张慧 1俞华 1董立红 1谢晓冬 1刘强 1耿超1
作者信息
- 1. 238000 安徽巢湖,安徽医科大学第四附属医院眼科
- 折叠
摘要
Abstract
Objective To utilize optical coherence tomography angiography(OCTA)to precisely measure blood flow density and the choroidal vascular index(CVI)of the choroidal capillary(CC)and large/medium-caliber vessel(LMCV)layers in the macular region of patients with retinal vein occlusion(RVO).By synchronously analyzing coagulation profiles,to reveal the correlation between choroidal microcirculatory disorders and systemic coagulation abnormalities,elucidate the differences between branch RVO(BRVO)and central RVO(CRVO),and provide new evidence-based medical insights for understanding RVO pathogenesis and developing differentiated treatment strategies.Methods It was a cross-sectional study.A total of 129 subjects(129 eyes)who were diagnosed with RVO at the department of ophthalmology in Fourth Affili-ated Hospital of Anhui Medical University from January 2024 to January 2026 were enrolled,and were divided into three groups:a control group(49 cases with no fundus lesions),a BRVO group(53 cases),and a CRVO group(27 cases).OCTA was employed to detect blood flow density and CVI in the macular CC and LCMV layers.Concurrently,coagulation indica-tors including platelet count(PLT),D-dimer(DD),and fibrinogen(FBG)were measured.Inter-group differences were com-pared using the Kruskal-Wallis H test,One-way ANOVA,and Welch's ANOVA,followed by pairwise comparisons using Dunn's post-hoc test with Bonferroni correction.Results Choroidal capillary blood flow density:the control group exhib-ited significantly higher blood flow density in the total choroidal capillaries and all sensitive regions(inner temporal/supe-rior,outer temporal/superior/nasal/inferior)compared to both the BRVO and CRVO groups(all P＜0.001).There was no sig-nificant difference was observed between the BRVO and CRVO groups(all P＞0.05).There were no statistical differences in the fovea,inner nasal,and inner inferior regionsamong the three groups(all P＞0.05).Choroidal large/medium vessel blood flow density:the control group showed significantly higher blood flow density in the total choroidal large/medium vessels and most sub-regions(fovea,innertemporal/superior/nasal,outer temporal/superior/inferior)compared to the two disease groups(all P＜0.05).There wasno significant difference between the BRVO and CRVO groups(all P＞0.05).CVI:the total CVI of choroidal large/medium vessels and key sub-regions(fovea,inner superior/nasal,outer superior)were significantly higher in the control group than in the disease groups(all P＜0.05).There was no significant difference in CVI between the BRVO and CRVO groups(all P＞0.05).Coagulation function:levels of DD,fibrinogen,and platelets in the CRVO group were significantly higher than those in the control group(all P＜0.05).Furthermore,DD levels in the CRVO group were signifi-cantly higher than in the BRVO group(P=0.002).No significant differences in coagulation indicators were found between the BRVO group and the control group(all P＞0.05).There was no significant difference in routine coagulation time indica-tors such as prothrombin time(PT),activated partial thromboplastin time(APTT),and thrombin time(TT)among the three groups(all P＞0.05).DD levels exhibited a highly significant negative correlation with the CVI in the superior sector of the outer macular ring(r=-0.25,P＜0.01).Conversely,APTT showed a significant positive correlation with the CVI in the tempo-ral sector of the outer macular ring(r=+0.2,P＜0.05).Conclusions RVO patients universally exhibit impaired choroidal blood flow density and reduced CVI,with damage showing regional specificity(primarily affecting the inner temporal/supe-rior macula and multiple outer regions).This characteristic is similar between BRVO and CRVO.However,coagulation ab-normalities demonstrate type specificity:only CRVO patients exhibit a significant hypercoagulable state(elevated DD,fi-brinogen,and platelets).These findings suggest that CVI can serve as a universal indicator for quantifying vascular damage in RVO,while DD aids in differentiating CRVO from BRVO.This supports the implementation of differentiated clinical in-tervention strategies:focusing on systemic anticoagulation for CRVO and local microcirculatory protection for BRVO.Fur-thermore,DD is identified as an independent risk factor for reduced CVI in the outer macular region.关键词
视网膜静脉阻塞/相干光层析血管成像术/脉络膜血流密度/脉络膜血管指数/凝血功能/D-二聚体Key words
Retinal vein occlusion/Optical coherence tomography angiography/Choroidal blood flow density/Choroidal vascular index/Coagulation function/D-dimer
