The Viterbi Family Department of Ophthalmology/Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.
Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Br J Ophthalmol. 2020 Aug;104(8):1103-1108. doi: 10.1136/bjophthalmol-2019-314789. Epub 2019 Nov 1.
To evaluate changes in circumpapillary vessel density (cpVD) and retinal nerve fibre layer (cpRNFL) thickness after a successfully treated episode of acute primary angle closure (APAC) and to identify factors associated with glaucoma progression in these eyes.
Twenty-six patients successfully treated for a unilateral episode of APAC were included in this prospective study. Optical coherence tomography (OCT) cpRNFL thickness and OCT angiography (OCTA) cpVD were compared between 2 and 8 months after treatment. Multiple logistic regression analysis was conducted to identify factors that influenced cpRNFL outcome.
cpRNFL thicknesses was thinner in the affected eye (94.0 µm (95% CI: 87.3 to 100.8)) than in the unaffected fellow eye (103.1 µm (99.3 to 106.9)) at 2 months (p=0.039). The cpRNFL thickness of the affected eye decreased 8 months after remission (89.5 µm (84 to 95)), but was unchanged in the unaffected eye. Although cpVD was significantly lower (p=0.001) in APAC eyes 2 months after treatment (56.7% (53.8 to 59.7)) compared with fellow eyes (62.9% (61.4 to 64.4)), there was no significant change in cpVD of the affected eye between 2 and 8 months. In the multivariable analysis, the only factor that was associated with cpRNFL progression was lower cpVD at 2 months after APAC remission (OR=1.79, p=0.036).
Early reductions of the vessel density and long-term decrease in cpRNFL thickness were observed during the first 8 months after an APAC attack. A lower vessel density at 2 months was the best predictor of conversion to an abnormal cpRNFL thickness. Glaucomatous progression should be suspected in eyes with lower vessel density even after remission of an episode of APAC.
评估急性原发性闭角型青光眼（APAC）成功治疗后周边血管密度（cpVD）和视网膜神经纤维层（cpRNFL）厚度的变化，并确定这些眼睛青光眼进展的相关因素。
本前瞻性研究纳入了 26 例单侧 APAC 成功治疗的患者。治疗后 2 至 8 个月比较了光学相干断层扫描（OCT）cpRNFL 厚度和 OCT 血管造影（OCTA）cpVD。进行多因素逻辑回归分析以确定影响 cpRNFL 结果的因素。
治疗后 2 个月，患眼的 cpRNFL 厚度（94.0μm（95%CI：87.3 至 100.8））比健眼（103.1μm（99.3 至 106.9））更薄（p=0.039）。缓解后 8 个月，患眼的 cpRNFL 厚度下降（89.5μm（84 至 95）），但健眼无变化。尽管治疗后 2 个月 APAC 眼的 cpVD 明显降低（p=0.001）（56.7%（53.8 至 59.7）），但与健眼（62.9%（61.4 至 64.4））相比，无明显变化。在多变量分析中，唯一与 cpRNFL 进展相关的因素是 APAC 缓解后 2 个月的 cpVD 较低（OR=1.79，p=0.036）。
APAC 发作后前 8 个月观察到血管密度早期降低和 cpRNFL 厚度长期下降。APAC 缓解后 2 个月的血管密度较低是 cpRNFL 厚度异常转化的最佳预测指标。即使在 APAC 发作缓解后，血管密度较低的眼睛也应怀疑青光眼进展。
