Karjou Zahra, Yazdani Shahin, Savareh Behrouz Alizadeh, Kheiri Bahareh, Radinmehr Fatemeh
Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Ophthalmic Vis Res. 2025 Jul 10;20. doi: 10.18502/jovr.v20.15461. eCollection 2025.
Vascular changes along with loss of the neural rim at the optic nerve head (ONH) are established hallmarks of glaucomatous optic neuropathy. The current study investigates changes in the position of major retinal vessels outside the ONH in eyes with definite or suspected glaucoma and reports its clinical associations.
This retrospective case-control study was conducted on a dataset of 2390 patients with definite or suspected glaucoma and serial photographic documentation from 2015 to 2022. Images were overlaid chronologically and examined for vascular displacement (VD) outside the margin of the ONH up to one disc diameter using the built-in fundus camera software; in the case of VD detection, the change was verified using MATLAB software. The amount of VD was measured in pixels and expressed in a unitless arbitrary ratio derived from the amount of VD in pixels divided by the largest optic disc diameter in pixels. During the study period, a small number of eyes showed evidence of VD, which made up the case group; eyes without evidence of VD from the same dataset were chosen as controls.
A total of 23 eyes demonstrated VD, and 60 eyes with no evidence of VD were selected as controls. The mean amount of VD was 0.15 0.01 in case eyes compared to 0.01 0.01 in control eyes ( 0.001). Definite glaucomatous damage was observed in 20 (87%) eyes in the case group compared to 35 (58.3%) eyes in the control group ( = 0.014). The best-corrected visual acuity in eyes with VD, both at baseline and at the final visit, was significantly worse than in controls ( = 0.018 and = 0.032, respectively). Eyes with VD had greater cupping both at baseline ( = 0.025) and at the final examination ( = 0.04). During the study period, 16 (69.6%) eyes with VD and 12 (20%) control eyes required glaucoma surgery ( = 0.001). Patients with VD also showed a statistical trend toward being younger (mean age, 54.5 16.5 vs 61.3 15.5 years, = 0.088).
VD outside the ONH may occur in eyes with glaucoma and is associated with factors reflecting more significant glaucomatous damage. Eyes with VD outside the ONH have lower visual acuity, greater cupping, and require glaucoma surgery more often, indicating more significant glaucoma severity or progression.
视神经乳头（ONH）处的血管变化以及神经边缘的丧失是青光眼性视神经病变的既定特征。本研究调查了明确或疑似青光眼患者ONH外主要视网膜血管位置的变化，并报告其临床相关性。
本回顾性病例对照研究基于2390例明确或疑似青光眼患者的数据集以及2015年至2022年的系列摄影记录进行。图像按时间顺序叠加，并使用内置的眼底相机软件检查ONH边缘外直至一个视盘直径范围内的血管移位（VD）；若检测到VD，则使用MATLAB软件进行验证。VD量以像素为单位测量，并以无量纲的任意比率表示，该比率由像素中的VD量除以像素中的最大视盘直径得出。在研究期间，少数眼睛显示出VD迹象，这些眼睛构成病例组；从同一数据集中选择无VD迹象的眼睛作为对照组。
共有23只眼睛出现VD，60只无VD迹象的眼睛被选为对照组。病例组眼睛的平均VD量为0.15±0.01，而对照组眼睛为0.01±0.01（P<0.001）。病例组20只（87%）眼睛观察到明确的青光眼性损害，而对照组为35只（58.3%）眼睛（P = 0.014）。有VD的眼睛在基线和末次随访时的最佳矫正视力均显著低于对照组（分别为P = 0.018和P = 0.032）。有VD的眼睛在基线（P = 0.025）和末次检查时（P = 0.04）杯盘比更大。在研究期间，16只（69.6%）有VD的眼睛和12只（20%）对照组眼睛需要进行青光眼手术（P = 0.001）。有VD的患者在年龄上也有统计学上的年轻化趋势（平均年龄，54.5±16.5岁对61.3±15.5岁，P = 0.088）。
青光眼患者的眼睛可能会出现ONH外的VD，并且与反映更严重青光眼损害的因素相关。ONH外有VD的眼睛视力较低、杯盘比更大，并且更常需要进行青光眼手术，表明青光眼严重程度或进展更为显著。
