Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA.
Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA.
Br J Ophthalmol. 2023 Oct;107(10):1444-1451. doi: 10.1136/bjo-2022-321157. Epub 2022 Jul 8.
BACKGROUND/AIMS: To investigate the factors associated with choroidal microvasculature drop-out (MvD) enlargement detected by optical coherence tomography angiography (OCT-A) in glaucomatous eyes.
Ninety-one eyes of 68 primary open-angle glaucoma patients were enrolled. Only eyes with a minimum of four good quality OCT-A and OCT scans of the optic nerve head acquired at least and with a minimum of 2 years follow-up were included. Area and angular circumference of MvD were analysed on en face images. Univariable and multivariable mixed effects models were constructed to identify the factors contributing to MvD area and angular circumference change over time.
Peripapillary MvD was detected in 53 (58.2%) eyes at baseline and in an additional 17 (18.6%) eyes during follow-up, whereas MvD was not detected in 21 (23.0 %) eyes during the entire follow-up period. In multivariable analysis, worse baseline visual field (VF) mean deviation (MD) (ß=0.27, 95% CI 0.10 to 0.44, p=0.002), greater intraocular pressure (IOP) fluctuations (ß=0.86, 95% CI 0.24 to 1.48, p=0.007), higher peak IOP (ß=0.17, 95% CI -0.01 to 0.35, p=0.067) and greater number of IOP lowering medications (ß=1.36, 95% CI 0.67 to 2.05, p<0.001) were associated with faster MvD area enlargement. Worse baseline VF MD and greater IOP fluctuation were also associated with significantly faster MvD circumferential enlargement in multivariable models.
Greater IOP fluctuation, higher peak IOP, worse baseline VF MD and greater number of glaucoma medications were significantly associated with MvD enlargement in glaucomatous eyes. The identification of factors associated with MvD enlargement may improve our understanding of the role of choroidal vasculature in glaucoma.
背景/目的：研究光学相干断层扫描血管造影（OCT-A）检测到的青光眼患者脉络膜微血管丢失（MvD）扩大的相关因素。
纳入 68 例原发性开角型青光眼患者的 91 只眼。仅纳入至少获得 4 次高质量 OCT-A 和视神经头 OCT 扫描且至少随访 2 年的眼。在面对图像上分析 MvD 的面积和角周长。构建单变量和多变量混合效应模型，以确定随时间变化导致 MvD 面积和角周长变化的因素。
基线时，53 只（58.2%）眼检测到视盘周围 MvD，随访期间另外 17 只（18.6%）眼检测到 MvD，而整个随访期间 21 只（23.0%）眼未检测到 MvD。多变量分析显示，基线视野（VF）平均偏差（MD）更差（ß=0.27，95%CI 0.10 至 0.44，p=0.002），眼压（IOP）波动更大（ß=0.86，95%CI 0.24 至 1.48，p=0.007），眼压峰值更高（ß=0.17，95%CI -0.01 至 0.35，p=0.067），以及更多的降眼压药物（ß=1.36，95%CI 0.67 至 2.05，p<0.001）与 MvD 面积增大较快相关。在多变量模型中，基线 VF MD 更差和 IOP 波动更大也与 MvD 周向扩大明显相关。
眼压波动更大、眼压峰值更高、基线 VF MD 更差以及降眼压药物更多与青光眼患者的 MvD 增大显著相关。确定与 MvD 增大相关的因素可能有助于我们更好地理解脉络膜血管在青光眼发病机制中的作用。
