Sayah Diane N, Mazzaferri Javier, Descovich Denise, Costantino Santiago, Lesk Mark R
Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC; Department of Ophthalmology, Université de Montréal, Montreal, QC.
Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC.
Can J Ophthalmol. 2023 Aug;58(4):338-345. doi: 10.1016/j.jcjo.2022.02.009. Epub 2022 Mar 28.
Evidence suggests that ocular blood flow dysregulation in patients with vasospasticity could occur in response to biomechanical stimuli, contributing to optic nerve head susceptibility in glaucoma. We evaluate the role of vasospasticity in the association between ocular rigidity (OR) and neuroretinal damage, hypothesizing that low OR correlates with greater glaucoma damage in patients with vasospasticity.
Cross-sectional study.
Patients with open-angle glaucoma (OAG), suspect discs, or no glaucoma.
OR was measured using a noninvasive, validated method developed by our group. Retinal nerve fibre layer (RNFL) and ganglion cell complex thicknesses were acquired using spectral domain optical coherence tomography. Vasospasticity was assessed by a standardized questionnaire that was based on existing validated questionnaires and adapted to our requirements. Atherosclerosis was evaluated based on Broadway and Drance's (1998) cardiovascular disease score. Correlations between OR and structural parameters were assessed in patients with vasospasticity and those with atherosclerosis.
Of 118 patients with either OAG (n = 67), suspect discs (n = 26), or no glaucoma (n = 25) who were recruited consecutively, 10 were classified as having vasospasticity, and 37 as having atherosclerosis. In the vasospastic group, significant correlations were found between OR and the minimum ganglion cell complex thickness (r = 0.681, p = 0.030), the average RNFL thickness (r = 0.745, p = 0.013), and the RNFL in the temporal quadrant (r = 0.772, p = 0.009), indicating more damage with lower OR. Similar trends were maintained when applying multiple testing correction; however, only the eighth RNFL clock hour corresponding to the inferior-temporal peripapillary region remained significantly correlated with OR in the vasospastic group (p = 0.015). In contrast, no correlation was found in the atherosclerotic group (p > 0.05).
The findings of the current pilot study indicate a trend for more neuronal structural damage in less-rigid eyes of patients with vasospasticity, meaning that OR may play a greater role in glaucoma in vasospastic patients than in patients with atherosclerosis. Although these results provide interesting insight into the pathophysiology of OAG, further investigation is needed to confirm our observations.
有证据表明，血管痉挛患者的眼部血流调节异常可能是对生物力学刺激的反应，这会增加青光眼患者视神经乳头的易感性。我们评估血管痉挛在眼硬度（OR）与神经视网膜损伤之间关联中的作用，假设低OR与血管痉挛患者更严重的青光眼损伤相关。
横断面研究。
开角型青光眼（OAG）患者、可疑视盘患者或无青光眼患者。
使用我们团队开发的一种经过验证的非侵入性方法测量OR。使用光谱域光学相干断层扫描获取视网膜神经纤维层（RNFL）和神经节细胞复合体厚度。血管痉挛通过基于现有经过验证的问卷并根据我们的要求改编的标准化问卷进行评估。根据百老汇和德兰斯（1998年）的心血管疾病评分评估动脉粥样硬化情况。在血管痉挛患者和动脉粥样硬化患者中评估OR与结构参数之间的相关性。
在连续招募的118例OAG患者（n = 67）、可疑视盘患者（n = 26）或无青光眼患者（n = 25）中，10例被归类为有血管痉挛，37例被归类为有动脉粥样硬化。在血管痉挛组中，发现OR与最小神经节细胞复合体厚度（r = 0.681，p = 0.030）、平均RNFL厚度（r = 0.745，p = 0.013）以及颞侧象限的RNFL（r = 0.772，p = 0.009）之间存在显著相关性，表明OR越低损伤越严重。应用多重检验校正时保持了类似趋势；然而，在血管痉挛组中，仅对应于颞下视乳头周围区域的第八个RNFL钟点与OR仍显著相关（p = 0.015）。相比之下，在动脉粥样硬化组中未发现相关性（p > 0.05）。
当前初步研究的结果表明，血管痉挛患者中眼硬度较低的眼睛存在神经元结构损伤更严重的趋势，这意味着OR在血管痉挛患者的青光眼中可能比在动脉粥样硬化患者中发挥更大作用。尽管这些结果为OAG的病理生理学提供了有趣的见解，但需要进一步研究来证实我们的观察结果。
