Department of Ophthalmology, Nowon Eulji University Hospital, Eulji University College of Medicine, Seoul, Korea.
Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Gyeonggi, Korea.
Sci Rep. 2023 Apr 21;13(1):6513. doi: 10.1038/s41598-023-33637-7.
This observational case series study is conducted to compare the extent of microvasculature impairment in the peripapillary retina and choroid in eyes with primary open-angle glaucoma (POAG), and to investigate the association of the discrepancy between the microvasculature impairments of each layer with the rate of progressive retinal nerve fiber layer (RNFL) thinning. A total of 88 POAG eyes with a localized RNFL defect were enrolled, including 67 eyes with and 21 eyes without choroidal microvasculature dropout (CMvD). Circumferential widths of retinal microvascular impairment (RMvI) and CMvD were measured, and eyes were classified based on the relative width of CMvD to RMvI (CMvD/RMvI ratio). The rate of RNFL thinning was determined by linear regression based on ≥ 5 serial OCT examinations. Thinner global RNFL and worse visual field mean deviation at baseline were associated with a larger circumferential width of the RMvI, whereas the presence of cold extremities, lower mean arterial pressure and thinner juxtapapillary choroid were associated with a larger circumferential width of the CMvD. The rate of global RNFL thinning was faster in eyes with larger relative CMvD width than in eyes with equal CMvD and RMvI widths and in eyes without CMvD (P = 0.001). Lower mean arterial pressure (P = 0.041), larger CMvD width (P = 0.046), larger CMvD/RMvI ratio (P = 0.041), and detection of disc hemorrhage during the follow-up (P = 0.013) were significant factors associated with faster global RNFL thinning. Larger CMvD width relative to RMvI width may be indicative of an increased risk of faster RNFL thinning in POAG with localized RNFL defect. Comparing the microvasculature impairment in individual layers may help predict more rapid glaucoma progression.
本观察性病例系列研究旨在比较原发性开角型青光眼（POAG）患者视乳头周围视网膜和脉络膜微血管损伤的程度，并探讨各层微血管损伤差异与视网膜神经纤维层（RNFL）渐进性变薄速率之间的关系。共纳入 88 只局部 RNFL 缺损的 POAG 眼，其中 67 只眼有脉络膜微血管无灌注（CMvD），21 只眼无 CMvD。测量视网膜微血管损伤（RMvI）和 CMvD 的周向宽度，并根据 CMvD 与 RMvI 的相对宽度（CMvD/RMvI 比值）对眼睛进行分类。根据≥5 次 OCT 检查的线性回归确定 RNFL 变薄率。基线时较薄的全视网膜神经纤维层和更差的视野平均偏差与 RMvI 的周向宽度更大相关，而冷肢体、较低的平均动脉压和更薄的视盘旁脉络膜与 CMvD 的周向宽度更大相关。与 RMvI 等宽和无 CMvD 的眼相比，CMvD 相对宽度较大的眼全视网膜神经纤维层变薄速度更快（P=0.001）。较低的平均动脉压（P=0.041）、较大的 CMvD 宽度（P=0.046）、较大的 CMvD/RMvI 比值（P=0.041）以及在随访期间检测到视盘出血（P=0.013）是与全视网膜神经纤维层变薄速度更快相关的显著因素。CMvD 宽度相对于 RMvI 宽度的增加可能提示具有局部 RNFL 缺损的 POAG 患者的 RNFL 变薄速度更快。比较各层的微血管损伤有助于预测更快速的青光眼进展。
