School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China.
Acta Ophthalmol. 2023 Mar;101(2):e226-e235. doi: 10.1111/aos.15243. Epub 2022 Sep 2.
The purpose of this study is to quantify the alteration of retinal peripapillary microvasculature and structure in unilateral indirect traumatic optic neuropathy (ITON) and figure out predicted factors of visual improvement for ITON patients with endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) after one month.
Twenty healthy controls and 72 unilateral ITON patients were included. Optical coherence tomography angiography was used to analyse radial peripapillary capillary (RPC) density, peripapillary retinal nerve fibre layer (pRNFL) thickness, superficial retinal capillary plexus (SRCP) and deep retinal capillary plexus (DRCP) density. Associations between preoperative parameters and postoperative best-corrected visual acuity (BCVA) were determined. The receiver operating characteristic (ROC) curves were used to figure out predicted factors of visual improvement for ITON after ETOCD one month.
In ITON eyes, the preoperative global RPC density, pRNFL thickness and SRCP density were reduced compared with unaffected eyes (p ≤ 0.001). Multivariate linear regression showed that preoperative global RPC density (Standardized β = -0.273), SRCP density (Standardized β = -0.183), DRCP density (Standardized β = -0.098) and preoperative BCVA (Standardized β = 0.795) were associated with the postoperative BCVA (All p < 0.001). The area under the curve (AUC) of preoperative global RPC density to predict visual improvement after ETOCD was 0.816, while the AUCs of preoperative BCVA, global pRNFL thickness, SRCP and DRCP density were 0.575, 0.756, 0.516 and 0.615, respectively.
The alteration of peripapillary area, especially the reduced RPC density, occurred in ITON eyes. The preoperative RPC density was associated with postoperative BCVA and was shown to be highly predictive for visual improvement after ETOCD one month.
本研究旨在定量分析单侧间接创伤性视神经病变（ITON）患者视乳头周围微血管和结构的改变，并探讨内镜经蝶入路视神经管减压术（ETOCD）1 个月后 ITON 患者视功能改善的预测因素。
纳入 20 名健康对照者和 72 名单侧 ITON 患者。采用光学相干断层血管造影术分析放射状视乳头周围毛细血管（RPC）密度、视乳头周围神经纤维层（pRNFL）厚度、浅层视网膜毛细血管丛（SRCP）和深层视网膜毛细血管丛（DRCP）密度。分析术前参数与术后最佳矫正视力（BCVA）之间的相关性。受试者工作特征（ROC）曲线用于确定 ETOCD 术后 1 个月 ITON 视力改善的预测因素。
在 ITON 眼中，术前全局 RPC 密度、pRNFL 厚度和 SRCP 密度均低于未受影响的眼睛（p≤0.001）。多元线性回归显示，术前全局 RPC 密度（标准化β=-0.273）、SRCP 密度（标准化β=-0.183）、DRCP 密度（标准化β=-0.098）和术前 BCVA（标准化β=0.795）与术后 BCVA 相关（均 p<0.001）。术前全局 RPC 密度预测 ETOCD 后视力改善的曲线下面积（AUC）为 0.816，而术前 BCVA、全局 pRNFL 厚度、SRCP 和 DRCP 密度的 AUC 分别为 0.575、0.756、0.516 和 0.615。
ITON 眼视乳头周围区域发生改变，特别是 RPC 密度降低。术前 RPC 密度与术后 BCVA 相关，是 ETOCD 术后 1 个月视力改善的高度预测因素。
