急性发作期高眼压持续时间对闭角型青光眼患者的影响:基于OCTA的研究

目的　基于OCTA分析急性闭角型青光眼急性发作期不同时长的持续高眼压对视盘血流密度及视网膜形态结构的影响。方法　采用前瞻性横断面对照研究，以急性闭角型青光眼急性发作期首次发作伴有轻度白内障的患者为研究对象。根据急性发作期高眼压持续时间分为2组，高眼压持续≤2 d为A组，高眼压持续>2 d为B组。所有患眼均行超声乳化白内障吸除联合人工晶状体植入联合房角分离术，术前及术后1个月均行 OCTA 检查，分别观察两组患眼黄斑区平均神经节细胞复合体(mGCC)厚度，视盘周围平均视网膜神经纤维层(RNFL)厚度，视盘整体及上方、鼻侧、下方、颞侧区域毛细血管血流密度的变化，并对比分析。结果　共纳入30例（30眼）急性闭角型青光眼患者，其中A、B组各15例（15眼）。A、B 两组患眼间术前 mGCC 厚度及视盘整体、上方、鼻侧、下方、颞侧区域毛细血管血流密度差异均无统计学意义（均为P>0.05），RNFL 厚度A组小于B组，差异有统计学意义(P=0.010)。术后 1个月，A、B 两组患眼间 RNFL 厚度差异无统计学意义（P=0.212），A组患眼mGCC 厚度及视盘整体、上方、鼻侧、下方、颞侧区域毛细血管血流密度均大于B组，差异均有统计学意义（均为P<0.05）。A组及B组患眼术后1个月与术前相比， mGCC 厚度， RNFL 厚度，视盘整体及上方、鼻侧、下方、颞侧区域毛细血管血流密度均有所下降，差异均有统计学意义（均为P<0.05）。结论　OCTA 测量的 mGCC 厚度、RNFL 厚度、视盘血流密度等指标可作为评价急性闭角型青光眼急性高眼压对视网膜损伤的量化指标。

Effect of persistent elevation of intraocular pressure on patients with acute angle-closure glaucoma based on optical coherence tomography angiography

Objective　To explore the effect of persistent elevation of intraocular pressure (IOP) in acute angle-closure glaucoma (AACG) on the vessel density at optic disc and the retinal morphology based on optical coherence tomography angiography (OCTA). Methods　In this prospective cross-sectional controlled study, patients with mild cataracts during the first onset of AACG were included. According to the duration of high IOP in acute attack period, they were divided into 2 groups: Group A (≤2 days) and Group B (>2 days). Phacoemulsification combined with intraocular lens implantation and goniosynechialysis were performed in all patients. Before operation and 1 month after operation, all eyes were examined by OCTA to compare and analyze the changes in mean macular ganglion cell complex (mGCC) thickness, mean retinal never fiber layer (RNFL) thickness, and capillary vessel density (VD) in the whole, superior, nasal, inferior, and temporal regions of optic disc between the two groups. Results　A total of 30 eyes from 30 patients with AACG (15 patients/eyes in Group A and 15 patients/eyes in Group B) were enrolled. There was no significant difference in the mean mGCC thickness, capillary VD in the whole, superior, nasal, inferior, and temporal regions of optic disc between the two groups before operation (all P>0.05), but the RNFL thickness in Group A was smaller than that in Group B (P=0.010). One month after operation, there was no significant difference in RNFL thickness between the two groups (P=0.212), but the mGCC thickness and capillary VD in the whole, superior, nasal, inferior, and temporal regions of optic disc in Group A were larger than those in Group B (all P<0.05). One month after operation, the mGCC thickness, RNFL thickness, and capillary VD in the whole, superior, nasal, inferior, and temporal regions of optic disc in both groups were significantly lower than those before operation (all P<0.05). Conclusion　mGCC thickness, RNFL thickness, and capillary VD at optic disc measured by OCTA can be used as quantitative indexes to evaluate retinal damage caused by high IOP in AACG.