• <tr id="yyy80"></tr>
  • <sup id="yyy80"></sup>
  • <tfoot id="yyy80"><noscript id="yyy80"></noscript></tfoot>
  • 99热精品在线国产_美女午夜性视频免费_国产精品国产高清国产av_av欧美777_自拍偷自拍亚洲精品老妇_亚洲熟女精品中文字幕_www日本黄色视频网_国产精品野战在线观看 ?

    Comparison of 24×20 mm2 swept-source OCTA and fluorescein angiography for the evaluation of lesions in diabetic retinopathy

    2022-11-14 06:12:06QiaoZhuZengSiYingLiYuOuYaoEnZhongJinJinFengQuMingWeiZhao
    International Journal of Ophthalmology 2022年11期

    Qiao-Zhu Zeng, Si-Ying Li, Yu-Ou Yao, En-Zhong Jin, Jin-Feng Qu, Ming-Wei Zhao

    1Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing 100044,China

    2Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China

    Abstract

    ● KEYWORDS: ultra-widefield swept-source optical coherence tomography angiography; fluorescein angiography;comparison; diabetic retinopathy

    INTRODUCTION

    Diabetic retinopathy (DR) is the second most common microvascular complication of diabetes and the main cause of preventable blindness in working-aged adults from 20 to 74 years old[1]. Reliable identification of vascular abnormalities promotes early intervention of DR and helps avoid visual impairment.

    Fluorescein angiography (FA) has been the gold standard imaging technique for the evaluation of DR for 50y.However, it is invasive, time-consuming and relatively expensive. It may also cause several side effects, including nausea, vomiting, and even anaphylaxis. In addition, an inherent limitation of the technique is the leakage of dye from pathologic vessels, which could mask the underlying fluorescence.

    Optical coherence tomography angiography (OCTA) can depict retinal and choroidal microvasculature abnormalities in DR with highly detailed depth-resolved visualization. It is a quantitative, noninvasive, and dye-free technique that allows for the imaging of different layers without obscuration by dye leakage[2-3]. We have been investigating swept-source OCTA (SS-OCTA) extensively since its first report in 2006[4].

    The wavelength of infrared light is longer than that of the spectral domain OCT, bringing faster scans and increased tissue penetration[5]. With the advent of widefield sweptsource OCTA (WF SS-OCTA), the field of view (FOV) has significantly increased to 50°-80° of the retina surface.

    An ultra-widefield SS-OCTA device is available from TowardPi Medical Technology (TowardPi Medical Technology Co., Ltd, Beijing, China): BM400K. It is a 400 kHz SS-OCTA instrument that uses a laser at a central wavelength of 1060 nm with a bandwidth of 100 nm and FOV of 81°×68°, which may potentially change the paradigm of diagnosis and follow-up of DR based on FA.

    To date, there have been limited studies comparing SS-OCTA,especially ultra-widefield SS-OCTA with FA, for the evaluation of DR lesions[5-10], such as the foveal avascular zone (FAZ),nonperfusion area (NPA), microaneurysms (MAs), intraretinal microvascular abnormalities (IRMAs), and neovascularization(NV). Therefore, we aimed to compare ultra-widefield SSOCTA with traditional FA for detecting DR lesions and to explore the substitution possibility of ultra-widefield SS-OCTA for FA.

    SUBJECTS AND METHODS

    Ethical ApprovalThis study was approved by the Institutional Review Board of Peking University People’s Hospital, and informed consent was obtained from all subjects.All procedures adhered to the tenets of the Declaration of Helsinki.

    PatientsThis prospective, observational study was conducted at Peking University People’s Hospital from September 1,2021, until December 31, 2021. Patients with treatment-na?ve DR were consecutively recruited. Age and gender matched healthy controls were also incorporated.

    Inclusion criteria were patients aged 18 years or more with type 1 or 2 diabetes who were clinically diagnosed with DR. Exclusion criteria included eyes with significant media opacities, other chorioretinal diseases that could impact imaging of the retinal vasculature (e.g., central serous retinopathy, retinal vein occlusions, myopic degeneration,history of glaucoma or uveitis, presence of an epiretinal membrane, or vitreomacular traction syndrome); or history of treatments [e.g., intravitreal therapy with anti-vascular endothelial growth factor (anti-VEGF) or steroids, macular laser treatment, panretinal photocoagulation; pars plana vitrectomy,etc.]; signal strength index of SS-OCTA<7; or images with severe artifacts preventing accurate analysis. DR was graded according to the International Clinical Diabetic Retinopathy Disease Severity Scale[11].

    All included patients underwent a full ophthalmic examination,including measurement of best corrected distance visual acuity(BCVA), intraocular pressure (IOP), slit lamp examination, and indirect ophthalmoscopy. Data on baseline demographics (sex,age, type of diabetes, diabetes duration, glycated hemoglobin,etc.) and current ophthalmologic examination findings were collected.

    Image AcquisitionPatients were imaged with a 400 kHz SSOCTA instrument (BM400K, TowardPi Medical Technology Co., Ltd, Beijing, China) that uses a laser at a central wavelength of 1060 nm with a bandwidth of 100 nm. Images of 24×20 mm2areas were obtained. Vascular layers were autosegmented using the built-in software. We carefully verified the accuracy of automatic segmentation with B-scans. The slab used for comparison with FA was the superficial capillary plexus (SCP) slab, which is between the inner limiting membrane (ILM) and 9 μm above the inner plexiform layer(IPL).

