in the macular region was decreased in both PDR and NPDR group(all PSymbol|@@0.017), and the VD of the parafoveal was decreased in each quadrant(PSymbol|@@0.017), with the most significant decrease in the PDR group. The FAZ area of patients in the PDR and NPDR groups was significantly larger than that in the NDR group(PSymbol|@@0.017). Age, homocysteine, best corrected visual acuity(LogMAR), axial length and glycosylated hemoglobin(HbA1c)of patients with DR were negatively correlated with VD in the macular foveal(PSymbol|@@0.05), while homocysteine, best corrected visual acuity(LogMAR), axial length, and the duration of diabetes were negatively correlated with VD in the macular 3mm×3mm(PSymbol|@@0.05). Triglycerides, best corrected visual acuity(LogMAR), and HbA1c were negatively correlated with VD in the parafoveal(PSymbol|@@0.05), while total cholesterol and central macular thickness had no significant correlation with VD(PSymbol～@@0.05).

CONCLUSION: The microcirculation changes in the macular area of DR patients can be monitored by OCTA, and the systemic condition of DR patients is closely related to their macular microcirculation.