视野半侧缺损的原发性开角型青光眼视网膜微循环改变的研究

目的研究视野半侧缺损的原发性开角型青光眼(POAG)视盘旁和黄斑区血管密度的改变及其与视网膜神经纤维层(RNFL)厚度及视野指标的关系。方法横断面研究。收集2015年10月至2018年10月于复旦大学附属眼耳鼻喉科医院眼科应用Humphery视野计30-2程序检测为视野半侧缺损的POAG患者(POAG组)28例(28只眼),同期纳入性别、年龄匹配的健康志愿者(健康对照组)31名(31只眼)。所有受试者均接受了全面的眼科检查,包括RNFL、视网膜神经节细胞复合体(GCC)厚度及视野检查等,并收集了一般信息。采用相干光层析血管成像术检测视盘旁放射状盘周毛细血管(RPC)和黄斑区视网膜浅层毛细血管丛(SCP)的血管密度。健康对照组与POAG组、健康对照组与POAG组视野正常半侧检测结果比较采用独立样本秩和检验,POAG组内视野缺损半侧与视野正常半侧检测结果比较采用配对秩和检验。结果POAG组男性16例,女性12例,年龄(47±12)岁;POAG组与健康对照组性别分布、年龄、眼压、中央角膜厚度、眼轴长度和眼内灌注压差异均无统计学意义(均P>0.05)。POAG组上、下半侧视野缺损者分别有19、9例。POAG组视盘旁RPC和黄斑区SCP血管密度分别为45.86%(34.92%~52.78%)、39.31%(32.55%~46.79%),均低于健康对照组56.90%(51.69%~60.84%)、47.48%(37.95%~52.25%)],差异均有统计学意义(Z=-6.56,-5.86;均P<0.01)。POAG组RNFL和GCC厚度分别为84.4(62.1~97.1)、76.4(60.3~92.5)μm,均小于健康对照组110.6(95.7~131.6)、98.1(84.0~109.2)μm;Z=-6.57,-6.36;均P<0.01]。POAG组中视野缺损半侧对应的视盘旁RPC和黄斑区SCP血管密度分别为44.12%(34.73%~53.20%)和36.81%(29.73%~47.82%),明显低于视野正常半侧对应的血管密度51.85%(38.64%~61.02%)、41.78%(33.93%~49.22%);Z=-4.62,-4.12;均P<0.01]。POAG组视野正常半侧对应的视盘旁RPC和黄斑区SCP血管密度均低于健康对照组(Z=-5.08,-4.95;均P<0.01);视野正常半侧对应的RNFL和GCC厚度分别为93.0(61.9~116.5)μm和86.3(67.2~98.2)μm,均小于健康对照组(Z=-5.15,-5.35;均P<0.01);但二者间视野指标差异无统计学意义(均P>0.05)。结论视野半侧缺损的POAG患者视盘旁RPC及黄斑区SCP血管密度降低并伴有RNFL及GCC变薄,其中视野正常半侧对应区域的视盘旁RPC及黄斑区SCP血管密度也降低并伴有RNFL及GCC变薄,提示POAG视网膜血管和结构的改变发生在视功能改变前。(中华眼科杂志,2021,57:201-206)

Retinal vessel density in primary open-angle glaucoma with a hemifield defect

Objective To evaluate the retinal vessel density in eyes with primary open-angle glaucoma(POAG)with single-hemifield visual field(VF)defects and its relationship to retinal nerve fiber layer(RNFL)thickness and visual field indices.Methods Cross-sectional study.Twenty-eight POAG patients with single-hemifield VF defects and 31 normal controls were recruited from October 2015 to October 2018 in the Eye,Ear,Nose and Throat Hospital of Fudan University.All subjects underwent complete ophthalmological examinations,including RNFL,retinal ganglion cell complex(GCC)thickness and visual field tests,and the general information was collected.The peripapillary radial peripapillary capillaries(RPC)and macular superifical retinal capillary plexus(SCP)were derived from optical coherence tomography angiography.The retinal vessel density,structural values,and VF values were compared among the corresponding hemifields of POAG and healthy eyes using the Rank Sum test.Results There were 16 males and 12 females in POAG patients,with the age of(47±12)years;there were no significant differences in gender distribution,age,intraocular pressure,central corneal thickness,axial length and intraocular perfusion pressure between POAG patients and the normal controls(all P>0.05).Among POAG patients,there were 19 cases with upper and 9 cases with lower visual field defect.In the POAG eyes,the vascular density of peripapillary RPC and macular SCP were 45.86%(34.92%-52.78%)and 39.31%(32.55%-46.79%),respectively.In the normal eyes,the vascular density of peripapillary RPC and macular SCP were 56.90%(51.69%-60.84%)and 47.48%(37.95%-52.25%),respectively.The difference was statistically significant(Z=-6.56,-5.86;both P<0.01).The RNFL and GCC thicknesses in the POAG group were 84.4(62.1-97.1),76.4(60.3-92.5)μm,respectively,which were smaller than those in normal controls110.6(95.7-131.6),98.1(84.0-109.2)μm;Z=-6.57,-6.36;both P<0.01].In the POAG eyes,the peripapillary RPC44.12%(34.73%-53.20%)vs.51.85%(38.64%-61.02%);Z=-4.62;P<0.01]and macular SCP36.81%(29.73%-47.82%)vs.41.78%(33.93%-49.22%);Z=-4.12;P<0.01]vessel densities were reduced in the abnormal hemisphere compared with the opposite hemisphere.Compared with the normal eyes,the normal hemisphere of the POAG eyes had lower peripapillary RPC and macular SCP vessel densities(Z=-5.08,-4.95;both P<0.01),a thinner RNFL and a thinner retinal GCC93.0(61.9-116.5)μm vs.110.6(95.7-131.6)μm,Z=-5.15;86.3(67.2-98.2)μm vs.98.1(84.0-109.2)μm,Z=-5.35;both P<0.01].But the mean deviation and pattern standard deviation values of the VF were not significantly different between them(both P>0.05).Conclusions The retinal vessel density reduce in eyes with POAG with single-hemifield VF defects.The normal hemisphere of POAG eyes have a reduced retinal microcirculation along with the thinning of the RNFL and GCC,suggesting that vascular dysfunction and structural changes preceded VF loss in POAG.(Chin J Ophthalmol,2021,57:201-206)