使用光学相干断层扫描血管造影术对无视野缺损的无功能垂体腺瘤早期视网膜微循环的研究
Early Retinal Microcirculation in Nonfunctioning Pituitary Adenomas Without Visual Field Defects Using Optical Coherence Tomography Angiography.
作者信息
Chou Yuyu, Wang Xuqian, Wang Ye, Gan Linyang, Xing Bing, You Hui, Ma Jin, Zhong Yong
机构信息
Department of Ophthalmology (YC, XW, LG, JM, YZ), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Ocular Fundus Diseases (YC, XW, LG, JM, YZ) and Chinese Academy of Medical Sciences, Beijing, China; Department of Epidemiology and Statistics (YW), Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, and Peking Union Medical College, Beijing, China; Department of Neurosurgery (BX) and Radiology (HY), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; China Pituitary Disease Registry Center (YC, XW, BX, HY, JM, YZ), Beijing, China; and China Pituitary Adenoma Specialist Council (XW, BX, HY, JM, YZ), Beijing, China.
出版信息
J Neuroophthalmol. 2022 Dec 1;42(4):509-517. doi: 10.1097/WNO.0000000000001562. Epub 2022 Apr 27.
BACKGROUND
For patients with nonfunctioning pituitary adenoma (NFPA) without manifesting visual acuity impairment or visual field defect (VFD), more sensitive and objective assessment methods will allow earlier detection before irreversible damage to the visual system. This study aimed to evaluate retinal vessel densities (VDs) alterations in these patients using optical coherence tomography angiography and to determine its diagnostic abilities.
METHODS
Between patients with NFPA without VFDs and age-matched, sex-matched healthy control individuals, comparisons of visual field metrics, retinal structural thickness, and microcirculation were conducted after adjusting for axial length (AL) and signal index of scans. Receiver operating characteristic (ROC) curves were further depicted to assess the diagnostic performance of significant parameters. To explore the impact of symptom duration, tumor size, and axial length on the significant parameters, multivariate regression analysis was conducted.
RESULTS
This cross-sectional study reviewed 107 patients with NFPA. Twenty-seven eyes of patients with NFPA without VFDs and 27 eyes of healthy controls were enrolled. Compared with healthy controls, patients with NFPA without VFDs had similar foveal avascular zone areas and perimeters, macular ganglion cell complex (mGCC) and peripapillary retinal nerve fiber layer thicknesses, and macular VDs. Only the VD in the radial peripapillary capillary (RPC) segment of the inferior temporal (IT) sector was much lower in the patient group. The 2 largest area under the ROC curves were the focal loss volume (FLV) of the mGCC and the VD in the RPC of the IT sector, both of which were significantly related to symptom duration and tumor size.
CONCLUSIONS
At the early stage of NFPA before VFD and retinal thickness thinning, fundus microcirculation impairments may occur initially in the microvascular density of the RPC segment of the IT sector. The FLV and the VD of RPC at the IT sector may provide a basis for the early diagnosis of NFPA without VFD in clinical practice.
背景
对于无视力损害或视野缺损（VFD）的无功能垂体腺瘤（NFPA）患者，更敏感和客观的评估方法将有助于在视觉系统发生不可逆损害之前更早地进行检测。本研究旨在使用光学相干断层扫描血管造影术评估这些患者的视网膜血管密度（VD）变化，并确定其诊断能力。
方法
在无VFD的NFPA患者与年龄、性别匹配的健康对照个体之间，在调整眼轴长度（AL）和扫描信号指数后，对视野指标、视网膜结构厚度和微循环进行比较。进一步绘制受试者操作特征（ROC）曲线以评估显著参数的诊断性能。为了探讨症状持续时间、肿瘤大小和眼轴长度对显著参数的影响，进行了多变量回归分析。
结果
这项横断面研究纳入了107例NFPA患者。纳入了27例无VFD的NFPA患者的患眼和27例健康对照者的眼睛。与健康对照相比，无VFD的NFPA患者的黄斑无血管区面积和周长、黄斑神经节细胞复合体（mGCC）和视乳头周围视网膜神经纤维层厚度以及黄斑VD相似。仅颞下（IT）象限的视乳头周围放射状毛细血管（RPC）段的VD在患者组中明显较低。ROC曲线下面积最大的两个指标是mGCC的局灶性丢失体积（FLV）和IT象限RPC的VD，二者均与症状持续时间和肿瘤大小显著相关。
结论
在NFPA的VFD和视网膜厚度变薄之前的早期阶段，眼底微循环障碍可能最初发生在IT象限RPC段的微血管密度上。IT象限的FLV和RPC的VD可为临床实践中无VFD的NFPA的早期诊断提供依据。
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