| Objective: In this study,we measured the shape of macular arch ring of diabetic macular edema(DME)patients by optical coherence tomography angiography(OCTA),and comparison of DME before and after anti-VEGF treatment,best corrected visual acuity(BCVA),central subfield thickness(CST),the area of foveal avascular zone(FAZ).Methods:Forty-two patients(56 eyes)with DME were selected from Department of Ophthalmology in the Hospital from Jun 2018 to September2019.Application of fundus fluorescence angiography(FFA)and optical coherence tomography(OCT)diagnosed with center-involved Clinically significant macular Edema,selecting patients with central subfield thickness(CST)more than 250 microns,All cases were treated with intravitreal iniection of Conbercept.Before operation and 1week,1 month after operation,routinely check the best corrected visual acuity(BCVA).The patient was examined by OCTA(CIRRUS HD-OCT5000,Zeiss),and the macular area was scanned to record the number of points involved in macular arch damage.According to ETDRS standard,the damage degree of FAZ contour was evaluated,which was divided into three groups: light(≤1/4FAZ perimeter damage),moderate(> 1/4FAZ perimeter damage ≤3/4FAZ perimeter damage),and heavy(FAZ contour complete damage).512 scans to measure the CST,according to OCTA3 * 3mm scan to get the superficial macular arch of the macular area Image and use Image J software to calculate the area of FAZ.The SPSS 22.0 statistical software package was used,compare the difference of different groups and different observation time with repeated measures analysis of variance,the difference of observation time before and 1week after operation and 1 month after operation was compared in three groups with Friedman nonparametric test was designed in random area group.The properative and postoperative best corrected visual acuity,center macular thickness and the area of FAZ were compared between the three groups.Results:BCVA of the three groups before and after operation: the visual acuity of the three groups was not all the same(F=49.928,P<0.05),1 week and 1 month after surgery,BCVA changes in the mild group and the moderate group were statistically significant(M=23.115,M=27.208,P < 0.05).Compared with the preoperative BCVA(0.455±0.100,0.785±0.146),the difference was statistically significant one week after surgery(0.400±0.108,P<0.05,0.700±0.152,P<0.05),and the difference was statistically significant one month after surgery(0.455±0.100,0.340±0.088,P<0.05,0.785±0.146,0.585±0.114,P<0.05).Severe group: visual acuity change was not the same between different observation times(M=11.286,P<0.05).Before and 1 week after surgery,BCVA(1.405±0.242,1.350±0.201)had no statistical significance(P= 0.088),and visual acuity did not improve.The difference was statistically significant(1.405±0.242,1.290±0.159,P<0.05)1 month after surgery compared with that before surgery.2.Changes in CST(table 2): CST was not the same before,1 week and 1month after surgery(F=205.885,P < 0.05).The difference in the degree of macular arch ring damage was statistically significant(F=220.416,P < 0.05),and the change in CST was statistically significant:There were statistically significant differences between preoperative(434±54.83,614±81.49,728±80.02)and 1 week after surgery(295±44.83,420±77.90,650±74.31,P <0.05).1 month after the operation(195±34.83,250±34.83,554±64.83)compared with the preoperative statistical significance(P < 0.05).3.Changes of FAZ(table 3): the area of FAZ by using Image J software.The area of FAZ difference between the groups of different degrees was statistically significant(F =168.108,P<0.05),The area of FAZ difference between different observation times was statistically significant(F=42.793,P<0.05).In the mild group,there was no significant change in the area of the FAZ at 1 month after surgery(P=6.519,P>0.05).In the moderate group,the area of FAZ was significantly decreased 1 month after surgery(P<0.05).The FAZ area of the moderate group decreased significantly in the severe group 1 month(P<0.05).In the severe group,the area of the FAZ was decreased 1 month after surgery.(P=0.012,P<0.05).Conclusions:1.After anti-VEGF treatment for DME,CMT decreased in all three groups.CMT was significantly reduced in the mild and moderate groups in which damage was less or equal to 3/4 FAZ.2.After operation,BCVA was correlated with the degree of macular edema damage detected by OCTA.In case that damage range of the arch ring was less than or equal to 3/4 FAZ,BCVA improvement was obvious;In case that damage range of the arch ring was more than 3/4 FAZ,BCVA improvement was not obvious,and the recovery time of BCVA was slower.3.1 month after anti-VEGF treatment,the area of FAZ decreased in both the moderate and severe groups,and the change was rapid and obvious in the mild group compared with the severe group.4.Anti-VEGF treatment has a more significant effect on DME with no damage or partial damage of macular arch ring,For DME with severely damaged of macular arch ringd,CMT and BCVA improvement are not obvious afteranti-VEGF treatment,and the patient is slow to respond to this treatment. |
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