Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Instituto de Olhos Sao Sebastiao, Rio de Janeiro, Brazil.
Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
Ophthalmol Glaucoma. 2021 May-Jun;4(3):286-294. doi: 10.1016/j.ogla.2020.10.009. Epub 2020 Oct 16.
To quantify abnormalities in the peripapillary microvasculature in eyes with primary open-angle glaucoma (POAG) and paracentral visual field (VF) loss.
Prospective, cross-sectional study.
Thirty-three POAG patients, including 15 with paracentral VF loss and 18 with peripheral VF loss, and 31 control participants underwent swept-source OCT angiography (OCTA) of the peripapillary region.
The POAG groups were matched by VF mean deviation (MD). The peripapillary microvasculature from the internal limiting membrane to the retinal nerve fiber layer (RNFL) interface was quantified within a 0.70-mm annulus around Bruch's membrane opening after removal of large vessels. Both vessel density (VD) and the integrated OCTA by ratio analysis signal (IOS) suggestive of flow were measured. Regional VD and IOS were measured from the affected hemisphere corresponding to the VF hemifield of more severe loss, which was used to calculate the paracentral total deviation (PaTD), or total deviation within the central 10°. One eye per participant was included.
Difference in peripapillary OCTA measurements between paracentral and peripheral VF loss groups and correlation of peripapillary VD and IOS with PaTD.
The POAG groups had matched VF MD (-3.1 ± 2.5 dB paracentral vs. -2.3 ± 2.0 dB peripheral; P = 0.31), did not differ in average RNFL thickness (71.1 ± 14.7 μm vs. 78.1 ± 15.0 μm; P = 0.55), but differed in age (59.2 ± 9.6 years paracentral vs. 67.4 ± 6.6 years peripheral; P = 0.02). Compared with control participants, both paracentral and peripheral VF loss groups showed reduced VD (P < 0.001 and P = 0.009, respectively) and IOS (P < 0.001 and P = 0.01, respectively) in the affected hemisphere. Compared with POAG eyes with peripheral VF loss, the paracentral group showed reduced peripapillary VD (38.0 ± 2.0%, 35.0 ± 2.2%, respectively; P = 0.001) and IOS (44.3 ± 3.1%, 40.4 ± 4.0%, respectively; P = 0.02) in the affected hemisphere. Among all POAG eyes, peripapillary VD and IOS of the affected hemisphere correlated significantly with functional measurement of paracentral loss (PaTD, r = 0.40, P = 0.02; r = 0.45, P = 0.008; respectively). These correlations remained significant after adjusting for age (r = 0.41, P = 0.02; r = 0.47, P = 0.01; respectively).
Regional peripapillary microvasculature showed decreased VD and flow in POAG with paracentral loss, supporting its importance in this glaucoma subtype.
定量分析原发性开角型青光眼（POAG）伴旁中心视野（VF）丧失患者的视盘周围微脉管系统异常。
前瞻性、横断面研究。
33 名 POAG 患者，包括 15 名伴旁中心 VF 丧失患者和 18 名伴周边 VF 丧失患者，以及 31 名对照参与者接受了扫频源光学相干断层扫描血管造影（OCTA）检查视盘周围区域。
通过视野平均偏差（MD）对 POAG 组进行匹配。在去除大血管后，从内界膜到视网膜神经纤维层（RNFL）界面，在 Bruch 膜开口周围 0.70mm 环内定量测量视盘周围微血管。测量血管密度（VD）和比值分析信号（IOS）的综合 OCTA，后者提示血流。从受影响的半侧相应于更严重损失的 VF 半视野测量区域 VD 和 IOS，用于计算旁中心总偏差（PaTD），或中央 10°内的总偏差。每位参与者纳入一只眼。
旁中心和周边 VF 丧失组之间视盘 OCTA 测量值的差异，以及视盘周围 VD 和 IOS 与 PaTD 的相关性。
POAG 组的 VF MD 匹配（旁中心-3.1±2.5dB 与周边-2.3±2.0dB；P=0.31），平均 RNFL 厚度无差异（71.1±14.7μm 与 78.1±15.0μm；P=0.55），但年龄不同（旁中心 59.2±9.6 岁与周边 67.4±6.6 岁；P=0.02）。与对照组相比，旁中心和周边 VF 丧失组在受影响的半侧均表现出 VD（P<0.001 和 P=0.009）和 IOS（P<0.001 和 P=0.01）降低。与周边 VF 丧失的 POAG 眼相比，旁中心组在受影响的半侧表现出更低的视盘周围 VD（38.0±2.0%，35.0±2.2%；P=0.001）和 IOS（44.3±3.1%，40.4±4.0%；P=0.02）。在所有 POAG 眼中，受影响半侧的视盘周围 VD 和 IOS 与旁中心损失的功能测量显著相关（PaTD，r=0.40，P=0.02；r=0.45，P=0.008）。在调整年龄后，这些相关性仍然显著（r=0.41，P=0.02；r=0.47，P=0.01）。
旁中心损失的 POAG 患者视盘周围微脉管系统的区域性 VD 和血流减少，支持其在这种青光眼亚型中的重要性。