    Color fundus photographs (CFP) and FA imaging were performed using an Optos 200Tx (Optos plc, Dunfermline,United Kingdom). Early-phase FA images captured at 30-45s with high quality were acquired for analysis. SS-OCTA and FA was performed the same day.

    Image Processing and AnalysisEn face SCP SS-OCTA images and representative FA images were exported in PNG and TIF formats, respectively. They were aligned using Photoshop CS6 (version 13.0.0.0, Adobe, San Jose, CA,USA). Three user-specified landmarks on both modalities were accurately matched by translation, rotation, and rescaling of the target images. A representative algorithm of registering images is presented in Figure 1.

    All images were coded and randomized to avoid measurement bias. Two masked ophthalmologists (Zeng QZ and Li SY)independently evaluated CFP, FA, and SS-OCTA images. A third trained ophthalmologist (Zhao MW) adjudicated cases with discrepancies. CFP and FA were used for DR severity grading. Registered SS-OCTA and FA images were imported into Image J in the format of PNG (bundled with Java 1.8.0_172) for quantitative analysis.

    The FAZ area (mm2) and perimeter (mm) were measured by manually outlining the FAZ margin by means of Image J (Figure 2A, 2B). NPA was represented as an area of the fundus lacking retinal arterioles, venules, and capillaries,with a pruned appearance of adjacent vessels on FA, and on SS-OCTA, it was defined as the deficiency of capillary bed between terminal arterioles and a proximal venule or larger vessels[9]. NPAs were manually traced and measured in each image using Image J (Figure 2C, 2D). MAs were defined as pinpoint hyperfluorescent spots with or without leakage on FA and as various morphologic patterns, including fusiform,saccular, curved and rarely coiled shapes, in SS-OCTA images[12](Figure 2E, 2F). IRMAs were intraretinal new vessels adjacent to the areas of capillary loss, which were tortuous, dilated and looped (Figure 2G, 2H). NVs were defined as extraretinal vessels present in the vitreoretinal interface (VRI) slab and shown as Figure 2I-2J on en face SCP and FA.

    Statistical AnalysisAll statistical analyses were performed with Stata/SE 15.0 (V.15.0; Stata, College Station, TX,USA). For patient characteristics, descriptive methods, with standard summary statistics including the mean (SD), median,interquartile range (IQR), and proportions were applied. For DR lesion comparisons between SS-OCTA and FA images,Student’sttest was performed to compare normally distributed quantitative variables, while the nonparametric Wilcoxon signed rank test was used for nonnormally distributed quantitative variables. We applied the intraclass correlation coefficient (ICC) and its 95% confidence interval (CI) to assess the agreement between SS-OCTA and FA pairwise for continuous variables. The ICC (range, 0-1) was deemed as good agreement (ICC 0.75 to 1), moderate agreement (ICC 0.5 to 0.75), and poor agreement (ICC<0.5)[13]. Bland-Altman plots were used to assess the agreement between the two imaging techniques.P<0.05 was considered to be statistically significant.

    RESULTS

    DemographicsForty-six eyes of 23 patients with treatmentna?ve DR were included in the study, as well as twenty-three age and gender matched healthy subjects. Demographics and clinical characteristics are provided in Table 1. There were 10 eyes with proliferate DR (PDR) and 36 eyes with nonproliferate DR (NPDR; 6, 17 and 13 eyes with mild, moderate and severe DR). Mean age of DR patients was 50.3±11.9y.The male:female ratio was 3:1. Twenty-one (91.3%) of the 23 patients had type 2 diabetes mellitus. The mean duration of diabetes was 8.6±4.6y, and the mean glycated hemoglobin(HbA1c) was 9.8%±4.6%. Hypertension was more common in patients with DR than in normal controls (56.5%vs8.6%,P<0.001). Three eyes (6.5%) had diabetic macular edema. The median BCVA in logarithm of minimum angle of resolution(logMAR) was 0.2 (range, 0.1-0.3), and the mean IOP was 15.3±2.6 mm Hg.

    Ultra-widefield SS-OCTA and FA images were available in all 46 eyes of 23 participants. FA images were successfully aligned to the 24×20 mm2SCP SS-OCTA images and were included in the subsequent analysis.

    Quantitative Assessment of Diabetic Retinopathy Lesions Foveal avascular zoneRepresentative SS-OCTA of DR patients and normal controls were shown in Figure 3. The size of FAZ on OCTA were compared between normal and DR eyes (Table 2). Area of FAZ was larger in cases than controls(0.34±0.069 mm2vs0.287±0.108 mm2,P=0.006).

    In DR eyes, the mean FAZ area was 0.34±0.069 and 0.334±0.087 mm2on SS-OCTA and FA, respectively(P=0.428), while the median FAZ perimeter was 2.382(IQR, 2.201-2.59) and 2.333 (IQR, 2.138-2.6) mm on SSOCTA and FA images (P=0.733; Table 3). FAZ area ICCs were significant between SS-OCTA and FA [0.767 (0.615-0.864),P<0.001], suggesting good agreement between the two imaging techniques. The ICCs of the FAZ perimeter were also statistically significant between SS-OCTA and FA [0.881(0.795-0.932),P<0.001], which indicated that the repeatability was good (Table 4). The above reproducibility results were also demonstrated using Bland-Altman plots (Figure 4A, 4B).Nonperfusion areaNPAs were detected in 22 patients(95.7%). There was no significant difference in the size of the NPA between the images on SS-OCTA and FA (12.389, IQR 4.96-28.3vs11.125, IQR 5-28.31 mm2,P=0.197), as presented in Table 3. The ICC of NPA size was also high [0.999 (0.998-0.999),P<0.001]. A Bland-Altman plot comparing the NPA between SS-OCTA and FA is shown in Figure 4C.

