原发性开角型及慢性闭角型青光眼患者视盘毛细血管密度和视野缺损的关联性研究

目的 本研究旨在通过分析原发性开角型青光眼(POAG)患者和慢性原发性闭角型青光眼(PACG)患者的视盘毛细血管密度与视野缺损的相关性,探讨视盘毛细血管密度在青光眼诊断和病情评估中的价值。方法 纳入2017年9月2018年9月我院收治的POAG患者90例(90眼)作为POAG组,慢性PACG患者75例(75眼)作为PACG组,2组的年龄、性别和视野平均缺损(MD)值进行了匹配。此外,纳入同期性别、年龄匹配的60位健康体检者60眼作为对照组。检测所有参与者的视盘毛细血管密度、视网膜神经纤维层(RNFL)厚度及视野缺损情况。结果 POAG和PACG患者的平均RNFL厚度和平均毛细血管密度均显著低于正常人(P<0.05),而POAG患者和PACG患者的平均RNFL厚度和平均毛细血管密度差异没有统计学意义(P>0.05)。对于POAG患者,其视盘上方、下方、颞侧和全区的RNFL厚度与视野MD值呈负相关(r=-0.525,-0.462,-0.246,-0.453,P均<0.05),但是鼻侧的RNFL厚度与视野MD值无相关性(r=-0.198,P>0.05)。4个区域和全区的毛细血管密度与视野MD值均呈显著负相关(r=-0.341,-0.426,-0.285,-0.298,-0.557,P均<0.05)。对于PACG患者,仅上方、下方和全区的RNFL厚度与视野MD值相关(r=-0.543,-0.604,-0.448,P均<0.05),但是4个区域及全区的毛细血管密度均与视野MD值显著相关(r=-0.613,-0.494,-0.179,-0.413,-0.589,P均<0.05)。结论 视盘毛细血管密度与POAG和PACG患者的视野缺损相关,视盘毛细血管密度的变化对于青光眼的诊断和病情评估有重要的参考价值。

The relationship between optic disc capillary density and mean defect of visual field in primary open-angle and angle-closure glaucoma

Objective To investigate the relationship between optic disc capillary density and visual field defects in patients with primary open angle glaucoma (POAG) and chronic primary angle-closure glaucoma (PACG), as well as to explore the value of optic disc capillary density in glaucoma diagnosis and disease assessment. Methods From Sep. 2017 to Sep. 2018, 90 eyes of 90 POAG patients were included in the POAG group, and 75 eyes of 75 patients with chronic PACG were included in the PACG group. The age, gender, and visual field mean deviation (MD) values of the two groups were matched. In addition, 60 eyes of 60 sex- and age-matched healthy subjects were included as control. The optic disc capillary density, retinal nerve fiber layer (RNFL) thickness, and MD were measured in all participants. Results The average RNFL thickness and mean capillary density of the optic disc were significantly lower in POAG and PACG patients than those in normal subjects (P<0.05), but there was no significant difference in mean RNFL thickness and mean capillary density between POAG patients and PACG patients (P>0.05). For POAG patients, the thickness of superior, inferior, temporal and average RNFL optic disc was inversely correlated with MD of the visual field (r=-0.525, -0.462, -0.246, -0.453, all P<0.05), but in the nasal quadrant, there was no correlation between the thickness of RNFL and the MD value of the visual field (r=-0.198, P>0.05). However, there were significant negative correlations between the capillary density of the four quadrants and the whole region and the MD value of the visual field (r=-0.341, -0.426, -0.285, -0.298, -0.557, all P<0.05). For PACG patients, only the superior, inferior, temporal and average RNFL thickness was related to the visual field MD value (r=-0.543, -0.604, -0.448, all P<0.05), but the capillary density of the four quadrants and the whole region was significantly correlated with the visual field MD values (r=-0.613, -0.494, -0.179, -0.413, -0.589, all P<0.05). Conclusions Optic disc capillary density is associated with visual field defects in patients with POAG and PACG. The change of capillary density has important value for the diagnosis and evaluation of glaucoma.