Pinhas Alexander, Andrade Romo Jorge S, Lynch Giselle, Zhou Davis B, Castanos Toral Maria V, Tenzel Phillip A, Otero-Marquez Oscar, Yakubova Shoshana, Barash Alexander, Della Rocca David, Della Rocca Robert, Chui Toco Y P, Rosen Richard B, Reddy Harsha S
Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
Department of Ophthalmology, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
Clin Ophthalmol. 2022 Mar 20;16:867-875. doi: 10.2147/OPTH.S356631. eCollection 2022.
Hemodynamic changes surrounding the optic nerve head are known to occur in thyroid-related orbitopathy (TRO). This pilot study explores the capillary and non-capillary peripapillary perfusion changes of the retina in TRO eyes without dysthyroid optic neuropathy (DON) using optical coherence tomography angiography (OCT-A).
Non-capillary and capillary peripapillary perfusion densities were calculated using single 4.5 × 4.5mm en face "RPC layer" OCT-A scans of 8 TRO patients without DON (8 eyes, mean age 40.6 years, range 23-69 years). Results were compared to a previously published dataset of 133 healthy controls (133 eyes, mean 41.5 years, range 11-83 years). The strength of association was measured between OCT-A perfusion densities and clinical measures of TRO.
Non-capillary peripapillary perfusion density in TRO eyes was found to be significantly decreased compared to healthy controls (TRO group 15.4 ± 2.9% vs controls 21.5 ± 3.1%; p < 0.0001). Capillary peripapillary perfusion densities showed no significant difference (TRO group 42.5 ± 1.8% vs controls 42.5 ± 1.5%; p = 1.0). Clinical measures of disease did not correlate well with OCT-A perfusion densities (p>0.05).
These findings may represent decreased blood flow and subclinical ischemia to the optic nerve. We discuss possible pathogenic mechanisms of thyroid-related vasculopathy, including vessel wall thickening due to immunologically-induced media enlargement.
已知甲状腺相关眼病（TRO）会发生视神经乳头周围的血流动力学变化。本初步研究使用光学相干断层扫描血管造影（OCT-A）探索无甲状腺功能异常性视神经病变（DON）的TRO患者眼睛视网膜的毛细血管和非毛细血管视乳头周围灌注变化。
对8例无DON的TRO患者（8只眼，平均年龄40.6岁，范围23 - 69岁）进行单次4.5×4.5mm的视网膜色素上皮层（RPC层）OCT-A正面扫描，计算非毛细血管和毛细血管视乳头周围灌注密度。将结果与之前发表的133名健康对照者（133只眼，平均41.5岁，范围11 - 83岁）的数据集进行比较。测量OCT-A灌注密度与TRO临床指标之间的关联强度。
发现TRO患者眼睛的非毛细血管视乳头周围灌注密度与健康对照相比显著降低（TRO组15.4±2.9%，对照组21.5±3.1%；p<0.0001）。毛细血管视乳头周围灌注密度无显著差异（TRO组42.5±1.8%，对照组42.5±1.5%；p = 1.0）。疾病的临床指标与OCT-A灌注密度相关性不佳（p>0.05）。
这些发现可能代表视神经血流减少和亚临床缺血。我们讨论了甲状腺相关血管病变的可能致病机制，包括免疫诱导的中膜增大导致的血管壁增厚。
