경도 비증식당뇨망막병증에서 빛간섭단층혈관촬영술을 이용한 황반부 미세혈관의 초기변화
Foveal Microvascular Changes Based on Optical Coherence Tomography Angiography in Mild Nonproliferative Diabetic Retinopathy
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목적: 빛간섭단층혈관촬영술을 이용하여 당뇨환자에서 당뇨망막병증이 없는 환자와 경도 비증식당뇨망막병이 있는 환자의 미세혈류변화에 대해 알아보고자 하였다. 대상과 방법: 빛간섭단층혈관촬영술을 시행한 당뇨환자 39명을 후향적으로 분석하였다. 안저검사로 당뇨망막병증이 없는 군(22명, 44안)과 경도 비증식당뇨망막병증을 보인 군(17명, 34안)으로 분류하였다. 빛간섭단층혈관촬영술은 중심와를 중심으로 3 × 3 mm 범위를 촬영하였고, 이를 이용하여 표층과 심부모세혈관총의 오목무혈관부위와 중심와, 중심와부근 혈류밀도를 분석하였다. 결과: 경도 비증식당뇨망막병증이 있는 환자군이 당뇨망막병증이 없는 환자군과 비교해서 심부모세혈관총의 오목무혈관부위의 유의한 증가(p=0.008), 심부모세혈관총의 중심와부근 혈류밀도의 유의한 감소(p=0.013), 중심와 및 중심와부근 두께의 유의한 감소(p=0.018, p=0.003)를 보였다. 표층모세혈관총의 오목무혈관부위, 중심와 혈류밀도, 중심와부근 혈류밀도와 심부모세혈관총의 중심와 혈류밀도는 두 군 사이에 유의한 차이는 없었다. 결론: 경도 비증식당뇨망막병증이 있는 환자군이 당뇨망막병증이 없는 환자군에 비해 빛간섭단층혈관촬영술에서 심부모세혈관총의 오목무혈관부위의 증가, 심부 중심와부근 혈류밀도의 감소, 중심와 두께의 감소, 중심와부근 두께의 감소가 있다.
Abstract
Purpose: To investigate the microvascular change in diabetic patients with no diabetic retinopathy (DR) and mild nonproliferative DR (NPDR) using optical coherence tomography angiography (OCTA). Methods: We retrospectively reviewed the medical records of 44 eyes of 22 patients with no DR and 34 eyes of 17 patients with mild NPDR. OCTA was performed on a 3 × 3 mm region centered in the fovea and parafoveal areas. The foveal avascular zone (FAZ) and foveal and parafoveal flow density (FD) in superficial and deep vascular plexuses were analyzed using OCTA. Results: The FAZ of deep capillary plexus in patients with mild NPDR was significantly larger than in patients with no DR (p = 0.008). The parafoveal deep FD, foveal and parafoveal thickness in patients with no DR was significantly larger than in patients with mild NPDR (p = 0.013, p = 0.018 and p = 0.003, respectively). Superficial FAZ, superficial foveal FD, superficial parafoveal FD and deep foveal FD were not significantly different between the patients with no DR and those with mild NPDR. Conclusions: OCTA allows detection of deep FAZ enlargement, reduction in parafoveal deep FD as well as foveal and parafoveal thickness in patients with mild NPDR compared with patients with no DR.
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