Einhorn Clinical Research Center, Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York.
Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
JAMA Ophthalmol. 2019 Jun 1;137(6):618-625. doi: 10.1001/jamaophthalmol.2019.0434.
Systemic blood flow alterations have been described using video nailfold capillaroscopy (NFC) in high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) variants of primary open-angle glaucoma (POAG). To date, no previous studies have explored alterations in nailfold capillary blood flow in exfoliation glaucoma (XFG).
To investigate the measure of peripheral blood flow as a surrogate marker of systemic vascular involvement in patients with XFG, HTG, and NTG, as well as in individuals serving as controls, using NFC.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional clinic-based study at the New York Eye and Ear Infirmary of Mount Sinai was conducted from July 6, 2017, to May 18, 2018. A total of 111 participants (30 XFG, 30 NTG, 30 HTG, and 21 controls) received a comprehensive ophthalmic examination to confirm eligibility. Exclusion criteria were the presence of connective tissue disease, uncontrolled diabetes, history of bleeding disorders, and/or history of trauma or surgery to the nondominant hand.
Resting capillary blood flow at the nailfold of the fourth digit of the nondominant hand in patients with NTG, HTG, XFG, and controls, using NFC.
Two participants were excluded owing to poor nailfold image quality, resulting in 109 participants. Sixty-two participants (57%) were women and 79 (72%) were white. Mean (SD) age of the participants was 67.9 (11.7) years. Mean (SD) resting peripheral capillary blood flow at the nailfold for controls was 70.9 (52.4) picoliters/s (pL/s); HTG, 47.5 (41.9) pL/s; NTG, 40.1 (16.6) pL/s; and XFG, 30.6 (20.0) pL/s. Multivariable analysis of the differences of flow in HTG vs control participants showed values of -18.97 (95% CI, -39.22 to 1.27; P = .07) pL/s, NTG vs controls of -25.17 (95% CI, -45.92 to -4.41; P = .02) pL/s, and XFG vs controls of -28.99 (95% CI, -51.35 to -6.63; P = .01) pL/s.
Decreased resting peripheral capillary blood flow may occur in patients with XFG and NTG compared with individuals without glaucoma. These findings may contribute to understanding the possible systemic nature of glaucoma.
已经使用视频甲襞毛细血管显微镜（NFC）描述了原发性开角型青光眼（POAG）的高压性青光眼（HTG）和正常眼压性青光眼（NTG）变体中的系统性血流改变。迄今为止，尚无先前的研究探讨过剥脱性青光眼（XFG）中甲襞毛细血管血流的改变。
使用 NFC 研究 XFG、HTG 和 NTG 患者以及对照组个体的外周血流作为全身血管受累的替代标志物。
设计、地点和参与者：这是一项 2017 年 7 月 6 日至 2018 年 5 月 18 日在西奈山纽约眼耳医院进行的基于诊所的横断面研究。共有 111 名参与者（30 名 XFG、30 名 NTG、30 名 HTG 和 21 名对照组）接受了全面的眼科检查以确认合格性。排除标准为患有结缔组织疾病、未控制的糖尿病、出血性疾病史、以及/或者存在非优势手创伤或手术史。
使用 NFC 测量非优势手第四指甲襞的静息毛细血管血流，用于 NTG、HTG、XFG 和对照组的患者。
由于甲襞图像质量差，有 2 名参与者被排除在外，最终有 109 名参与者。62 名参与者（57%）为女性，79 名参与者（72%）为白人。参与者的平均（SD）年龄为 67.9（11.7）岁。对照组的静息外周毛细血管血流平均值（SD）为 70.9（52.4）皮升/秒（pL/s）；HTG 为 47.5（41.9）pL/s；NTG 为 40.1（16.6）pL/s；XFG 为 30.6（20.0）pL/s。HTG 与对照组参与者的流量差异的多变量分析显示值为-18.97（95%CI，-39.22 至 1.27；P=0.07）pL/s，NTG 与对照组的-25.17（95%CI，-45.92 至-4.41；P=0.02）pL/s，XFG 与对照组的-28.99（95%CI，-51.35 至-6.63；P=0.01）pL/s。
与无青光眼的个体相比，XFG 和 NTG 患者的静息外周毛细血管血流可能减少。这些发现可能有助于理解青光眼可能的全身性本质。
