Fan Xintong, Ying Yue, Zhai Ruyi, Sheng Qilian, Sun Yanan, Xu Huan, Kong Xiangmei
Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.
NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
Ann Transl Med. 2022 May;10(9):527. doi: 10.21037/atm-21-5695.
As the vascular theory has led many researchers to focus on vascular dysfunction in the pathogenesis of glaucoma, a better understanding of ocular microcirculation would be of great significance. The emergence of optical coherence tomography angiography (OCTA) has shed light on the various fundus microvascular changes that occur in glaucoma, thus providing ample evidence in the role of microvascular dysfunction in glaucoma. The aim of this review is to provide an overview of the retinal and choroidal microvascular alterations that occur in glaucoma and to address the role of microvascular alterations in the pathogenesis, diagnosis, prognosis, and treatment of glaucoma.
The literature regarding fundus microvascular alterations in glaucoma and after glaucoma treatment, including alterations of vascular perfusion and vascular reactivity, was broadly researched using PubMed and Web of Science databases. The endothelium involvements during the glaucoma course were also searched in the databases broadly.
Previous OCTA studies show vessel density (VD) decreases in the retinal macular and peripapillary regions and choroidal microvascular dropout. Such microvascular alterations are correlated with structural and functional defects and have potential value for the early diagnosis and prognosis of glaucoma. Retinal microvascular autoregulation is also impaired in glaucomatous eyes. Furthermore, various studies have demonstrated the role of the vascular endothelium in glaucoma. Different topical medications and surgical interventions have been shown to have an impact on microvasculature in glaucoma, and animal experiments have indicated the endothelial system may be a new target in glaucoma treatment.
Ample evidence proved the involvement of retinal and choroidal microvascular structural and functional changes in the course of glaucoma. This review makes a novel contribution to the literature by summarizing the microvascular alterations in glaucoma eyes and the microvascular changes after topical or surgical treatments.
由于血管理论引导众多研究者关注青光眼发病机制中的血管功能障碍，因此更好地了解眼部微循环具有重要意义。光学相干断层扫描血管造影（OCTA）的出现，揭示了青光眼发生时眼底各种微血管变化，从而为微血管功能障碍在青光眼中的作用提供了充分证据。本综述旨在概述青光眼患者视网膜和脉络膜微血管改变，并探讨微血管改变在青光眼发病机制、诊断、预后及治疗中的作用。
使用PubMed和Web of Science数据库广泛检索有关青光眼及青光眼治疗后眼底微血管改变的文献，包括血管灌注和血管反应性的改变。同时也在数据库中广泛检索青光眼病程中内皮细胞的参与情况。
以往的OCTA研究显示，视网膜黄斑和视乳头周围区域的血管密度（VD）降低以及脉络膜微血管缺失。这些微血管改变与结构和功能缺陷相关，对青光眼的早期诊断和预后具有潜在价值。青光眼患者的视网膜微血管自动调节功能也受损。此外，多项研究证明了血管内皮细胞在青光眼中的作用。不同的局部用药和手术干预已被证明对青光眼的微血管有影响，动物实验表明内皮系统可能是青光眼治疗的新靶点。
充分证据证明视网膜和脉络膜微血管结构和功能变化参与了青光眼病程。本综述通过总结青光眼患者的微血管改变以及局部或手术治疗后的微血管变化，为该领域文献做出了新贡献。
