光学相干断层扫描血管造影测量的黄斑区青光眼局灶性灌注损失。
Glaucomatous Focal Perfusion Loss in the Macula Measured by Optical Coherence Tomographic Angiography.
机构信息
From the Casey Eye Institute and Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA.
From the Casey Eye Institute and Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA..
出版信息
Am J Ophthalmol. 2024 Dec;268:181-189. doi: 10.1016/j.ajo.2024.07.008. Epub 2024 Jul 14.
PURPOSE
To measure low perfusion area (LPA) and focal perfusion loss (FPL) in the macula using optical coherence tomography (OCT) angiography (OCTA) for glaucoma.
DESIGN
Prospective, cross-sectional "case-control" comparison study.
METHODS
A total of 60 patients with primary open-angle glaucoma (POAG) and 37 healthy participants were analyzed. AngioVue 6 × 6-mm high-definition (400 × 400 transverse pixels) macular OCTA scans were performed on one eye of each participant. Flow signal was calculated using the split-spectrum amplitude-decorrelation angiography algorithm. En face ganglion cell layer plexus (GCLP) and superficial vascular complex (SVC) images were generated. Using custom software, vessel density (VD) maps were obtained by computing the fraction of area occupied by flow pixels after low-pass filtering by local averaging 41 × 41 pixels. LPA was defined by local VD below 0.5 percentile over a contiguous area above 98.5 percentile of the healthy reference population. The FPL was the percentage VD loss (relative to normal mean) integrated over the LPA.
RESULTS
Among patients with POAG, 30 had perimetric and 30 had preperimetric glaucoma. The LPA was 0.16±0.38 mm in normal and 5.78±6.30 mm in glaucoma subjects (P < .001). The FPL was 0.20%±0.47% in normal and 7.52%±8.84% in glaucoma subjects (P < .001). The perimetric glaucoma diagnostic accuracy, measured by the area under the receiver operating curve, was 0.993 for LPA and 0.990 for FPL. The sensitivities were, respectively, 96.7% and 93.3% at 95% specificity. The LPA and FPL had good repeatability (0.957 and 0.952 by intraclass correlation coefficient). Diagnostic accuracy was better than GCLP VD (AROC 0.950, sensitivity 83.3%) and OCT ganglion cell complex (GCC) thickness (AROC 0.927, sensitivity 80.0%) and GCC focal loss volume (AROC 0.957, sensitivity 80.0%). The LPA and FPL correlated well with central VF mean deviations (Pearson r = -0.716 and -0.705 respectively, both P < .001).
CONCLUSION
Assessment of macular FPL using OCTA is useful in evaluating glaucomatous damage.
目的
使用光学相干断层扫描血管造影（OCTA）测量青光眼的黄斑低灌注区（LPA）和局灶性灌注损失（FPL）。
设计
前瞻性、横断面“病例对照”比较研究。
方法
对 60 例原发性开角型青光眼（POAG）患者和 37 例健康参与者的一只眼进行 AngioVue 6×6mm 高清（400×400 横向像素）黄斑 OCTA 扫描。使用分段谱幅度相关血管造影算法计算血流信号。生成神经节细胞层丛（GCLP）和浅层血管复合体（SVC）的面像。使用定制软件，通过对 41×41 像素的局部平均进行低通滤波，计算出血流像素所占面积的分数，获得血管密度（VD）图。将 LPA 定义为在健康参考人群的 98.5%以上的连续区域中，局部 VD 低于 0.5 百分位数。FPL 是 LPA 内整合的相对正常平均值的 VD 损失百分比（相对）。
结果
在 POAG 患者中，30 例为周边青光眼，30 例为前期青光眼。正常组的 LPA 为 0.16±0.38mm，青光眼组为 5.78±6.30mm（P<0.001）。正常组的 FPL 为 0.20%±0.47%，青光眼组为 7.52%±8.84%（P<0.001）。接受者操作特征曲线下面积测量的周边青光眼诊断准确性，LPA 为 0.993，FPL 为 0.990。特异性分别为 95%时，敏感性分别为 96.7%和 93.3%。LPA 和 FPL 具有良好的可重复性（组内相关系数分别为 0.957 和 0.952）。诊断准确性优于 GCLP VD（AROC 0.950，敏感性 83.3%）和 OCT 神经节细胞复合体（GCC）厚度（AROC 0.927，敏感性 80.0%）和 GCC 局灶性损失体积（AROC 0.957，敏感性 80.0%）。LPA 和 FPL 与中央 VF 平均偏差相关性良好（Pearson r=-0.716 和-0.705，均 P<0.001）。
结论
使用 OCTA 评估黄斑 FPL 有助于评估青光眼损伤。
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