非动脉炎性前部缺血性视神经病变患眼视盘周围及黄斑区视网膜血流参数变化特征

目的：观察非动脉炎性前部缺血性视神经病变（NAION）患眼视盘周围及黄斑区视网膜血流相关参数的变化特征。方法：回顾性病例对照研究。选择2017年10月至2018年6月在南京医科大学附属无锡第二医院确诊的萎缩型NAION患者（发病时间>3个月）18例（18眼）。另选取眼部检查正常的门诊健康体检者20例（20眼）作为正常对照组。使用AngioVue OCT血管成像系统对所有受检者进行视盘及其血流成像、黄斑区血流成像及黄斑视神经节细胞复合体（GCC）扫描，测量视盘周围神经纤维（pRNFL）厚度、GCC厚度和整个平面视网膜血流密度（wiVD），包括视盘周围放射状毛细血管（RPC）、视乳头旁的RPC血流密度（ppVD）、浅层毛细血管丛（SCP）、深层毛细血管丛（DCP）及黄斑中心凹旁血流密度（pfVD）。组间数据比较采用卡方检验及独立样本t检验，Logistic回归及线性回归分析各血流参数对NAION发病、GCC等的影响，Pearson相关分析上下部分ppVD与pRNFL的相关性。结果：与正常对照组比较，NAION组pRNFL厚度、RPC wiVD、ppVD明显较低（t=-6.567、-6.958、-6.668，P<0.001），SCP wiVD、DCP wiVD及GCC厚度亦明显较低（t=-6.226、-2.760、-6.340，P<0.001）。Logistic回归分析显示NAION发病与ppVD相关（b=0.502，OR=1.653，P=0.045）。线性回归分析显示NAION患者的LogMAR BCVA与SCP wiVD相关（b=-0.726，P=0.003），pRNFL厚度与ppVD相关（b=0.883，P=0.001）。上半部分的pRNFL厚度与上半部分ppVD呈正相关（r=0.946，P<0.001），下半部分的pRNFL厚度与下半部分ppVD呈正相关（r=0.680，P=0.031）。结论：病程>3个月的NAION患眼视盘周围及黄斑区大血管附近血流显著减少。NAION患眼ppVD越稀疏，NAION发病可能性越大，pRNFL相对越薄；SCP wiVD越稀疏，NAION患眼的视力相对越差。

Measurement of Peripapillary and Macular Retinal Vasculature Parameters in Nonarteritic Anterior Ischemic Optic Neuropathy

Objective: To evaluate the changes of peripapillary and macular retinal vasculature parameter in nonarteritic anterior ischemic optic neuropathy (NAION) patients. Methods: In this case-control study,eighteen consecutive patients (18 eyes) who were clinically diagnosed with atrophic NAION (at least 3 months after onset of symptoms) between October 2017 and June 2018 were included. Twenty healthyoutpatient patients (20 eyes) with normal eye examination were selected as the control group. The optic nerve head and macular was scanned by optic coherence tomography angiography (OCTA) for all subjects.The following parameters, including peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell complex (GCC), whole en face image vessel density (wiVD) of the radial peripapillary capillaries (RPC), peripapillary RPC vessel density (ppVD), superficial capillary plexus (SCP), deep capillary plexus (DCP), and parafoveal vessel density (pfVD) were measured. Multi-factor regression analyses were used to analyze the effects of blood flow parameters on the incidence of NAION, LogMAR BCVA, pRNFL and GCC. Pearson correlation between ppVD and pRNFL was analyzed. Results: Compared with the control group, pRNFL thickness, RPC wiVD and ppVD of the NAION group were significantly reduced (t=-6.567,-6.958, -6.668, P<0.001) and the SCP wiVD, DCP wiVD and GCC thickness were significantly reduced (t=-6.226, -2.760, -6.340, P<0.001). NAION development was related to ppVD (b=0.502, OR=1.653,P=0.045). The LogMAR BCVA of the NAION group was related to SCP wiVD (b=-0.726, P=0.003), the pRNFL thickness was related to ppVD (b=0.883, P=0.001), and significant correlations were also found between ppVD and pRNFL thickness in the superior and inferior sectors (r=0.946, P<0.001; r=0.680,P=0.031). Conclusions: OCTA provided detailed visualization of the peripapillary and macular retinal capillary rarefaction predominating near larger vessels, correlated with visual acuity loss and pRNFL thickness thin in affected eyes of NAION whose disease course was more than 3 months. The sparser the ppVD of the affected eye is, the more likely NAION is to develop, and the poorer visual acuity is correlated with thinner pRNFL and sparser of SCP wiVD.