应用SS-OCTA分析白内障术中不同眼内压对黄斑区血流的影响

目的：应用扫频光学相干断层扫描血管成像(SS-OCTA)对比研究白内障术中不同眼内压患者手术前后黄斑区血流的变化情况，为白内障个性化手术参数设计提供临床参考。

方法：前瞻性随机对照研究。收集2021-01/04于四川省人民医院住院行白内障手术的患者61例77眼，使用随机数字表分为A组(37眼)和B组(40眼)，术中分别予以75、90cm灌注瓶瓶高，相当于55.5、66.6mmHg术中平均眼内压。所有患者除常规眼科检查外，术前、术后1、7、30d均行黄斑区SS-OCTA检查，观察黄斑区视网膜厚度及放射状毛细血管网(RPCP)层、浅层血管网(SVP)层、中层血管网(IVP)层、深层血管网(DVP)层灌注面积和血管密度。

结果：手术前后各时间点两组患者最佳矫正视力(BCVA)、眼压、黄斑中心凹无血管区(FAZ)面积、黄斑区视网膜厚度及各层灌注面积和血管密度均无组间差异性(均P>0.05)，但均有时间差异性(均P<0.05)，两组患者术后各时间点BCVA均较术前明显改善，眼压和FAZ面积均较术前下降(均P<0.05)，黄斑区视网膜厚度及各层灌注面积和血流密度均较术前增加。

结论：白内障术后黄斑区视网膜厚度及各层血流密度和灌注面积均增加，FAZ面积下降，有助于促进术后视力的恢复，且术中选择55.5、66.6mmHg不同眼内压情况下，患者术后眼底血流改变情况无明显差异，故术中可以灵活选择眼内压，为患者提供个性化手术设计方案。

Analyze the effect of different intraocular pressures on macular blood flow during cataract surgery by using SS-OCTA

AIM:To provide a clinical reference for the design of personalized surgical parameters for cataract, swept source optic coherence tomography angiography(SS-OCTA)was applied to comparatively study the blood flow of the macular area before operation in patients with different intraocular pressure during cataract surgery.

METHODS: Prospective randomized controlled study. A total of 61 patients(77 eyes)who underwent cataract surgery in Sichuan Provincial People''s Hospital from January to April 2021 were collected and divided into group A(37 eyes)and group B(40 eyes)for the study using a random number table. Group A and group B received the height of 75 and 90cm perfusion bottles with intraoperative,corresponding to 55.5 and 66.6mmHg intraoperative mean intraocular pressure,respectively. All patients were examined with SS-OCTA in macula area before and 1,7 and 30d after surgery, except routine ophthalmologic examination, the macular retinal thickness, the perfusion area and vessel density of the radial perioptic capillary plexus(RPCP)layer, superficial vascular plexus(SVP)layer, intermediate vascular plexus(IVP)layer and deep vascular plexus(DVP)layer were observed.

RESULTS: There were no significant differences in the best corrected visual acuity(BCVA), intraocular pressure, foveal avascular zone(FAZ), macular retinal thickness, perfusion area and vascular density between the two groups at each time point before and after surgery(all P>0.05),but there were differences in time(all P<0.05). In both groups, BCVA improved significantly from preoperative values at all time points after surgery, intraocular pressure and FAZ decreased compared with preoperative values(all P<0.05), and macular retinal thickness, perfusion area in all layers, and blood flow density were increased compared with preoperative values.

CONCLUSION:The macular retinal thickness, blood flow density and perfusion area of all layers increased,and the FAZ area decreased after cataract surgery, which may help to promote the recovery of visual acuity after surgery. At different intraocular pressures of 55.5 and 66.6mmHg intraoperatively, there was no significant difference in the patients''postoperative fundus blood flow changes, therefore, intraocular pressure can be flexibly selected during the operation to provide patients with personalized surgical design.