目的：探讨光学相干断层扫描血管成像技术(optical coherence tomography angiography，OCTA)在斜视性弱视伴偏中心注视患者中应用的价值。方法：收集2018年1月到2020年5月斜视性弱视伴偏中心注视的患者17人为研究组，采用OCTA系统软件工具，以μm为单位测量视网膜固视点和黄斑中心凹之间的距离，同时收集非斜视、弱视且中心注视健康者17人为对照组，并分析受试者的浅层视网膜血管丛的黄斑中心凹血流长度密度(vessel length density，VLD)、灌注密度(perfusion density，PD)、黄斑中心凹无血流信号区(foveal avascular zone，FAZ)、面积、FAZ周长及FAZ圆形度。结果：斜视组弱视眼偏心距离为(632.18±310.62) μm，黄斑中心凹浅层血管丛VLD为(5.31±3.44) mm?1，PD为0.16±0.08，黄斑中心凹无血流信号区FAZ面积(0.28±0.17) mm2，FAZ周长(2.05±0.56) mm、FAZ圆形度0.67±0.06；与研究组対侧眼和对照组相比，VLD差异有统计学意义(P<0.05)，PD、FAZ面积等差异无统计学意义(P>0.05)。斜视组弱视眼偏心度与偏中心距离显著相关(r=0.834，P<0.001)。结论：OCTA可以量化偏中心距离，斜视性弱视伴偏中心注视眼的黄斑中心凹血流长度密度较対侧眼及健康眼低。
Objective: To explore the application value of optical coherence tomography angiography (OCTA) in patients with strabismic amblyopia accompanied by eccentric fixation. Methods: Seventeen strabismus amblyopia patients with eccentric fixation admitted to our hospital from January 2018 to May 2020 were enrolled as the study group. OCTA software was used to measure the distance between fixation point and macular fovea in micron units. Seventeen non-strabismus and non-amblyopia patients with centric fixation were enrolled as the control group. Vessel length density (VLD), perfusion density (PD), and foveal avascular zone (FOZ) were measured for the superficial retinal vascular cluster. Perimeter of FAZ and circularity of FAZ were analyzed. Results: The eccentric fixation distance was (632.18 ±310.6) μm, the macular fovea retinal thickness was (207.82±17.79) μm, the VLD of the superficial retinal vascular plexus was (5.31±3.44) mm?1, the PD was 0.16±0.08, the FAZ area was 0.28±0.17 mm2, the FAZ perimeter was 2.05±0.56 mm, and the FAZ circularity was 0.67±0.06. These results showed statistically significant differences in the VLD compared with the fellow eyes (P=0.043) and the control group (P=0.049), but there were no statistically significant differences in the PD, or FAZ area. In the strabismus group, the eccentricity of amblyopia was significantly correlated with the eccentric distance (r=0.834, P<0.001). Conclusion: OCTA can quantify the eccentric distance. The blood flow length density of macular fovea in strabismic amblyopia with eccentric fixation is lower than that in contralateral and healthy eyes.
患者因“左眼视物模糊2 0余年”就诊，2 0余年前曾行左眼小梁切除术，视力：右眼(oculus dexter，OD)无光感(no light perception，NLP)，左眼(oculus sinister，OS)光感(light perception，LP)光定位准确，右眼巩膜葡萄肿(鼻上)，前房浅约1/4 CT，瞳孔固定散大，晶状体脱位于玻璃体腔，左眼结膜上方滤过泡扁平，前房浅，约1/4 CT，虹膜层状分离漂浮于前房，上方虹膜切口引流通畅，C/D：0.4。眼压(intraocular pressure，IOP)示：右眼13.0 mmHg，左眼16.0 mmHg。超声生物显微(ultrasound biomicroscopy，UBM)示：右眼各象限前房角狭窄，晶体脱位；左眼前房浅，颞侧前房角狭窄，其余象限关闭，虹膜层状分离。B超示：右眼晶体脱离。诊断：左眼虹膜劈裂；右眼晶体脱位。
The patient was treated with ‘left eye blurred vision for more than 20 years’. The patient underwent left trabeculectomy more than 20 years ago. Visual acuity oculus dexter (OD): no light perception (NLP), oculus sinister (OS): light perception (LP), and light positioning was accurate, right eye scleral staphyloma (nose), the anterior chamber was approximately 1/4 CT, the pupil was fixed and scattered, the lens was displaced into the vitreous cavity, and the left eye conjunctiva was filtered. The blister was flat, the anterior chamber was shallow, about 1/4 CT, and the iris layer was separated and floated in the anterior chamber. The upper iris incision led to smooth flow, C/D: 0.4. Intraocular pressure (IOP): R 13.0 mmHg, L 16.0 mmHg. Ultrasound biomicroscopy (UBM): in the right eye, anterior chamber angle was narrow in each quadrant, dislocation of the lens; anterior chamber of the left eye was shallow, anterior chamber angle of the temporal stenosis was narrow, the remaining quadrants were closed, iris lamellar separated. B-ultrasound: the right eye lens was displaced into the vitreous cavity. Diagnosis: left eye Iridoshcisis; right eye lens dislocation.
