OCT在高眼压症患者视盘结构和微循环评估中的作用

目的　基于OCT评估高眼压症（OHT）患者视盘结构和微循环的特征。方法　前瞻性连续收集2018年6月至2021年12月于北京大学第三医院眼科中心就诊的OHT患者（OHT组）56例（56眼），收集同期原发性开角型青光眼（POAG）患者（POAG组）33例（33眼）和健康人群（正常对照组）39名（39眼），采用OCT测量受试者杯盘比、Bruch膜开口（BMO）宽度、最小盘沿宽度（MRW）和视盘旁视网膜神经纤维层（RNFL）厚度，采用OCTA测量受试者视盘血管密度（VD），运用广义线性混合模型比较各组受试者以上指标的组间差异，并通过Bonferroni校正调整检验水平。 结果　与OHT组比较，POAG组患者的杯盘面积比、垂直杯盘比、水平杯盘比和视杯体积均增加，盘沿面积下降，差异均有统计学意义（均为校正P<0.05）；POAG组患者盘沿面积小于正常对照组，而杯盘面积比和垂直杯盘比均大于正常对照组，差异均有统计学意义（均为校正P<0.05）；OHT组和正常对照组受试者各项杯盘比指标之间两两比较差异均无统计学意义（均为校正P>0.05）。各组受试者间的BMO宽度和MRW差异均无统计学意义（均为校正P>0.05）。OHT组和正常对照组受试者视盘旁RNFL厚度均高于POAG组（均为校正P<0.05），但OHT组与正常对照组比较差异无统计学意义（校正P>0.05）。在微循环指标的比较中，OHT组患者的视盘旁VD高于POAG组，POAG组患者视盘旁VD低于正常对照组，OHT组患者视盘旁VD低于正常对照组（均为校正P<0.05）。OHT组患者视盘内VD低于正常对照组（P<0.05)。结论　OHT患者的视盘区域结构与正常人群无差异，视盘区域会出现VD下降，POAG患者的视盘结构及微循环损伤重于OHT患者。

Assessment of structure and microcirculation of the optic disc in ocular hypertension patients by optical coherence tomography

Objective　To assess the structure and microcirculation of the optic disc in ocular hypertension (OHT) patients based on optical coherence tomography (OCT). Methods　A total of 56 OHT patients (56 eyes) treated in the Ophthalmology Department of Peking University Third Hospital between June 2018 and December 2021 were prospectively collected and included in the OHT group, 33 primary open-angle glaucoma (POAG) patients (33 eyes) during the same period in the POAG group, and 39 normal individuals (39 eyes) in the normal control group. The cup-to-disc ratio (CDR), Bruch membrane opening (BMO) width, minimum rim width (MRW), and peripapillary retinal nerve fiber layer (RNFL) thickness were measured by OCT. The vessel density (VD) in the optic disc was evaluated by optical coherence tomography angiography (OCTA). The above parameters between the groups were compared using a generalized linear mixed model, and the test levels were adjusted by the Bonferroni correction method. Results　Compared with the OHT group, the cup-to-disc area ratio, vertical CDR, horizontal CDR, and cup volume significantly increased, while the rim area significantly decreased in the POAG group (all adjusted-P<0.05). The rim area in the normal control group was larger than that in the POAG group, while the cup-to-disc area ratio and vertical CDR were smaller (all adjusted-P<0.05). No significant difference was observed in CDRs between the OHT group and the normal control group (all adjusted-P>0.05). Similarly, no significant difference was found in BMO width and MRW among the three groups (all adjusted-P>0.05). The peripapillary RNFL thickness in the OHT group and normal control group was significantly higher than that in the POAG group (both adjusted-P<0.05), but there was no significant difference between the OHT group and the normal control group (adjusted-P>0.05). The peripapillary VD in the OHT group was significantly higher than that in the POAG group (adjusted-P<0.05). The peripapillary VD in the POAG group was significantly lower than that in the normal control group (adjusted-P<0.05). The peripapillary VD in the OHT group was significantly lower than that in the normal control group (adjusted-P<0.05). VD in the optic disc in the OHT group was lower than that in the normal control group (P<0.05).Conclusion　The structure of the optic disc shows no difference between OHT patients and normal persons. VD in the optic disc decreases in OHT patients. The damage to the structure and microcirculation of the optic disc is severer in POAG patients compared with OHT patients.