青光眼白内障联合手术前后视盘血流的变化观察 △

目的 评价青光眼白内障联合手术前后视盘血流的变化。方法 对拟做青光眼白内障联合手术、晶状体为中度混浊的青光眼患者,分别于术前、术后1 d、术后1周、术后1个月和术后3个月检查光学相干断层扫描血管成像(OCTA),采用视盘血流高清模式 4.5 mm程序(Angio HD Disc 4.5 mm),分析视网膜神经纤维层厚度变化、视盘和盘周的血流密度变化。手术中Phaco的灌注瓶高统一设置为60~65 cm。结果 共观察36例(37眼),术前、术后1 d、术后1周、术后1个月和术后3个月的视盘内所有血管密度分别为:(52.78±3.59)%、(44.90±3.59)%、(49.56±5.32)%、(51.18±6.68)%、(53.94±5.64)%;视盘内所有毛细血管密度分别为(43.64±2.91)%、(36.71±4.09)%、(40.72±6.73%)、(41.96±6.17)%、(46.2±5.47)%,术后1 d均较术前有明显下降,差异有统计学意义(P<0.000 1),术后1周均开始逐步回升,术后3个月时达术前水平,术后1 d和术后1周、1个月、3个月差异均有统计学意义(P<0.05);整幅图像所有血管血流密度、整幅图像所有毛细血管血流密度、盘周所有血管血流密度和盘周毛细血管血流密度术前、术后差异均无统计学意义。70岁以上组和70岁以下组、原发性闭角型青光眼(PACG)组和原发性开角型青光眼(POAG)组组间术前、术后视盘血流密度下降差异均无统计学意义。术前、术后的视网膜神经纤维层厚度差异也无统计学意义。结论 青光眼白内障联合手术对视网膜神经纤维层厚度没有影响,但对视盘内的血流密度有显著影响,第1天显著下降,术后逐步恢复,3个月时接近术前水平;但对视盘周围的血流没有影响。

Changes of optic disc blood flow before and after combined cataract and glaucoma surgery

Objective To evaluate the changes of optic disc blood flow before and after combined cataract and glaucoma surgery.Methods Patient who was preparing the combined cataract and glaucoma surgery with moderate lens opacity was examined using optical coherence tomography angiography(OCTA) before,1 day, 1 week, 1 month, and 3 months after surgery. We chose the model Angio HD Disc 4.5 mm to analyze the changes of the thickness of retinal nerve fiber layer and the changes of vessel density inside and around optic disc. The height of perfusion bottle in Phaco was set at 60 to 65 cm during the surgery.Results Thirty-six eyes of 37 patients were observed. The vessel density(VD) of all radial peripapillary capillary(RPC) inside the optic disc before,1 day, 1 week, 1 month, and 3 months after surgery were (52.78±3.59)%, (44.90±3.59)%, (49.56±5.32)%, (51.18±6.68)%, (53.94±5.64)%,respectively. The VD of capillary radial peripapillary capillary inside optic disc were (43.64±2.91)%, (36.71±4.09)%, (40.72±6.73%), (41.96±6.17)%, (46.2±5.47)%,respectively.The VD of all RPC and capillary RPC inside optic disc at 1 day after surgery was significantly decreased than that before surgery (P<0.000 1). The gradual recovery began at 1 week after surgery, and the preoperative level was reached at 3 months.There were also significant differences between 1 day and 1 week, 1 month, and 3 months after surgery (P<0.05). No statistically differences were found for the VD of all RPC and capillary RPC in whole image and peripapillary area. There was no significant difference in the decrease of VD inside optic disc between the groups over 70 years old and under 70 years old, primary angle-closure glaucoma and primany open angle glaucoma. No statistically differences were found for the thickness of retinal nerve fiber layer before and after operation.Conclusions Combined cataract and glaucoma surgery had no significant effect on the thickness of retinal nerve fiber layer,and had a significant effect on the vessel density inside the optic disc. The density decreased significantly at 1 day after surgery, then gradually recovered and approached the preoperative level at 3 months. On the contrary, the surgery had no effect on the vessel density around the optic disc.