急性中心性浆液性脉络膜视网膜病变患者脉络膜血管指数及中心凹下脉络膜厚度测量分析

摘要

目的 观察测量中心性浆液性脉络膜视网膜病变(CsC)患者脉络膜血管指数(CVI)及中心凹下脉络膜厚度(SFCT),分析两者的稳定性与一致性.方法 回顾性研究.2016年11月1日至2018年3月18日首次就诊于首都医科大学附属北京友谊医院眼科的单眼急性CSC患者31例纳入研究.同时纳入年龄与CSC患者匹配的正常健康者31名作为对照.CSC患眼及其对侧眼、正常健康眼均接受OCT深度增强成像经黄斑中心凹单线扫描,测量其SFCT;对图像进行二值化处理,再计算中心凹下方1500 μm范围的CVI,即血管(或管腔)面积与脉络膜总面积的比值.CSC患眼、对侧眼及正常健康眼之间CVI、SFCT比较采用方差分析.采用组内相关系数(ICC)、Bland-Altman曲线及变异系数(CV)分析CVI、SFCT的可重复性、一致性及稳定性;采用Medcalc 18.2.1软件绘制Bland-Altman曲线,观察两种测量方法的一致性.结果 CSC患眼、对侧眼、正常健康眼三者之间CVI、SFCT两两比较,CSC患眼与对侧眼(t=3.470、2.844,P=0.001、0.006)、CSC患眼与正常健康眼(t=6.977、6.277,P＜0.001、＜0.001)、对侧眼与正常健康眼(t=3.508、3.433,P=0.001、0.001)之间的差异均有统计学意义.CVI、SFCT相对一致性分析结果显示,CVI单一测量、平均测量的ICC分别为0.967、0.983;SFCT单一测量、平均测量的ICC分别为0.937、0.967.CVI、SFCT的一致性均非常好,CVI的ICC数值略高于SFCT.CVI、SFCT可重复性分析结果显示,两次测量CVI的差值幅度较小,SFCT的差值幅度较大.CVI、SFCT稳定性分析结果显示,CVI、SFCT的CV分别为10.5％、25.3％;CVI的CV较SFCT更小.结论 与正常健康眼比较,CSC患眼及对侧眼CVI增高,SFCT增厚.与SFCT比较,CVI一致性、可重复性及稳定性更佳.%Objective To observe the choroidal vascularity index (CVI) and the subfoveal choroidal thickness (SFCT) of central serous chorioretinopathy (CSC),and to compare the stability and consistency of the two methods of measurement.Methods A retrospective study.Thirty-one patients with unilateral acute CSC who visited the Department of Ophthalmology of Beijing Friendship Hospital for the first time during the period from Nov 1st,2016 to Mar 18th,2018 were included in the study.Thirty-one healthy age-matched subjects were enrolled as controls.All CSC affected eyes and their fellow eyes and healthy eyes were scanned by single-line enhanced depth imaging of OCT through central fovea of macula to measure their SFCT.The image was binarized and then the CVI of a 1500 μm range below fovea was calculated,i.e.the ratio of vascular (or lumen) area to total choroidal area.CVI and SFCT were compared among CSC eyes,fellow eyes and healthy eyes by variance analysis.Intra-group correlation coefficient (ICC),Bland-Altman curve and coefficient of variation (CV) were used to analyze the repeatability,consistency and stability of CVI and SFCT;and Medcalc18.2.1 software was used to draw the Bland-Altman curve and observe the consistency of the two measurement methods.Results There were statistically significant differences in CVI and SFCT between CSC affected eyes and fellow eyes (t=3.470,2.844;P=0.001,0.006),CSC affected eyes and healthy eyes (t=6.977,6.277;P＜0.001,＜0.001),fellow eyes and healthy eyes (t=3.508,3.433;P=0.001,0.001).Relative consistency analysis of CVI and SFCT showed that the ICC of single measurement and average measurement of CVI were 0.967 and 0.983 respectively,and that of single measurement and average measurement of SFCT were 0.937 and 0.967 respectively.The consistency of CVI and of SFCT was very good.The ICC value of CVI was slightly higher than that of SFCT.The results of repeatability analysis of CVI and SFCT showed that the difference between the two CVI measurements was smaller,and the difference between the two SFCT measurements was larger.And CVI and SFCT stability analysis results showed that the CV of CVI and SFCT were 10.5％ and 25.3％ respectively.CVI has smaller CV than SFCT.Conclusions Compared with healthy eyes,CVI and SFCT are increased in CSC affected eyes and fellow eyes.And compared with SFCT,CVI has better consistency,repeatability and stability.