Pfahler Nicholas M, Barry Jordan L, Bielskus Indre E, Kakouri Agni, Giovingo Michael C, Volpe Nicholas J, Knepper Paul A
Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
Division of Ophthalmology, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA.
J Ophthalmol. 2020 Jun 8;2020:8324319. doi: 10.1155/2020/8324319. eCollection 2020.
Primary open-angle glaucoma (POAG) is associated with systemic microvascular dysfunction including hemorrhages and other abnormalities of the nailfold capillary bed. This study aimed to verify the specificity of nailfold capillary hemorrhages and other abnormalities as risk factors for POAG.
Nailfold video capillaroscopy was performed using a JH-1004 capillaroscope on the fourth and fifth digits of the nondominant hand in control ( = 277), POAG ( = 206), OHT ( = 57), and SG ( = 29) subjects. The number of hemorrhages, dilated capillaries >50 m, and avascular zones ≥200 m were counted and adjusted to counts per 100 capillaries. Descriptive analyses as well as univariate- and multivariable-adjusted logistic regression were performed comparing all groups with controls and POAG with OHT and SG. Subanalyses were conducted in POAG patients examining the association between nailfold capillary outcomes and previous glaucoma surgery, successful IOP control, or disease severity.
All nailfold capillary outcomes were significantly increased in POAG, no outcomes were increased in SG, and only hemorrhages were mildly increased in OHT. Hemorrhages were significantly more frequent in POAG compared with both OHT ( < 0.0001) and SG (=0.001). There were significant trends between higher numbers of hemorrhages and POAG compared with controls, OHT, and SG, with odds ratios of 18.3 (8.5-39.4), 9.1 (1.9-13.4), and 11.8 (1.7-7.3), respectively, for the presence of two or more hemorrhages per 100 capillaries. Hemorrhages were not significantly associated with previous glaucoma surgery, successful postoperative IOP control, or disease severity in POAG.
These findings suggest that systemic microvascular dysfunction is frequent in POAG and occurs early in the disease process. The high specificity of nailfold hemorrhages makes them viable clinical risk factors for POAG.
原发性开角型青光眼（POAG）与全身微血管功能障碍相关，包括出血和甲襞毛细血管床的其他异常。本研究旨在验证甲襞毛细血管出血及其他异常作为POAG危险因素的特异性。
使用JH - 1004型毛细血管镜对对照组（n = 277）、POAG组（n = 206）、高眼压症（OHT）组（n = 57）和正常眼压性青光眼（SG）组（n = 29）受试者非优势手的第四和第五指进行甲襞视频毛细血管镜检查。计数出血点数量、直径>50μm的扩张毛细血管数量和≥200μm的无血管区数量，并将其调整为每100条毛细血管中的计数。进行描述性分析以及单变量和多变量调整的逻辑回归分析，比较所有组与对照组，以及POAG组与OHT组和SG组。对POAG患者进行亚组分析，研究甲襞毛细血管检查结果与既往青光眼手术、眼压控制成功或疾病严重程度程度之间的关联。
POAG患者所有甲襞毛细血管检查结果均显著增加，SG组无检查结果增加，OHT组仅出血略有增加。与OHT组（P < 0.0001）和SG组（P = 0.001）相比，POAG组出血明显更频繁。与对照组、OHT组和SG组相比，出血数量较多与POAG之间存在显著趋势，每100条毛细血管中有两个或更多出血点时，优势比分别为18.3（8.5 - 39.4）、9.1（1.9 - 13.4）和11.8（1.7 - 7.3）。在POAG患者中，出血与既往青光眼手术、术后眼压控制成功或疾病严重程度无显著关联。
这些发现表明，全身微血管功能障碍在POAG中很常见，且在疾病过程早期就会出现。甲襞出血的高特异性使其成为POAG可行的临床危险因素。
