Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan; Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Miyagi, Japan.
Ophthalmology. 2021 May;128(5):663-671. doi: 10.1016/j.ophtha.2020.10.010. Epub 2020 Oct 14.
To determine whether decreased optic nerve head (ONH) blood flow (BF) precedes or follows decreased circumpapillary retinal nerve fiber layer thickness (cpRNFLT) in eyes with open-angle glaucoma (OAG).
Retrospective, longitudinal study.
This study followed up 350 eyes of 225 OAG patients for at least 2 years and collected data from each patient from at least 5 examinations obtained with laser speckle flowgraphy (LSFG) and OCT.
In the superior, temporal, and inferior ONH quadrants, tissue area mean blur rate (MT), representing ONH tissue BF, was measured with LSFG, whereas cpRNFLT was measured with OCT. A multivariate linear mixed-effects model was used to identify potential predictors of faster MT decrease, adjusting for possible confounding factors. Based on these results, each quadrant of each patient was assigned a risk point if the quadrant was the superior or temporal, if patient age was older than the median (61 years), and if patient pulse rate was higher than median (74 beats per minute). The quadrants were then compared with a mixed-effects Cox model for MT and cpRNFLT changes, defined as a difference between the baseline value and the values from the latest 2 consecutive follow-up visits of more than 1.96 × the corresponding coefficient of variation.
Ophthalmic and systemic variables and MT and cpRNFLT in the superior, temporal, and inferior quadrants.
The multivariate model showed that MT decrease was faster in older patients with higher pulse rate and slower in inferior quadrants (P < 0.05). Quadrants with 0 risk points showed primary cpRNFLT decrease (P = 0.048), 1-risk point quadrants showed simultaneous cpRNFLT and MT decrease (P = 0.260), and 2-risk point and 3-risk point quadrants showed primary MT decrease (P < 0.001).
Older patients with higher pulse rate are at greater risk of a primary reduction in ONH tissue BF, that is, preceding cpRNFLT decrease, in the superior and temporal quadrants.
确定在开角型青光眼（OAG）患者中，视盘血流（BF）减少是否先于或后于环周神经纤维层厚度（cpRNFLT）减少。
回顾性、纵向研究。
本研究对 225 例 OAG 患者的 350 只眼进行了至少 2 年的随访，并从每位患者的至少 5 次激光散斑血流图（LSFG）和 OCT 检查中收集数据。
在视盘的上、颞和下象限，使用 LSFG 测量组织面积平均模糊率（MT），代表视盘组织 BF，而使用 OCT 测量 cpRNFLT。使用多元线性混合效应模型来确定更快的 MT 下降的潜在预测因素，同时调整可能的混杂因素。基于这些结果，如果象限为上象限或颞象限，如果患者年龄大于中位数（61 岁），如果患者脉搏率高于中位数（74 次/分钟），则为每个患者的每个象限分配一个风险点。然后使用混合效应 Cox 模型比较 MT 和 cpRNFLT 的变化，定义为基线值与最新 2 次连续随访之间的差值，如果差值大于相应变异系数的 1.96 倍。
眼科和系统变量以及上、颞和下象限的 MT 和 cpRNFLT。
多元模型显示，脉搏率较高的老年患者 MT 下降较快，而下部象限 MT 下降较慢（P <0.05）。0 风险点象限显示原发性 cpRNFLT 下降（P=0.048），1 风险点象限显示同时存在 cpRNFLT 和 MT 下降（P=0.260），2 风险点和 3 风险点象限显示原发性 MT 下降（P<0.001）。
脉搏率较高的老年患者，在上、颞象限视盘 BF 原发性减少的风险更大，即先于 cpRNFLT 减少。
