脉络膜微血管缺失对青光眼进展速度的影响：一项前瞻性研究。

Influence of Choroidal Microvasculature Dropout on the Rate of Glaucomatous Progression: A Prospective Study.

机构信息

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

出版信息

Ophthalmol Glaucoma. 2020 Jan-Feb;3(1):25-31. doi: 10.1016/j.ogla.2019.10.001. Epub 2019 Oct 25.

DOI:10.1016/j.ogla.2019.10.001

PMID:32672639

Abstract

PURPOSE

To determine the prognostic significance of choroidal microvasculature dropout (MvD) to predict the future rate of progressive retinal nerve fiber layer (RNFL) thinning in eyes with primary open-angle glaucoma (POAG).

DESIGN

Prospective, longitudinal case series.

PARTICIPANTS

This study enrolled 101 eyes of 101 patients with POAG who underwent OCT angiography (OCTA) imaging of the optic nerve head at baseline and were followed up for at least 2 years thereafter, during which RNFL thickness was measured by serial spectral-domain OCT.

METHODS

The peripapillary microvasculature was evaluated by examining en face OCTA images. Choroidal MvD was defined as a focal sectoral capillary dropout with no visible microvascular network in the choroidal layer. The rate of RNFL thinning was determined by linear regression of serial OCT RNFL thickness measurements.

MAIN OUTCOME MEASURES

Influence of the presence of an MvD on the rate of subsequent RNFL thinning.

RESULTS

Microvasculature dropout was identified in 48 eyes (47.5%). The rate of global RNFL thinning was significantly faster in eyes with MvD than eyes without MvD (-1.6±0.8 vs. -1.2±0.9 μm/year, P = 0.018). Eyes with MvD in the inferior hemisphere (n = 41) showed a faster rate of inferior RNFL thinning than eyes without MvD (P = 0.036). Eyes with MvD in both the superior and inferior hemispheres (n = 5) showed faster rates of superior (P = 0.027) and inferior (P = 0.016) RNFL thinning than eyes without MvD. Multivariate regression analysis showed that MvD at baseline (P = 0.003) and the presence of disc hemorrhage during follow-up (P = 0.001) were independently associated with a faster rate of global RNFL thinning.

CONCLUSIONS

Microvasculature dropout was an independent predictor of a faster rate of progressive RNFL thinning in patients with POAG. Microvasculature dropout location was topographically associated with the location of faster RNFL thinning.

摘要

目的

确定脉络膜微血管丢失（MvD）对预测原发性开角型青光眼（POAG）患者未来视网膜神经纤维层（RNFL）进行性变薄的预后意义。

设计

前瞻性、纵向病例系列。

参与者

本研究纳入了 101 名 POAG 患者的 101 只眼，这些患者在基线时接受了视神经头部 OCT 血管造影（OCTA）成像，并在之后至少 2 年进行了随访，在此期间通过连续的光谱域 OCT 测量了 RNFL 厚度。

方法

通过检查 OCTA 图像的正视面评估了视盘周围微血管。脉络膜 MvD 定义为脉络膜层中出现局灶性扇形毛细血管丢失且无可见微血管网络。通过对连续 OCT RNFL 厚度测量的线性回归来确定 RNFL 变薄的速度。

主要观察指标

存在 MvD 对随后 RNFL 变薄速度的影响。

结果

48 只眼（47.5%）发现了微血管丢失。与无 MvD 的眼相比，有 MvD 的眼的全局 RNFL 变薄速度明显更快（-1.6±0.8 比-1.2±0.9 μm/年，P=0.018）。在下半球有 MvD 的眼（n=41）比无 MvD 的眼表现出更快的下 RNFL 变薄速度（P=0.036）。在上、下半球均有 MvD 的眼（n=5）表现出比无 MvD 的眼更快的上（P=0.027）和下（P=0.016）RNFL 变薄速度。多变量回归分析显示，基线时的 MvD（P=0.003）和随访期间的盘状出血（P=0.001）与更快的全局 RNFL 变薄率独立相关。