    Figure 2 Representative DR lesions on corresponding FA and SS-OCTA images A, B: FAZ; C, D: NPA; E, F: Cluster of MA; G, H: IRMA; I, J:NV. DR: Diabetic retinopathy; FA: Fluorescein angiography; SS-OCTA: Swept-source optical coherence tomography angiography; FAZ: Foveal avascular zone; NPA: Nonperfusion area; MA: Microaneurysms; IRMA: Intraretinal microvascular abnormalities; NV: Neovascularization.

    Table 1 Demographic and clinical characteristics of included patients and controls

    Table 2 Comparison of FAZ on SS-OCTA between DR eyes and controls

    Figure 3 Representative SS-OCTA of healthy controls (A) and DR eyes (B).

    Figure 4 Bland-Altman analysis of FAZ area (A), FAZ perimeter (B), NPA (C), counts of MA, IRMA and NV in SS-OCTA and FA (D-F)FAZ: Foveal avascular zone; NPA: Nonperfusion area; MA: Microaneurysms; IRMA: Intraretinal microvascular abnormalities; NV: Neovascularization; SS-OCTA: Swept-source optical coherence tomography angiography.

    Table 3 Detection of DR lesions on SS-OCTA versus FA

    Counts of microaneurysms, intraretinal microvascular abnormalities, and neovascularization Measurements of MA,IRMA and NV count are also shown in Table 3. MAs were detected in all eyes using the two techniques. The median total MA count was 35 (IQR, 19-46) and 73 (IQR, 43-93) on SS-OCTA and FA, respectively (P<0.001). The ICC of MA count indicated that the repeatability of the difference between SS-OCTA and FA was stable [0.875 (0.785-0.929),P<0.001; Table 4].

    Table 4 The ICCs of DR lesions between SS-OCTA and FA

    The detection rate of IRMAs was 80.4% on both the modalities.There were 31 and 29 eyes with NV in SS-OCTA and FA,respectively. No significant difference in IRMA count was found between the images on SS-OCTA and FA (4, IQR, 1-7vs4,IQR, 1-8,P=0.061), as well as the NV count (0, IQR 0-1vs0, IQR 0-1,P=0.561). The repeatability of IRMA and NV count was good (ICC=0.987 and 0.829) in SS-OCTA and FA (Table 4). All the results are also presented as Bland-Altman plots in Figure 4D-4F.

    DISCUSSION

    In this study, we compared the differences between ultrawidefield SS-OCTA (24×20 mm2) and traditional FA in detecting microvascular lesions in treatment-na?ve DR patients,including FAZ, NPA, MA, IRMA and NV.

    Ophthalmic imaging modalities are increasingly significant in the screening, diagnosis, and monitoring of DR. For several decades, FA has been the gold standard in the clinical assessment of DR lesions. With advances in imaging techniques, OCTA may serve as a three-dimensional, depth-resolved, rapid, and noninvasive imaging modality as an adjunct for assessing microvascular changes[14]. Due to a fast-tuning laser source and balance detection, SS-OCT can achieve higher spectral resolution than SD-OCT and therefore leads to increased tissue penetration[5,15-16]. In this study, a scan size of 24×20 mm2area was obtained with a 400 kHz ultra-widefield SS-OCTA instrument (BM400K, TowardPi Medical Technology Co.,Ltd., Beijing, China). Among all the commercially available SS-OCTA devices, BM400K can achieve the largest scan range, which may potentially change the current paradigm of FA-based diagnosis and follow-up of DR.

    To our best knowledge, this is the first prospective report to assess the potential use of ultra-widefield SS-OCTA as a noninvasive adjunct to traditional FA in DR and to explore the substitution possibility of ultra-widefield SS-OCTA for FA.

    Our findings indicated that there was no significant difference in the FAZ area, FAZ perimeter, NPA, IRMA count or NV between SS-OCTA and FA. Good agreement between FA and SS-OCTA in the evaluation of those lesions was also confirmed. It is admitted that the FOV in FA is wider than that of ultra-widefield SS-OCTA; however, SS-OCTA may be clinically useful enough because the majority of lesions in PDR cases are observed within the mid periphery of the retina,which is covered by OCTA images[17]. In addition, SS-OCTA could be performed as a first-line examination in all diabetic patients without a risk of adverse effects. Moreover, SS-OCTA could be an important tool with segmentations for follow-up,which can provide quantitative indexes.

    Consistent with previous studies, FAZ measurement was found to be similar between the two imaging modalities[18]. In a study including 20 eyes of 14 patients with non-proliferative and proliferative DR, Couturieret al[19]proposed that compared with FA, OCTA allowed better visualization of the FAZ,although their study did not quantitate this observation. As our results showed, the mean size of the FAZ in the same eye was measured to be slightly larger in SS-OCTA than in FA,which was comparable to that of other studies[16,20-22]. Overall,measurement of the FAZ with SS-OCTA is valuable in the clinical routine in detecting ischemic maculopathy and DR progression.

