Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine.
Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul.
J Glaucoma. 2023 Nov 1;32(11):918-925. doi: 10.1097/IJG.0000000000002270. Epub 2023 Jul 19.
Microvasculature dropout in the parapapillary choroidal layer was a more important biomarker of glaucomatous nerve fiber layer thinning when it presented with deep-layer microvasculature of the optic disc rather than when it presents by itself.
To characterize open angle glaucoma eyes with optic nerve head deep-layer microvasculature dropout (MvD-D) and parapapillary choroidal layer microvasculature dropout (MvD-P) and compare their retinal nerve fiber layer (RNFL) thinning rate.
This study included 122 open angle glaucoma eyes that underwent ≥5 serial spectral-domain optical coherence tomography scans during a mean follow-up of 5.4 years. Swept-source optical coherence tomography angiography was used to evaluate MvD-P and MvD-D. Subjects were classified into 3 groups according to the presence of MvD-P and MvD-D: (1) no dropout (n=37); (2) solely MvD-P (n=40), and (3) both MvD-P and MvD-D (n=45). The RNFL thinning rate was compared among the 3 groups, and the associated factors were assessed by Cox proportional hazard analysis.
RNFL thinning rates were highest in the group with both MvD-P and MvD-D, followed by the group with solely MvD-P and finally by the no dropout group (-0.24 vs. -0.65 vs. -1.20 μm/y, P <0.001). Thinner central corneal thickness [hazard ratio (HR)0.990, P =0.003], presence of disc hemorrhage (HR=1.802, P =0.035), and coexistence of MvD-P and MvD-D (HR=2.941, P <0.001) were the factors associated with RNFL thinning.
The coexistence of MvD-P and MvD-D was associated with faster RNFL thinning than MvD-P alone or no dropout, which suggested that observing the optic disc deep microvasculature along with parapapillary choroidal layer using Swept-source optical coherence tomography angiography may be clinically relevant in monitoring glaucoma progression.
当视盘深层微血管与旁视网膜脉络膜层微脉管缺失（MvD-P）同时存在时，比单独出现时，视盘旁视网膜脉络膜层微脉管缺失（MvD-P）更能成为青光眼神经纤维层变薄的重要生物标志物。
描述具有视神经头深层微血管缺失（MvD-D）和旁视网膜脉络膜层微脉管缺失（MvD-P）的开角型青光眼眼，并比较其视网膜神经纤维层（RNFL）变薄率。
本研究纳入了 122 只开角型青光眼眼，这些眼在平均 5.4 年的随访期间接受了≥5 次的频域光学相干断层扫描。使用扫频源光相干断层扫描血管造影评估 MvD-P 和 MvD-D。根据 MvD-P 和 MvD-D 的存在情况，将受试者分为 3 组：（1）无缺失（n=37）；（2）仅 MvD-P（n=40）；（3）MvD-P 和 MvD-D 均存在（n=45）。比较 3 组的 RNFL 变薄率，并通过 Cox 比例风险分析评估相关因素。
MvD-P 和 MvD-D 均存在组的 RNFL 变薄率最高，其次是仅 MvD-P 存在组，最后是无缺失组（-0.24 vs. -0.65 vs. -1.20 μm/y，P <0.001）。较薄的中央角膜厚度[风险比（HR）0.990，P =0.003]、盘状出血的存在（HR=1.802，P =0.035）和 MvD-P 和 MvD-D 的共存（HR=2.941，P <0.001）是与 RNFL 变薄相关的因素。
与单独的 MvD-P 或无缺失相比，MvD-P 和 MvD-D 的共存与更快的 RNFL 变薄相关，这表明使用扫频源光相干断层扫描血管造影观察视盘深层微血管与旁视网膜脉络膜层可能与青光眼进展的监测有关。
