| Objective: To observe the changes of subfoveal choroid thickness(SFCT),choroidal vascular index(CVI)and choriocapillary blood flow density(CBFD)before and after anti-vascular endothelial growth factor(VEGF)treatment in patients with diabetic retinopathy(DR)and diabetic macular edema(DME),and to explore their clinical significance.Methods: This is a prospective study.The selected subjects were 70 patients(88 eyes)with diabetes mellitus(DM)who were admitted to the Department of Ophthalmology and endocrinology,Yijishan Hospital,Wannan Medical University from July 2021 to August 2022.According to the results of optical coherence tomography(OCT),fundus photography and the judgment of two clinically experienced doctors,the patients were divided into: No diabetic retionpathy(NDR)group(15 eyes,15 cases);Nonproliferative diabetic retinopathy(NPDR)group(40 cases 53 eyes): mild/moderate NPDR(19 cases 27 eyes),severe NPDR(21 cases 26 eyes);And DME group(15 cases,20 eyes).Healthy peers(15 cases,15 eyes)were included as healthy control group.The patients with diabetic macular edema and the indications for intravitreous injection were treated with anti-VEGF therapy.All subjects,including DME patients,underwent enhanced depth imaging optical coherence tomography(EDI-OCT)and optical coherence tomography angiography(OCTA)examination 1 day before surgery,1week after surgery,and 1 month after surgery.Image J software was used to measure and calculate the SFCT,CVI and CBFD of each group.At the same time,the basic data of the subjects in each group were collected,including age,sex,eye difference,DM course and best corrected visual acuity(BCVA).Finally,the data were statistically analyzed by SPSS 25.0.Results:1.There were no statistically significant differences in age,sex and eye difference among the five groups(P > 0.05).There were significant differences in DM course and BCVA among the five groups(P < 0.001).The course of DM in DME group was significantly higher than that in NDR group(P < 0.0001)and m NPDR group(P <0.001),s NPDR group was higher than NDR group(P < 0.05).In BCVA,DME group was significantly higher than healthy control group,NDR group,m NPDR group(P <0.001),s NPDR group was higher than healthy control group(P < 0.05).2.There was no significant difference in SFCT among the five groups(P=0.349).3.CVI in the diabetes group was significantly reduced compared with the control group,with statistical significance(P < 0.001).The CVI of healthy control group,NDR group,m NPDR group,s NPDR group and DME group were significantly different(P < 0.001),DME group was significantly lower than healthy control group,NDR group and m NPDR group,and the difference was statistically significant(P < 0.01).s NPDR group was significantly lower than healthy control group,NDR group and m NPDR group,and the difference was statistically significant(P < 0.05).CVI in m NPDR group was significantly decreased compared with control group,the difference was statistically significant(P < 0.01).4.The CBFD of the five groups showed statistically significant difference(P < 0.001),and the DME group was significantly lower than the healthy control group,NDR group and m NPDR group,with statistical significance(P < 0.05).The s NPDR group was significantly lower than the healthy control group and NDR group,and the difference was statistically significant(P < 0.01).5.BCVA(Log MAR),the course of DM and SFCT were negatively correlated with CVI,while CBFD was positively correlated with CVI(P < 0.05).Other indicators were not correlated with CVI.6.There was no statistical significance in SFCT and CVI of the DME group 1 day before anti-VEGF treatment,1 week after surgery,and 1 month after surgery(P > 0.05).The postoperative CBFD of the DME group was higher than that before surgery.There were significant differences in CBFD 1 day before surgery,1 week after surgery and 1month after surgery(P < 0.05).SFCT and BCVA(Log MAR)were negatively correlated with CVI before and after surgery,but there was no correlation between CBFD and CVI before and after surgery(P > 0.05).Conclusion:1.CVI is closely related to the severity of DR.In the early stage of DR patients before the appearance of retinopathy,CVI in the corresponding macular area is reduced,and with the worsening of the disease course,CVI is further reduced,suggesting that CVI can be used as an indicator to monitor the occurrence and development of DR.2.CBFD in DME patients at 1 week and 1 month after anti-VEGF treatment was higher than that at 1 day before surgery,suggesting that CBFD could be used as a detection index for the analysis of postoperative efficacy of anti-VEGF drug injection. |
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