    NPA was another common finding on both imaging techniques.The published literature has proposed that OCTA detects NPA to nearly the same or even better extent than FA[7,9,23-27].Nevertheless, the FOV for traditional OCTA is restricted compared with that for FA. The SS-OCTA employed in our study widens the FOV to 24×20 mm2, which is the largest yet.In the study by Sawadaet al[7], they applied panoramic OCTA images (OCTA, PLEX Elite 9000 system) for NPA assessment in DR patients, with 2.4 times enlargement of the single-center OCTA FOV. It was concluded that wide-angle OCTA was likely to be clinically useful to detect NPAs, although they did not quantitate the size of NPAs. For the detection of IRMA and NV, SS-OCTA also showed similar counts to FA, consistent with some previous studies[8]. FA could differentiate NVs from IRMA because the latter shows no signs of leakage[28].However, it is not necessary to perform invasive FA simply to distinguish between IRMAs and NVs.

    MAs are the first detectable sign of early DR, manifested as hyperfluorescent spots in FA. The extent and location of MAs are an essential component of the fundus evaluation when assessing DR severity and progression risk. MAs at the posterior retina have been extensively investigated, and ultra-widefield SS-OCTA (UWF-SS-OCTA) has also gained added importance due to the ready visualization of the retinal periphery. To date, the relative ability of UWF-SS-OCTA versus UWF-FA to visualize MAs has not been fully evaluated. In our study, MA count differed significantly between images on SSOCTA and FA. FA identified more MAs than SS-OCTA, which was consistent with some previous studies[15-16,23-24]. Elnahry and Ramsey[15]reported that significantly more MAs were identified on FA images (102±27.5) compared with OCTA(47.5±11.7,P<0.0001). Salzet al[23]also found that OCTA was able to identify a mean (SD) of 6.4 (4.0) MAs, while FA identified a higher mean (SD) of 10 (6.9) MAs. In Enderset al[16]study, the mean MA count was 14 in FA and 13 in OCTA.

    There could be several reasons for the discrepancies in MA identifications in FA and UWF-SS-OCTA. In FA, the dye remains in the abnormally dilated blood vessel, leading to the brightly hyperfluorescent appearance of MAs; leakage of some MAs can also highlight and exaggerate their appearance[23],resulting in more MAs detected in FA. However, the SS-OCTA segmented images do not show leakage, which may explain the smaller and less prominent MAs on SS-OCTA than FA. In addition, high-speed SS-OCTA could limit the identification of low-flow lesions such as MAs, some of which are completely occluded[29]. Histopathologic studies reported that the lumen configuration in MAs consists of thickened, hyalinized, fibrous,laminated, and lipid-containing basement membrane, as well as hypercellular or multilayered endothelial cells[29]. Hence,the turbulent blood flow inside some types of MAs may not be perfectly displayed in OCTA[24]. It has to be admitted that FA appears to be the preferred modality over UWF-SS-OCTA for the assessment of MAs. When using SS-OCTA, MAs may be detected more readily with 6×6 mm2angiography rather than montage or UWF-SS-OCTA[30-31]. Continued evolution of UWF-SS-OCTA is needed with further research. UWFSS-OCTA and FA should be combined to better evaluate DR microvasculature lesions. On the other hand, the agreement between MAs in SS-OCTA and FA was good, suggesting that the difference in visualizing MAs between the two techniques was stable and reliable.

    There are several limitations in our study. First, we included only a small number of eyes, and larger prospective series are needed to further confirm our encouraging results. Second,only taking the SCP into account in SS-OCTA may limit the significance of our results. Third, SS-OCTA has its intrinsic restrictions. In clinical practice, bias could be introduced due to increased heterogeneity with diverse axial lengths and patient cooperation, which could be studied in our future research[32].The manual segmentation and registration methods could also be a factor that may have introduced bias in the results.Additionally, we could carry out further studies to examine not only the differences in evaluation of retinal microvasculature using SS-OCTA and FA imaging but also assess both interand intra-observer variability of interpretation by graders with diverse levels of experience, the impact of SS-OCTA guided treatment for DR andetc.

    In conclusion, ultra-widefield SS-OCTA (24×20 mm2) can clinically assist in evaluating FAZ, NPA, IRMA and NV counts compared with traditional FA. Good or moderate agreement between FA and SS-OCTA in the evaluation of those lesions was also confirmed. Due to the limitations of signal processing and thresholding techniques, SS-OCTA detects fewer MAs.Overall, SS-OCTA represents a reliable, noninvasive, timesaving, easy-to-use and quantitative imaging technique in the assessment of microvasculature in DR, which offers a potential substitute for FA in DR evaluation.

    ACKNOWLEDGEMENTS

    Authors’ contributions:Conceptualization (Zhao MW);Data curation (Zeng QZ); Formal analysis (Zeng QZ, Li SY); Funding acquisition (Zhao MW); Investigation (Qu JF);Methodology (Zeng QZ, Li SY, Yao YO, Jin EZ); Project administration (Zeng QZ, Li SY); Resources (Zhao MW);Software (Zeng QZ, Li SY); Supervision (Qu JF, Zhao MW);Validation (Yao YO, Jin EZ); Visualization (Zeng QZ, Li SY);Roles/Writing - original draft (Zeng QZ, Li SY); Writingreview & editing (Zhao MW).

