Pugazhendhi Sangeethabalasri, Yu Miaomiao, Zhou Gabriella, Chen Yuxuan, Wang Ruikang, Liao Yaping Joyce
Department of Ophthalmology, School of Medicine, Stanford University, Stanford, CA, United States.
Department of Bioengineering, University of Washington, Seattle, WA, United States.
Front Med (Lausanne). 2023 Jan 12;9:1033838. doi: 10.3389/fmed.2022.1033838. eCollection 2022.
The hallmark of non-arteritic anterior ischemic optic neuropathy (NAION) is vascular compromise to the anterior optic nerve and thinning of the retinal nerve fiber layer (RNFL) and secondary degeneration of the retinal ganglion cell body or thinning of the ganglion cell complex (GCC). This study investigates optical coherence tomography (OCT) and OCT Angiography (OCTA) changes in chronic NAION and identifies imaging biomarkers that best predict disease.
We performed a retrospective case-control study of 24 chronic NAION eyes (18 patients) and 70 control eyes (45 patients) to compare both whole-eye and regional OCT, OCTA, static perimetry measurements. OCT measurements were quantified automatically using commercial software, and OCTA was analyzed using custom MATLAB script with large vessel removal to measure 154 total parameters per eye.
We confirmed that static perimetry mean deviation (MD) was significantly worse in chronic NAION (-13.53 ± 2.36) than control (-0.47 ± 0.72; < 0.001) eyes, and NAION eyes had 31 μm thinner RNFL (control: 95.9 ± 25.8 μm; NAION: 64.5 ± 18.0, < 0.001), and 21.8 μm thinner GCC compared with controls (control: 81.5 ± 4.4 μm; NAION: 59.7 ± 10.5, < 0.001). Spearman correlation analysis of OCTA parameters reveal that vessel area density (VAD) and flux are highly correlated with visual field MD and OCT measurements. Hierarchical clustering two distinct groups (NAION and control), where standardized measurements of NAION eyes were generally lower than controls. Two-way mixed ANOVAs showed significant interaction between patient status (control and chronic NAION) and structure (optic disk and macula) for annulus VAD and flux values and mean RNFL and GCC thickness. tests showed this effect stems from lower peripapillary values in NAION compared to controls. Separate logistic regression models with LASSO regularization identified VAD and flux are one of the best OCTA parameters for predicting NAION.
Ischemic insult to the optic disk is more severe likely from primary degeneration of the affected peripapillary region while macula is affected by secondary retrograde degeneration and loss of retinal ganglion cells. In addition to OCT measurements, peripapillary and macular vascular parameters such as VAD and flux are good predictors of optic nerve and retinal changes in NAION.
非动脉炎性前部缺血性视神经病变（NAION）的标志是前部视神经的血管受损、视网膜神经纤维层（RNFL）变薄以及视网膜神经节细胞体的继发性变性或神经节细胞复合体（GCC）变薄。本研究调查慢性NAION患者的光学相干断层扫描（OCT）和OCT血管造影（OCTA）变化，并确定最能预测疾病的成像生物标志物。
我们对24只慢性NAION患眼（18例患者）和70只对照眼（45例患者）进行了一项回顾性病例对照研究，以比较全眼和局部的OCT、OCTA及静态视野测量结果。使用商业软件自动定量OCT测量值，并使用带有大血管去除功能的自定义MATLAB脚本分析OCTA，每只眼睛测量154个总参数。
我们证实，慢性NAION患者的静态视野平均偏差（MD）（-13.53±2.36）明显比对照眼（-0.47±0.72；P<0.001）更差，且NAION患眼的RNFL比对照眼薄31μm（对照：95.9±25.8μm；NAION：64.5±18.0，P<0.001），GCC比对照眼薄21.8μm（对照：81.5±4.4μm；NAION：59.7±10.5，P<0.001）。对OCTA参数进行Spearman相关性分析发现，血管面积密度（VAD）和血流量与视野MD及OCT测量值高度相关。分层聚类将两组（NAION和对照）区分开来，NAION患眼的标准化测量值通常低于对照眼。双向混合方差分析显示，患者状态（对照和慢性NAION）与结构（视盘和黄斑）之间对于环周VAD、血流量值以及平均RNFL和GCC厚度存在显著交互作用。检验表明，这种效应源于NAION患眼视乳头周围的值低于对照眼。采用LASSO正则化的单独逻辑回归模型确定，VAD和血流量是预测NAION的最佳OCTA参数之一。
对视盘的缺血性损伤可能更严重，这可能源于受影响的视乳头周围区域的原发性变性，而黄斑则受到继发性逆行变性和视网膜神经节细胞丢失的影响。除了OCT测量外，视乳头周围和黄斑的血管参数，如VAD和血流量，是NAION患者视神经和视网膜变化的良好预测指标。
