青光眼患者视盘旁脉络膜微血管丢失和视网膜神经纤维层进行性变薄的评估。
Evaluation of Parapapillary Choroidal Microvasculature Dropout and Progressive Retinal Nerve Fiber Layer Thinning in Patients With Glaucoma.
机构信息
Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
出版信息
JAMA Ophthalmol. 2019 Jul 1;137(7):810-816. doi: 10.1001/jamaophthalmol.2019.1212.
IMPORTANCE
Parapapillary choroidal microvasculature dropout (MvD) is considered one of pathophysiological manifestations of glaucomatous damage.
OBJECTIVE
To evaluate the longitudinal change in the parapapillary choroidal MvD in patients with primary open-angle glaucoma (POAG), and to determine whether this change is associated with progressive retinal nerve fiber layer (RNFL) thinning.
DESIGN, SETTING, AND PARTICIPANTS: This prospective observational case series was conducted at a tertiary referral center in Korea and included 68 patients with POAG who exhibited parapapillary choroidal MvD in en face optical coherence tomography (OCT) angiography (OCTA) images who were enrolled from the ongoing Investigating Glaucoma Progression Study from January 1, 2016, through July 31, 2018. The mean (SD) follow-up period was 2.5 (0.2) years and observers were masked to the clinical characteristics of the participants for measurements. The OCTA images were obtained twice at an interval of at least 2 years, during which the RNFL thickness was measured at least 4 times in serial OCT examinations. Microvasculature dropout was defined as a focal sectoral capillary dropout with no visible microvascular network identified in the choroidal layer. The MvD area was measured in the OCTA images obtained at the baseline and the final follow-up. The significance of changes in the MvD area was defined using the 95% Bland-Altman limits of agreement. The rate of RNFL thinning was determined by linear regression of the serial OCT RNFL thickness measurements.
MAIN OUTCOMES AND MEASURES
The association between the change in the MvD area and the rate of RNFL thinning.
RESULTS
Of 68 Korean participants, 37 (54.5%) were women, and the mean (SD) age was 54.3 (13.1) years. Among 68 eyes, 22 (32.4%) showed increases in the MvD area during the follow-up. Faster global RNFL thinning was associated with a larger baseline parapapillary atrophy β-zone (β = -0.55; 95% CI, -0.96 to -0.14; P = .01), disc hemorrhage detection during the follow-up period (β = -0.75; 95% CI, -1.67 to -0.34; P = .001), and a larger increase in the MvD area (β = -4.74; 95% CI, -7.72 to -1.75; P = .002). The MvD area was not associated with the rate of RNFL thinning at baseline or the final follow-up.
CONCLUSIONS AND RELEVANCE
Microvasculature dropout enlargement was associated with progressive RNFL thinning in POAG.
重要性
脉络膜旁毛细血管丢失（MvD）被认为是青光眼损害的病理生理表现之一。
目的
评估原发性开角型青光眼（POAG）患者脉络膜旁 MvD 的纵向变化，并确定这种变化是否与进行性视网膜神经纤维层（RNFL）变薄有关。
设计、地点和参与者：这是一项在韩国的三级转诊中心进行的前瞻性观察性病例系列研究，纳入了 68 名在正电子发射断层扫描（OCT）血管造影（OCTA）图像中出现脉络膜旁 MvD 的 POAG 患者，这些患者来自 2016 年 1 月 1 日至 2018 年 7 月 31 日正在进行的青光眼进展研究。平均（SD）随访时间为 2.5（0.2）年，观察者对参与者的临床特征进行了盲法测量。OCTA 图像至少间隔 2 年获得两次，在此期间，在连续 OCT 检查中至少 4 次测量 RNFL 厚度。微血管丢失定义为脉络膜层中出现局灶性扇形毛细血管丢失，无可见微血管网络。在基线和最终随访时测量 OCTA 图像中的 MvD 区域。使用 95% Bland-Altman 一致性界限来定义 MvD 区域变化的意义。通过对连续 OCT RNFL 厚度测量值进行线性回归来确定 RNFL 变薄率。
主要结果和测量
MvD 区域变化与 RNFL 变薄率之间的关系。
结果
在 68 名韩国参与者中，37 名（54.5%）为女性，平均（SD）年龄为 54.3（13.1）岁。在 68 只眼中，有 22 只（32.4%）在随访期间 MvD 区域增加。全球 RNFL 变薄越快与较大的基线旁脉络膜萎缩β区（β=-0.55；95%置信区间，-0.96 至-0.14；P=0.01）、随访期间出现盘状出血（β=-0.75；95%置信区间，-1.67 至-0.34；P=0.001）和 MvD 区域较大增加（β=-4.74；95%置信区间，-7.72 至-1.75；P=0.002）相关。MvD 区域与基线或最终随访时的 RNFL 变薄率无关。
结论
脉络膜旁毛细血管丢失扩大与 POAG 中进行性 RNFL 变薄有关。
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