    Foundation:Supported by the National Key R&D Program of China (No.2020YFC2008200).

    Conflicts of Interest: Zeng QZ,None;Li SY,None;Yao YO,None;Jin EZ,None;Qu JF,None;Zhao MW,None.

    亚洲av日韩精品久久久久久密| 在线观看日韩欧美| 免费搜索国产男女视频| 大型黄色视频在线免费观看| 国产精品电影一区二区三区| 日日夜夜操网爽| 校园春色视频在线观看| 亚洲一区高清亚洲精品| 国产成人av教育| a在线观看视频网站| 免费看十八禁软件| 搡老妇女老女人老熟妇| 国产精品自产拍在线观看55亚洲| 日日干狠狠操夜夜爽| 国产精品久久视频播放| 一本久久中文字幕| 日韩有码中文字幕| 亚洲精品456在线播放app | 国产成人av教育| 免费看日本二区| 99久久成人亚洲精品观看| 国产探花在线观看一区二区| ponron亚洲| 深夜精品福利| 亚洲五月婷婷丁香| 国内精品久久久久精免费| 精品一区二区三区视频在线观看免费| 长腿黑丝高跟| 99精品久久久久人妻精品| 天堂网av新在线| 九九在线视频观看精品| 国产高清视频在线观看网站| 99精品久久久久人妻精品| 日韩大尺度精品在线看网址| 久久久久久九九精品二区国产| 国产高清视频在线观看网站| 黄色片一级片一级黄色片| 中文字幕久久专区| 我的老师免费观看完整版| 97超视频在线观看视频| 精品一区二区三区视频在线 | 亚洲人成网站在线播放欧美日韩| 五月玫瑰六月丁香| 成人av在线播放网站| 淫妇啪啪啪对白视频| 国产亚洲精品久久久久久毛片| 国产精品久久久久久精品电影| 亚洲国产欧美一区二区综合| 国产黄a三级三级三级人| 香蕉国产在线看| 两个人看的免费小视频| 国产高潮美女av| 老汉色av国产亚洲站长工具| 午夜激情欧美在线| 久久精品亚洲精品国产色婷小说| 97人妻精品一区二区三区麻豆| 国内毛片毛片毛片毛片毛片| 蜜桃久久精品国产亚洲av| 欧美精品啪啪一区二区三区| 久久久成人免费电影| 中亚洲国语对白在线视频| 亚洲avbb在线观看| 国产1区2区3区精品| 一级毛片高清免费大全| 成人一区二区视频在线观看| 精品一区二区三区av网在线观看| 99久久精品一区二区三区| 又黄又爽又免费观看的视频| 我的老师免费观看完整版| 精品久久久久久,| 国产精品一区二区三区四区久久| 天天添夜夜摸| 亚洲无线在线观看| 久久精品影院6| 免费观看人在逋| 欧美乱妇无乱码| 国产单亲对白刺激| 亚洲av成人精品一区久久| 国产午夜精品论理片| 夜夜看夜夜爽夜夜摸| 久久人人精品亚洲av| 国产私拍福利视频在线观看| 国产精品爽爽va在线观看网站| 欧美黑人巨大hd| 国产日本99.免费观看| 亚洲国产日韩欧美精品在线观看 | 国产三级黄色录像| 国产美女午夜福利| 日本熟妇午夜| 国产91精品成人一区二区三区| 高清毛片免费观看视频网站| 久久久久久久久免费视频了| 国产精品影院久久| 日韩av在线大香蕉| 午夜精品一区二区三区免费看| 色哟哟哟哟哟哟| 老汉色av国产亚洲站长工具| 桃色一区二区三区在线观看| 国产精品一区二区精品视频观看| 亚洲熟妇中文字幕五十中出| av片东京热男人的天堂| 在线观看66精品国产| 18禁国产床啪视频网站| 久久九九热精品免费| 中文字幕久久专区| 国产精品久久久av美女十八| a级毛片在线看网站| 天堂影院成人在线观看| 999久久久国产精品视频| 亚洲性夜色夜夜综合| www国产在线视频色| 欧美日韩精品网址| 19禁男女啪啪无遮挡网站| 狂野欧美白嫩少妇大欣赏| 91在线观看av| 男女做爰动态图高潮gif福利片| 夜夜爽天天搞| 99热精品在线国产| 国产成人系列免费观看| 高清毛片免费观看视频网站| 中文字幕av在线有码专区| 最好的美女福利视频网| 免费看十八禁软件| 99久久99久久久精品蜜桃| 亚洲乱码一区二区免费版| 成人午夜高清在线视频| 天堂网av新在线| 国产三级中文精品| 男女视频在线观看网站免费| 国产精品野战在线观看| 99re在线观看精品视频| 一级作爱视频免费观看| 少妇熟女aⅴ在线视频| 久久99热这里只有精品18| 一边摸一边抽搐一进一小说| 9191精品国产免费久久| 色综合亚洲欧美另类图片| 欧美色视频一区免费| 99国产精品99久久久久| 亚洲片人在线观看| 一本一本综合久久| 午夜日韩欧美国产| 国产蜜桃级精品一区二区三区| 最近在线观看免费完整版| 