摘要 目的：利用超广角扫频源光学相干断层扫描血管造影（UWF SS-OCTA）定量评估不合并视网膜病变的系统性红斑狼疮（SLE）患者的早期视网膜及脉络膜微循环及微结构的变化。 方法：收集并分析2024-05/2024-10于徐州医科大学附属医院就诊的不合并视网膜病变的SLE患者64例64只眼为研究对象，并选择年龄和性别匹配的健康受试者作为对照，所有受试者均行超广角OCTA检查。所有采集的24×20mm2UWF SS-OCTA图像被划分为1×1 mm2的24×20网格，进一步细分为中心区域和外围区域。将居中的12×12网格定义为中心区域，对应传统12×12mm2 OCTA图像的视场(field of view,FOV)，其余的被定义为外围区域。比较不合并视网膜病变的SLE患者及健康对照组的中心及周边视网膜深层毛细血管丛（DCP）、浅层毛细血管丛（SCP）、全层视网膜、脉络膜脉细血管层（choriocapillaris,CC）、脉络膜中大血管的血流密度（VD）；脉络膜血管容积（CVV）：脉络膜大中血管容积；脉络膜血管指数（CVI）：脉络膜大中血管容积与脉络膜总体积的比值；中央区域以及周边区域厚度视网膜内层、视网膜外层、视网膜整体、脉络膜的厚度。分析无视网膜病变的SLE患者视网膜及脉络膜微循环及微结构变化。 结果：共纳入64例不合并视网膜病变的SLE患者，结果表明，在未检查出视网膜病变时，SLE患者周边区域DCP及CC VD就已检测出微循环循环改变（均P＜0.01）；CVI在中央及周边区域都与对照组表现出明显差异（均P＜0.01）。 结论：超广角OCTA可较好地显示SLE患者亚临床视网膜及脉络膜周边血流变化，在未出现视网膜病变时已经观察到周边DCP、CC VD下降以及全区域CVI变化，超广角OCTA在识别SLE患者早期视网膜及脉络膜变化方面具有一定价值。

Abstract AIM: To quantitatively assess the early alterations of retinal and choroidal microcirculation and microstructure in patients with systemic lupus erythematosus (SLE) without coexisting retinopathy using ultra-widefield swept-source optical coherence tomography angiography (UWF SS-OCTA). METHODS: From May to October 2024, sixty-four SLE patients (64 eyes) without associated retinopathy from the Affiliated Hospital of Xuzhou Medical University were enrolled as the study group. Simultaneously, age-and gender-matched healthy individuals were recruited as the control group. All participants underwent optical coherence tomography angiography(OCTA). The 24×20 mm2ultra-widefield swept-source OCTA images obtained were divided into1×1mm2grids, totaling 24×20 units, which were further categorized into central and peripheral zones. The central 12×12 grid area was designated as the central zone, approximating the field of view of a conventional 12×12mm2OCTA image, while the remaining grids constituted the peripheral zone. We made comprehensive comparisons between SLE patients without retinopathy and healthy controls, including the vessel density (VD) of the deep capillary plexus (DCP), superficial capillary plexus (SCP), total retina, choriocapillaris(CC), as well as the choroidal medium and large vessels in both the central and peripheral retinal areas. Additionally, parameters such as choroidal vascular volume (CVV), representing the volume of choroidal medium and large vessels;choroidal vascular index (CVI), calculated as the ratio of choroidal medium and large vessel volume to the total choroidal volume; thickness measurements of the inner retina, outer retina, entire retina, and choroid in both central and peripheral zones; and the VD within a 300-μm radius around the foveal avascular zone (FAZ-300) were also evaluated. In this study the microcirculatory and microstructural alterations in the retina and choroid of SLE patients without retinopathy were systematically analyzed. RESULTS: A total of 64 SLE patients without concomitant retinopathy were enrolled in the study. The results revealed that microcirculatory alterations were detected. Specifically, the blood flow density (VD) of the deep capillary plexus (DCP) and choriocapillaris (CC) in the peripheral region of SLE patients without retinopathy under examination had significant changes (both P<0.01). Moreover,compared to the control group, the FAZ-300 in the outer retinal layer was decreased in the SLE patient group (P<0.05). Additionally, the choroidal vascular index (CVI) showed remarkable differences from that of the control group in both the central and peripheral zones (all P<0.01). CONCLUSION: UWF SS-OCTA excels at revealing subclinical retinal and choroidal peripheral blood flow changes in SLE patients. Without retinopathy, peripheral DCP and CC VD reductions and region-wide CVI alterations are observable. Thus, it’s valuable for spotting early retinal and choroidal changes in SLE patients, aiding timely treatment.