University of Florida College of Medicine - Jacksonville, Department of Ophthalmology, Jacksonville, Florida.
VA Eugene Healthcare Center, Eugene, Oregon, and Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon.
Ophthalmology. 2021 Aug;128(8):1222-1235. doi: 10.1016/j.ophtha.2020.12.027. Epub 2021 Feb 23.
To review the current published literature on the use of OCT angiography (OCTA) to help detect changes associated with the diagnosis of primary open-angle glaucoma.
Searches of the peer-reviewed literature were conducted in March 2018, June 2018, April 2019, December 2019, and June 2020 in the PubMed and Cochrane Library databases. Abstracts of 459 articles were examined to exclude reviews and non-English articles. After inclusion and exclusion criteria were applied, 75 articles were selected and the panel methodologist rated them for strength of evidence. Three articles were rated level I and 57 articles were rated level II. The 15 level III articles were excluded.
OCT angiography can detect decreased capillary vessel density within the peripapillary nerve fiber layer (level II) and macula (level I and II) in patients with suspected glaucoma, preperimetric glaucoma, and perimetric glaucoma. The degree of vessel density loss correlates significantly with glaucoma severity both overall and topographically (level II) as well as longitudinally (level I). For differentiating glaucomatous from healthy eyes, some studies found that peripapillary and macular vessel density measurements by OCTA show a diagnostic ability (area under the receiver operating characteristic curve) that is comparable with structural OCT retinal nerve fiber and ganglion cell thickness measurements, whereas other studies found that structural OCT measurements perform better. Choroidal or deep-layer microvasculature dropout as measured by OCTA is also associated with glaucoma damage (level I and II). Lower peripapillary and macular vessel density and choroidal microvasculature dropout are associated with faster rates of disease progression (level I and II).
Vessel density loss associated with glaucoma can be detected by OCTA. Peripapillary, macular, and choroidal vessel density parameters may complement visual field and structural OCT measurements in the diagnosis of glaucoma.
综述目前关于光学相干断层扫描血管造影术（OCTA）在原发性开角型青光眼诊断中应用的文献，以帮助发现相关变化。
2018 年 3 月、6 月、2019 年 4 月、2019 年 12 月和 2020 年 6 月，检索了同行评议文献，检索数据库包括 PubMed 和 Cochrane Library。共检查了 459 篇文章的摘要，排除了综述和非英文文章。在应用纳入和排除标准后，选择了 75 篇文章，并用小组方法学家对证据强度进行了评分。其中 3 篇文章评为 I 级，57 篇文章评为 II 级。15 篇 III 级文章被排除。
OCTA 可在疑似青光眼、前期青光眼和周边性青光眼患者中检测到神经纤维层（II 级）和黄斑（I 级和 II 级）内毛细血管密度降低。血管密度损失程度与青光眼严重程度整体和地形学（II 级）以及纵向（I 级）均显著相关。对于区分青光眼和正常眼，一些研究发现，OCTA 测量的神经纤维层和黄斑血管密度具有与结构 OCT 视网膜神经纤维和节细胞厚度测量相当的诊断能力（接受者操作特征曲线下面积），而其他研究则发现结构 OCT 测量的效果更好。OCTA 测量的脉络膜或深层微血管丢失也与青光眼损伤相关（I 级和 II 级）。较低的神经纤维层和黄斑血管密度以及脉络膜微血管丢失与疾病进展速度更快相关（I 级和 II 级）。
OCTA 可检测与青光眼相关的血管密度损失。神经纤维层、黄斑和脉络膜血管密度参数可能在青光眼诊断中补充视野和结构 OCT 测量。