国产亚洲精品综合一区在线观看| 午夜a级毛片| 成年人黄色毛片网站| 午夜日韩欧美国产| 最好的美女福利视频网| 成人三级黄色视频| 国产高清videossex| 亚洲欧洲精品一区二区精品久久久| 国产欧美日韩精品一区二区| 亚洲va日本ⅴa欧美va伊人久久| 国产精品98久久久久久宅男小说| 在线永久观看黄色视频| 久久久久性生活片| 亚洲电影在线观看av| 久久精品综合一区二区三区| svipshipincom国产片| 亚洲中文字幕一区二区三区有码在线看 | 久久中文字幕一级| 国内久久婷婷六月综合欲色啪| 我的老师免费观看完整版| 久久中文字幕一级| 国产探花在线观看一区二区| 久久精品aⅴ一区二区三区四区| 亚洲欧美日韩高清专用| 手机成人av网站| 日韩欧美三级三区| 人妻久久中文字幕网| 亚洲成人免费电影在线观看| 精品久久久久久久毛片微露脸| 亚洲男人的天堂狠狠| 黄色成人免费大全| 国产野战对白在线观看| 18禁国产床啪视频网站| 国产黄色小视频在线观看| 久久久色成人| 男女那种视频在线观看| 国产精品久久久人人做人人爽| 久久中文字幕人妻熟女| 日韩有码中文字幕| 啦啦啦韩国在线观看视频| 麻豆久久精品国产亚洲av| 国产精品免费一区二区三区在线| 国产精品久久久久久人妻精品电影| 国产成人欧美在线观看| 国产精品亚洲美女久久久| 神马国产精品三级电影在线观看| 亚洲精品色激情综合| 在线免费观看不下载黄p国产 | 禁无遮挡网站| 亚洲欧美日韩东京热| 日本精品一区二区三区蜜桃| 亚洲男人的天堂狠狠| 999精品在线视频| 日韩欧美免费精品| 中文字幕久久专区| 丰满的人妻完整版| 日本黄色片子视频| 国产爱豆传媒在线观看| 最近最新免费中文字幕在线| 在线观看舔阴道视频| 亚洲激情在线av| 中文字幕精品亚洲无线码一区| 老司机在亚洲福利影院| 天天添夜夜摸| 99精品在免费线老司机午夜| 国产免费av片在线观看野外av| 在线免费观看不下载黄p国产 | 精品国产乱码久久久久久男人| 后天国语完整版免费观看| 国产精品久久久av美女十八| 91av网站免费观看| 成熟少妇高潮喷水视频| 亚洲精品中文字幕一二三四区| 夜夜爽天天搞| 两人在一起打扑克的视频| 亚洲天堂国产精品一区在线| 亚洲无线观看免费| 亚洲专区国产一区二区| 国产精品久久久久久久电影 | 婷婷丁香在线五月| 国产97色在线日韩免费| 天天躁日日操中文字幕| or卡值多少钱| 操出白浆在线播放| 成人欧美大片| 亚洲国产精品999在线| 欧美zozozo另类| 法律面前人人平等表现在哪些方面| 99国产精品一区二区三区| 国产免费av片在线观看野外av| 亚洲精品久久国产高清桃花| 啦啦啦韩国在线观看视频| 日本免费一区二区三区高清不卡| 亚洲av日韩精品久久久久久密| 无人区码免费观看不卡| 不卡av一区二区三区| 国产精品久久久久久精品电影| 一本久久中文字幕| 日本在线视频免费播放| 九九在线视频观看精品| av欧美777| 最近最新中文字幕大全免费视频| 成人三级做爰电影| 婷婷精品国产亚洲av| 国产伦精品一区二区三区视频9 | 久久久久久国产a免费观看| 老司机福利观看| 日韩欧美 国产精品| 性色av乱码一区二区三区2| 亚洲欧美日韩高清在线视频| 国产精品久久久久久精品电影| 国产69精品久久久久777片 | 成人三级做爰电影| 亚洲成人精品中文字幕电影| 国内精品久久久久久久电影| 18禁观看日本| 最近在线观看免费完整版| 婷婷精品国产亚洲av| 偷拍熟女少妇极品色| 看免费av毛片| 国产免费av片在线观看野外av| 色视频www国产| 我的老师免费观看完整版| a级毛片在线看网站| 久久久久免费精品人妻一区二区| 午夜福利免费观看在线| 丰满人妻熟妇乱又伦精品不卡| 99视频精品全部免费 在线 | 日韩欧美 国产精品| 久久这里只有精品中国| 久久久色成人| 中文资源天堂在线| 国产真人三级小视频在线观看| 免费看十八禁软件| 中文字幕av在线有码专区| 人人妻,人人澡人人爽秒播| 舔av片在线| 美女 人体艺术 gogo| 无限看片的www在线观看| av欧美777| 午夜精品在线福利| 韩国av一区二区三区四区| 在线视频色国产色| 国产成人一区二区三区免费视频网站| 12—13女人毛片做爰片一| 色精品久久人妻99蜜桃| 成人国产综合亚洲| 精品久久久久久久毛片微露脸| 人妻丰满熟妇av一区二区三区| 久久精品aⅴ一区二区三区四区| 又爽又黄无遮挡网站| 日韩免费av在线播放| 亚洲精品久久国产高清桃花| 成人高潮视频无遮挡免费网站| 亚洲av电影在线进入| 