College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Nephrology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
Acta Ophthalmol. 2020 Nov;98(7):e848-e855. doi: 10.1111/aos.14395. Epub 2020 Mar 19.
To examine retinal neurovascular changes in patients with chronic kidney disease (CKD).
Case-control study. A total of 171 CKD cases and 40 controls were recruited (mean age 62.9 ± 10.3 versus 60.8 ± 9.2, p = 0.257). Retinal neural parameters, including parafoveal retinal thickness (PfRT), macular ganglion cell complex thickness (GCCt), global loss volume (GLV), focal loss volume (FLV) and peripapillary retinal nerve fibre layer thickness (RNFLt), were measured using optical coherence tomography (OCT). Microvascular parameters, including foveal avascular zone size, vessel density over the parafoveal superficial vascular plexus (SVP-VD), parafoveal deep vascular plexus (DVP-VD) and radial peripapillary capillary (RPC-VD), were measured using OCT angiography.
Chronic kidney disease (CKD) patients showed reduced PfRT, GCCt and RNFLt and increased GLV and FLV compared with the controls (all p < 0.005). Among patients with CKD, estimated glomerular filtration rate was an independent factor associated with PfRT (coefficient 0.19, p = 0.015), GCCt (coefficient 0.10, p = 0.006), GLV (coefficient - 0.08, p = 0.001), FLV (coefficient - 0.02, p = 0.006) and RNFLt (coefficient 0.15, p = 0.002). Parafoveal retinal thickness (PfRT), GCCt, GLV, FLV and RNFLt were correlated with SVP-VD (all p < 0.001) but not with DVP-VD (all p > 0.1).
Chronic kidney disease (CKD) patients demonstrated a significant reduction in macular thickness and changes in retinal neural parameters. These changes were associated with the severity of CKD and correlated with the microvascular rarefaction in the parafoveal SVP.
观察慢性肾脏病（CKD）患者的视网膜神经血管变化。
病例对照研究。共纳入 171 例 CKD 病例和 40 例对照（平均年龄 62.9±10.3 岁比 60.8±9.2 岁，p=0.257）。使用光学相干断层扫描（OCT）测量视网膜神经参数，包括黄斑中心凹旁视网膜厚度（PfRT）、黄斑神经节细胞复合体厚度（GCCt）、整体丢失体积（GLV）、局灶性丢失体积（FLV）和视盘周围视网膜神经纤维层厚度（RNFLt）。使用 OCT 血管造影测量微血管参数，包括黄斑无血管区大小、旁中心凹浅层血管丛（SVP-VD）血管密度、旁中心凹深层血管丛（DVP-VD）和视盘周围毛细血管（RPC-VD）。
与对照组相比，CKD 患者的 PfRT、GCCt 和 RNFLt 降低，GLV 和 FLV 升高（均 p<0.005）。在 CKD 患者中，估算肾小球滤过率是与 PfRT（系数 0.19，p=0.015）、GCCt（系数 0.10，p=0.006）、GLV（系数-0.08，p=0.001）、FLV（系数-0.02，p=0.006）和 RNFLt（系数 0.15，p=0.002）相关的独立因素。PfRT、GCCt、GLV、FLV 和 RNFLt 与 SVP-VD 均呈正相关（均 p<0.001），但与 DVP-VD 均无相关性（均 p>0.1）。
CKD 患者黄斑厚度明显变薄，视网膜神经参数发生变化。这些变化与 CKD 的严重程度相关，并与旁中心凹 SVP 的微血管稀疏有关。
