Cheng C Y, Liu C J, Chiou H J, Chou J C, Hsu W M, Liu J H
Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.
Ophthalmology. 2001 Aug;108(8):1445-51. doi: 10.1016/s0161-6420(01)00603-0.
To evaluate the retrobulbar hemodynamics in patients with chronic angle-closure glaucoma (CACG) by using color Doppler imaging (CDI) and to correlate the degree of glaucomatous visual field loss with the hemodynamic parameters.
Prospective case series.
Twenty-six Chinese patients with CACG and 26 age-matched and gender-matched normal subjects were recruited. All CACG patients had history of chronic intraocular pressure (IOP) elevation and asymmetric visual field defects between their fellow eyes. After receiving laser peripheral iridotomy and/or filtration surgery, all of them had bilateral medication-free controlled IOP before enrolling into the study.
Each subject underwent CDI measurement in the central retinal artery (CRA) and the nasal and temporal short posterior ciliary arteries (PCA). Visual fields of the CACG patients were obtained with Humphrey 24-2 program. The visual field defects were scored with the Advanced Glaucoma Intervention Study (AGIS) system. For each CACG patient, the eye with lower AGIS score was defined as the better eye and the eye with higher score as the worse eye.
Peak-systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI) were determined.
The EDV in the CRA and the temporal PCA was decreased significantly (P = 0.041 and 0.023, respectively) in the worse eyes of CACG patients compared with those in the control eyes. The better eyes of CACG patients showed no significant change in hemodynamic parameters compared with the control eyes. While comparing the fellow eyes of CACG patients, the worse eyes had significantly lower EDV in the temporal PCA (P = 0.012) than the contralateral better eyes. In 11 CACG patients with a difference of at least 8 in AGIS visual field scores between their fellow eyes, the worse eyes had significantly lower EDV (P = 0.041) in the CRA and lower PSV (P = 0.018) and EDV (P = 0.018) in the temporal PCA compared with those in the contralateral eyes. In multivariate regression analysis, the AGIS scores were significantly correlated with the PSV in the CRA (P = 0.015) and with the EDV (P < 0.001) and RI (P = 0.027) in the temporal PCA in patients with CACG.
Patients with well-controlled CACG may have decreased retrobulbar blood flow velocities and increased vascular resistance in the CRA and temporal PCA. The degree of retrobulbar hemodynamic impairment was well correlated with the degree of glaucomatous visual field loss.
运用彩色多普勒成像（CDI）评估慢性闭角型青光眼（CACG）患者的球后血流动力学，并将青光眼性视野缺损程度与血流动力学参数进行关联分析。
前瞻性病例系列研究。
招募了26例中国CACG患者以及26例年龄和性别匹配的正常受试者。所有CACG患者均有慢性眼压（IOP）升高病史，且双眼视野不对称性缺损。在接受激光周边虹膜切开术和/或滤过手术后，所有患者在纳入研究前双眼眼压均在未用药情况下得到控制。
每位受试者均接受视网膜中央动脉（CRA）以及鼻侧和颞侧睫状后短动脉（PCA）的CDI测量。采用Humphrey 24-2程序获取CACG患者的视野。视野缺损采用高级青光眼干预研究（AGIS）系统进行评分。对于每位CACG患者，AGIS评分较低的眼定义为较好眼，评分较高的眼定义为较差眼。
测定收缩期峰值流速（PSV）、舒张末期流速（EDV）和阻力指数（RI）。
与对照眼相比，CACG患者较差眼中CRA和颞侧PCA的EDV显著降低（分别为P = 0.041和0.023）。CACG患者较好眼的血流动力学参数与对照眼相比无显著变化。在比较CACG患者的双眼时，较差眼颞侧PCA的EDV显著低于对侧较好眼（P = 0.012）。在11例双眼AGIS视野评分差异至少为8分的CACG患者中，较差眼CRA的EDV显著低于对侧眼（P = 0.041），颞侧PCA的PSV（P = 0.018）和EDV（P =
0.018）也显著低于对侧眼。在多因素回归分析中，AGIS评分与CACG患者CRA的PSV（P = 0.015）、颞侧PCA的EDV（P < 0.001）和RI（P = 0.027）显著相关。
眼压控制良好的CACG患者可能存在球后血流速度降低以及CRA和颞侧PCA血管阻力增加的情况。球后血流动力学损害程度与青光眼性视野缺损程度密切相关。