亚洲欧美日韩高清在线视频| 波多野结衣高清作品| 天堂影院成人在线观看| 男女做爰动态图高潮gif福利片| 国产单亲对白刺激| 少妇人妻一区二区三区视频| 国产成人欧美在线观看| 日韩欧美精品v在线| 亚洲人成伊人成综合网2020| 999久久久国产精品视频| 18美女黄网站色大片免费观看| 小蜜桃在线观看免费完整版高清| 亚洲精品美女久久久久99蜜臀| 精品久久久久久久久久久久久| 中文字幕人成人乱码亚洲影| 亚洲精品456在线播放app | 蜜桃久久精品国产亚洲av| 精品久久久久久,| 久久这里只有精品19| 免费在线观看影片大全网站| 午夜精品在线福利| 人妻夜夜爽99麻豆av| 日韩高清综合在线| av福利片在线观看| 色精品久久人妻99蜜桃| 国产亚洲av高清不卡| 亚洲精华国产精华精| 欧美不卡视频在线免费观看| cao死你这个sao货| 又黄又爽又免费观看的视频| 色播亚洲综合网| 老司机深夜福利视频在线观看| 最近视频中文字幕2019在线8| 99久久精品一区二区三区| 国产欧美日韩精品亚洲av| 国产 一区 欧美 日韩| 99久久精品热视频| 欧美大码av| 免费av毛片视频| 国产激情久久老熟女| 国产一区二区在线观看日韩 | 精品久久久久久久久久免费视频| 欧美黄色片欧美黄色片| 夜夜躁狠狠躁天天躁| 午夜免费观看网址| 国产人伦9x9x在线观看| 国产91精品成人一区二区三区| 丰满人妻熟妇乱又伦精品不卡| 久久亚洲精品不卡| 级片在线观看| 深夜精品福利| 成人欧美大片| 一个人免费在线观看的高清视频| 香蕉久久夜色| 欧美成人性av电影在线观看| 国产乱人伦免费视频| 亚洲国产精品成人综合色| 不卡av一区二区三区| 性色av乱码一区二区三区2| 无限看片的www在线观看| 我要搜黄色片| 日韩精品中文字幕看吧| 啪啪无遮挡十八禁网站| 亚洲精品一卡2卡三卡4卡5卡| 91久久精品国产一区二区成人 | 免费在线观看成人毛片| 久久久久国内视频| 真人做人爱边吃奶动态| 国产男靠女视频免费网站| 亚洲黑人精品在线| 国产av麻豆久久久久久久| 日韩 欧美 亚洲 中文字幕| 欧美激情在线99| 淫妇啪啪啪对白视频| 欧美日本亚洲视频在线播放| 女警被强在线播放| av天堂在线播放| 一进一出抽搐动态| 男女午夜视频在线观看| www国产在线视频色| av国产免费在线观看| 精品午夜福利视频在线观看一区| 国产一区二区在线观看日韩 | 婷婷丁香在线五月| 久久婷婷人人爽人人干人人爱| 丰满人妻熟妇乱又伦精品不卡| 国产精品久久久人人做人人爽| 欧美中文综合在线视频| 黄片小视频在线播放| 国产精品永久免费网站| 男女床上黄色一级片免费看| 国产激情欧美一区二区| 露出奶头的视频| 亚洲午夜理论影院| 观看美女的网站| 无限看片的www在线观看| 亚洲七黄色美女视频| 亚洲国产日韩欧美精品在线观看 | 久久精品国产99精品国产亚洲性色| 午夜福利18| 久久久久国产一级毛片高清牌| 一a级毛片在线观看| 色尼玛亚洲综合影院| 国产91精品成人一区二区三区| 久久久久久久久免费视频了| 欧美一区二区国产精品久久精品| 国产精品亚洲美女久久久| 日本a在线网址| 日韩精品中文字幕看吧| 俺也久久电影网| 国产一区二区三区视频了| 别揉我奶头~嗯~啊~动态视频| ponron亚洲| 亚洲欧美激情综合另类| 99re在线观看精品视频| 观看免费一级毛片| 久久久久久国产a免费观看| 99久久99久久久精品蜜桃| 制服丝袜大香蕉在线| 日韩精品中文字幕看吧| 日本一二三区视频观看| 91字幕亚洲| 成年免费大片在线观看| 国产主播在线观看一区二区| 精品久久久久久久久久免费视频| 19禁男女啪啪无遮挡网站| 亚洲午夜理论影院| 亚洲aⅴ乱码一区二区在线播放| 亚洲专区国产一区二区| 99在线视频只有这里精品首页| 男人舔奶头视频| 夜夜夜夜夜久久久久| 亚洲国产精品sss在线观看| 成人亚洲精品av一区二区| 免费av毛片视频| 精品国产乱子伦一区二区三区| 视频区欧美日本亚洲| 黑人操中国人逼视频| 国产高清有码在线观看视频| 又紧又爽又黄一区二区| 亚洲人成电影免费在线| 国产成人系列免费观看| 一本精品99久久精品77| 国产黄a三级三级三级人| 色综合婷婷激情| 亚洲精品中文字幕一二三四区| av福利片在线观看| 午夜精品久久久久久毛片777| 伊人久久大香线蕉亚洲五| 国产97色在线日韩免费| 欧美日本视频| 亚洲七黄色美女视频| 免费av不卡在线播放| tocl精华| 午夜影院日韩av| 99热这里只有精品一区 | 亚洲avbb在线观看| 99精品欧美一区二区三区四区| 