青光眼视乳头旁脉络膜和视网膜萎缩的眼底血管造影研究

目的了解青光眼患者视乳头旁萎缩（peripapillary atrophy,PPA）即脉络膜和视网膜萎缩的发生频率及脉络膜血供情况。方法选择原发性青光眼患者43例（43只眼）,其中慢性闭角型青光眼16例（16只眼）,开角型青光眼27例（27只眼）,正常对照组33例（33只眼）。采用海德堡视网膜血管造影仪（HRA）对患者进行荧光素眼底血管造影和吲哚氰绿眼底血管造影（ICGA）同步检查,通过荧光素眼底血管造影进行PPAα带和β带的判定,观察其ICGA特点。结果PPAα带的ICGA表现为充盈正常和充盈减弱两种表现,PPAβ带的ICGA显示无脉络膜血管充盈,或仅见大脉络膜血管充盈。PPAα带的发生频率：慢性闭角型青光眼组为87.5％,开角型青光眼组为100,0％,对照组为84．8％,差异无统计学意义（χ^2=4．339,P=0．114）。PPAβ带的发生频率：慢性闭角型青光眼组为31．3％,开角型青光眼组为77．8％,对照组为21．9％,差异有统计学意义（χ^2=19,915,P=0．000）。PPAα带ICGA充盈减弱的发生频率：开角型青光眼组为66．7％,慢性闭角型青光眼组为53.8％,对照组为32.1％,差异有统计学意义（χ^2=6．648,P=0．036）。结论PPAβ带脉络膜血供缺乏,其发生频率以开角型青光眼组最高,慢性闭角型青光眼组次之。PPAα带的发生频率各组间差异无统计学意义,但开角型和慢性闭角型青光眼组的PPAα带较多表现为脉络膜血管充盈减弱,推测可能是PPAβ带扩大的前兆。

Indocyanine green and fluorescein angiography study of glaucomatous peripapillary atrophy

OBJECTIVE: To investigate the incidence of glaucomatous peripapillary atrophy (PPA) and choroidal circulation of glaucomatous patients. METHODS: The subjects of glaucoma groups included 43 (43 eyes) glaucomatous patients including 16 (16 eyes) chronic angle-closure glaucoma (CACG), 27 (27 eyes) open-angle glaucoma. Control group included 33 (33 eyes) cases. Indocyanine green angiography and fundus fluorescein angiography were performed on glaucoma groups and control group with Heidelberg retinal angiography (HRA) to observe alpha zone and beta zone of PPA. RESULTS: The frequency of beta zone in CACG, open-angle glaucoma and control group was 31.3%, 77.8% and 21.9%, respectively, with statistically significant difference between these groups (chi(2) = 19.915, P = 0.000). Beta zone showed ICG hypofluorescence in all eyes. There were no statistically significant difference in the frequency of alpha zone between glaucoma groups and control group. However, there were two different types of indocyanine green filling in alpha zone: normal or decreased choroid filling. Decreased choroid filling in alpha zone was observed in 53.8% of eyes with chronic angle-closure glaucoma, 66.7% of open-angle glaucoma and 32.1% of in control, the difference was significant (chi(2) = 6.648, P = 0.036). CONCLUSIONS: The frequency of zone beta with no choroidal filling in open-angle glaucoma group is the highest among these three groups. Zone alpha in glaucomatous eyes show decreased choroidal circulation, which may be the early sign for the extension of beta zone.