摘要目的 观察和分析急性期Vogt-小柳原田病(VKH)患者视网膜及脉络膜各毛细血管层血管密度并探讨其临床意义.方法 横断面对照研究.纳入北京协和医院眼科门诊2015年4月至2016年7月21例VKH患者(VKH组)和49名健康对照者(健康对照组),对所有患者及健康对照进行相干光层析血管成像术(OCTA)检查,利用系统内置软件分析视网膜各层及脉络膜毛细血管层血管密度.急性期VKH患眼视网膜及脉络膜各毛细血管层平均血管密度与健康对照应用双侧独立样本t检验分析,VKH患眼视网膜及脉络膜各毛细血管层血管密度与LogMAR最佳矫正视力(BCVA)之间的相关性分析采用Spearman相关性检验.结果 VKH急性期视网膜浅层毛细血管网(SCP)、视网膜深层毛细血管网(DCP)及脉络膜毛细血管(CC)层平均血管密度分别为51.56％±2.88％、56.51％±2.31％、58.14％±2.10％,均显著低于健康对照53.55％±2.51％、58.14％±2.10％、58.14％±2.10％(t=-3.890,3.910,-6.554;P＜0.01).患眼中OCTA扫描区内有视网膜脱离者CC层平均血管密度为63.46％±2.19％,显著低于无视网膜脱离(NRD)者65.85％± 1.79％ (t=3.890,P＜0.01).VKH组SCP、DCP层平均血管密度与LogMAR BCVA无显著相关性,而CC层血管密度与LogMAR BCVA呈显著负相关(r=-0.437,P＜0.01).结论 OCTA可以定量检测急性期VKH视网膜脉络膜各毛细血管层血管密度.急性期VKH患者SCP、DCP层和CC层均存在循环障碍,其中CC层血管密度与视力及视网膜脱离相关.

abstractsObjective To measure vascular density in retinal and choroidal capillary layers by optical coherence tomography angiography (OCTA) and to explore their potential clinical values in Vogt-Koyanagi-Harada disease (VKH).Methods This is a cross-sectional case-control study.Twenty-one acute VKH cases presented to Peking Union Medical College Hospital between April 2015 and July 2015 and 49 healthy controls were enrolled in this study.OCTA was performed with a split-spectrum amplitude-decorrelation angiography-optical coherence tomography (SSADA-OCT) system borrowed from Optovue Inc.Vascular densities of the capillary layers were analyzed by the built-in software.Bilateral independent sample t-test was used to compare retinal and choroidal vascular density of eyes in acute phase VKH with healthy controls.Spearman correlation test was used to analyze the correlation between the vascular density of retina and choroid in acute phase VKH and LogMAR best corrected visual acuity (BCVA).Results Mean vascular density of superficial capillary plexus (SCP),deep capillary plexus (DCP)and choriocapillaris (CC) in eyes of the acute VKH group were statistically lower than those of healthy control group (51.56％±2.88％,56.51％±2.31％,58.14％±2.10％ vs.53.55％±2.51％,58.14％±2.10％,58.14％±2.10％,t=-3.890,3.910,-6.554,all 3 P values were＜0.01).In VKH patients,eyes with retinal detachment (RD) had statistically lower mean vascular density in the CC layer than those without (NRD)(63.46％ ±2.19％ vs.65.85％± 1.79％,t=3.890,P＜0.01),while no statistically significant differences were found in vascular densities of SCP and DCP layers between RD and NRD eyes.Spearman's correlation test revealed a negative correlation between vascular density of the CC layer and logMAR BCVA(r=-0.437,P＜0.01),while no statistically significant associations were found between logMAR BCVA and vascular densities of SCP and DCP.Conclusions OCTA can be used for quantitative detection of vascular density of retina and choroidal capillary in acute VKH.There is circulatory disturbance in SCP,DCP and CC of acute VKH.Vascular density of CC is associated with visual acuity and retinal detachment.