少妇的逼水好多| 精品免费久久久久久久清纯| 又紧又爽又黄一区二区| 国产美女午夜福利| 巨乳人妻的诱惑在线观看| 日韩欧美国产在线观看| 欧美日韩中文字幕国产精品一区二区三区| 亚洲va日本ⅴa欧美va伊人久久| 午夜福利在线观看吧| 每晚都被弄得嗷嗷叫到高潮| 97超级碰碰碰精品色视频在线观看| 色噜噜av男人的天堂激情| 九色国产91popny在线| 麻豆国产97在线/欧美| 国产精品99久久久久久久久| 18美女黄网站色大片免费观看| 99久久久亚洲精品蜜臀av| 色视频www国产| 国产伦精品一区二区三区视频9 | 色老头精品视频在线观看| 亚洲精品久久国产高清桃花| 好男人电影高清在线观看| 久久久久国产一级毛片高清牌| 1024香蕉在线观看| 99精品在免费线老司机午夜| 18禁美女被吸乳视频| 全区人妻精品视频| 久久久久性生活片| 色综合亚洲欧美另类图片| 日日夜夜操网爽| 一夜夜www| 一区二区三区激情视频| 久久伊人香网站| 国产av不卡久久| 亚洲无线观看免费| 丝袜人妻中文字幕| 伊人久久大香线蕉亚洲五| 亚洲欧美精品综合久久99| 99热只有精品国产| 香蕉久久夜色| 高清毛片免费观看视频网站| 亚洲精品在线观看二区| 亚洲第一电影网av| 午夜福利免费观看在线| 黄色日韩在线| 无人区码免费观看不卡| 久久这里只有精品中国| 看片在线看免费视频| 亚洲av熟女| 午夜福利在线观看免费完整高清在 | 国产欧美日韩精品亚洲av| 久久精品亚洲精品国产色婷小说| 午夜福利视频1000在线观看| 亚洲美女黄片视频| 国产又黄又爽又无遮挡在线| 最近视频中文字幕2019在线8| 免费av不卡在线播放| bbb黄色大片| 国内揄拍国产精品人妻在线| 99热精品在线国产| 久久久久久久精品吃奶| 黄色 视频免费看| 首页视频小说图片口味搜索| 1024香蕉在线观看| 国产亚洲精品一区二区www| 91久久精品国产一区二区成人 | av国产免费在线观看| 亚洲在线自拍视频| 51午夜福利影视在线观看| 一区二区三区激情视频| 久久久国产成人精品二区| 97超视频在线观看视频| 熟妇人妻久久中文字幕3abv| 日本一二三区视频观看| 在线视频色国产色| 精品国产乱子伦一区二区三区| 51午夜福利影视在线观看| 色哟哟哟哟哟哟| 99久久综合精品五月天人人| 国产黄a三级三级三级人| 成人国产综合亚洲| 国产美女午夜福利| 99久久精品热视频| netflix在线观看网站| 性色avwww在线观看| 免费看a级黄色片| 九色国产91popny在线| 日韩欧美免费精品| 色哟哟哟哟哟哟| 成熟少妇高潮喷水视频| 亚洲国产欧美人成| 国产黄片美女视频| 18禁黄网站禁片午夜丰满| 男女做爰动态图高潮gif福利片| 一区二区三区国产精品乱码| 中国美女看黄片| 2021天堂中文幕一二区在线观| 午夜久久久久精精品| 久久中文字幕一级| 亚洲一区二区三区色噜噜| 亚洲精品456在线播放app | 欧美精品啪啪一区二区三区| 成人性生交大片免费视频hd| 午夜a级毛片| 国产成人精品久久二区二区免费| 中亚洲国语对白在线视频| 男人舔奶头视频| 制服人妻中文乱码| 精品免费久久久久久久清纯| 一区二区三区高清视频在线| 欧美另类亚洲清纯唯美| 久久久久久大精品| 欧美日韩综合久久久久久 | 不卡一级毛片| 日韩有码中文字幕| 国产野战对白在线观看| 少妇的丰满在线观看| 成人三级黄色视频| 亚洲成a人片在线一区二区| 欧美在线黄色| 欧美成人免费av一区二区三区| 日本 av在线| 免费在线观看日本一区| 中文字幕熟女人妻在线| 搞女人的毛片| 亚洲国产欧美一区二区综合| 日韩中文字幕欧美一区二区| 精品欧美国产一区二区三| 男人舔女人的私密视频| 夜夜夜夜夜久久久久| 午夜福利欧美成人| 99久久成人亚洲精品观看| 一二三四社区在线视频社区8| 亚洲国产欧美网| 欧美成人性av电影在线观看| 熟女电影av网| 在线观看免费午夜福利视频| 男女午夜视频在线观看| 亚洲国产中文字幕在线视频| 久久精品夜夜夜夜夜久久蜜豆| 男女视频在线观看网站免费| 小说图片视频综合网站| 免费av毛片视频| 国产亚洲精品综合一区在线观看| 男女视频在线观看网站免费| 国内少妇人妻偷人精品xxx网站 | 身体一侧抽搐| 欧美色欧美亚洲另类二区| 久久精品国产清高在天天线| 小蜜桃在线观看免费完整版高清| 成年女人永久免费观看视频| 国产精品亚洲美女久久久| 国产精品 国内视频| 日本黄大片高清| 久久久国产成人精品二区| 他把我摸到了高潮在线观看| 一级毛片高清免费大全| 91久久精品国产一区二区成人 |