Department of Ophthalmology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
JAMA Ophthalmol. 2019 Jun 1;137(6):681-688. doi: 10.1001/jamaophthalmol.2019.0422.
Investigating the vascular risk factors of glaucoma progression is important to individualize treatment; however, few studies have investigated these factors because the available methods have proven insufficient to evaluate the vascular features of patients with glaucoma. Recently, the advent of optical coherence tomography angiography (OCT-A) allowed both qualitative and quantitative microvascular data to be obtained, to in turn evaluate the perfusion status of different retinal layers.
To determine whether baseline parapapillary choroidal vessel density (VD) as measured by OCT-A was associated with future glaucoma progression.
DESIGN, SETTING, AND PARTICIPANTS: A prospective, observational, comparative study was conducted at Seoul St Mary's Hospital of The Catholic University of Korea from March 1, 2016, to December 31, 2018, for 108 glaucomatous eyes in which the retinal nerve fiber layer thickness and mean deviation were measured by at least 5 serial OCT and visual field (VF) examinations. The participants underwent OCT-A at baseline. Vessel density was measured using the en face image of the choroidal map of OCT-A within the β-zone parapapillary atrophy region.
Parapapillary choroidal VD, retinal nerve fiber layer thinning rate, mean deviation rate, and progression of glaucoma as measured by OCT and VF.
Among 108 patients (74 women and 34 men; mean [SD] age, 59.2 [13.1] years), 38 (35.2%) showed progression of glaucoma as measured by OCT and 34 (31.5%) showed progression of glaucoma as measured by VF at the last follow-up. The mean (SD) follow-up duration was 2.6 [2.3] years. The presence of disc hemorrhage (odds ratio, 5.57; 95% CI, 3.18-8.29; P = .001), baseline mean deviation (odds ratio, 0.83; 95% CI, 0.71-0.97; P = .02), and parapapillary choroidal VD (odds ratio, 1.18; 95% CI, 1.09-1.28; P = .01) were associated with progression of glaucoma as measured by VF, but not with progression of glaucoma as measured by OCT. Baseline parapapillary choroidal VD (β, 1.08; 95% CI, 1.02-1.13; P < .001) was associated with progression of glaucoma as measured by VF using Cox proportional hazards regression analysis.
These data suggest that lower parapapillary choroidal VD within the β-zone parapapillary atrophy at baseline among individuals with glaucoma could play some role in the risk of progression of glaucoma as measured by VF. The findings suggest that patients with glaucoma with lower parapapillary choroidal VD within the β-zone parapapillary atrophy at baseline warrant careful monitoring for progression of glaucoma as measured by VF.
研究青光眼进展的血管危险因素对于个体化治疗很重要；然而，由于现有的方法被证明不足以评估青光眼患者的血管特征，因此很少有研究调查这些因素。最近，光学相干断层扫描血管造影术（OCT-A）的出现允许获得定性和定量的微血管数据，从而评估不同视网膜层的灌注状态。
确定基线时通过 OCT-A 测量的视盘旁脉络膜血管密度（VD）是否与未来青光眼进展有关。
设计、设置和参与者：一项前瞻性、观察性、比较研究于 2016 年 3 月 1 日至 2018 年 12 月 31 日在韩国天主教大学首尔圣玛丽医院进行，纳入了 108 只患有青光眼的眼睛，这些眼睛通过至少 5 次连续 OCT 和视野（VF）检查测量了视网膜神经纤维层厚度和平均偏差。参与者在基线时接受了 OCT-A 检查。在视盘旁萎缩区的 OCT-A 脉络膜面图像上测量血管密度。
视盘旁脉络膜 VD、视网膜神经纤维层变薄率、平均偏差率以及 OCT 和 VF 测量的青光眼进展情况。
在 108 名患者（74 名女性和 34 名男性；平均[SD]年龄，59.2[13.1]岁）中，38 名（35.2%）患者根据 OCT 测量显示青光眼进展，34 名（31.5%）患者根据 VF 测量显示青光眼进展。平均（SD）随访时间为 2.6[2.3]年。视盘出血（比值比，5.57；95%CI，3.18-8.29；P = .001）、基线平均偏差（比值比，0.83；95%CI，0.71-0.97；P = .02）和视盘旁脉络膜 VD（比值比，1.18；95%CI，1.09-1.28；P = .01）与 VF 测量的青光眼进展有关，但与 OCT 测量的青光眼进展无关。基线时视盘旁脉络膜 VD（β，1.08；95%CI，1.02-1.13；P < .001）与 VF 测量的青光眼进展有关，使用 Cox 比例风险回归分析。
这些数据表明，青光眼患者视盘旁β 区萎缩区的脉络膜血管密度（VD）较低可能与 VF 测量的青光眼进展风险有关。这些发现表明，基线时视盘旁β 区萎缩区脉络膜 VD 较低的青光眼患者需要密切监测 VF 测量的青光眼进展情况。
