Michelson G, Langhans M J, Groh M J
Department of Ophthalmology, University Erlagen-Nürnberg, Germany.
J Glaucoma. 1996 Apr;5(2):91-8.
The objective of this study is to evaluate capillary blood flow of the juxtapapillary retina and neuroretinal rim area in primary open angle glaucoma (POAG) by a new noninvasive method performing a high-definition topography of perfused vessels of the retina and the optic nerve head with simultaneous evaluation of blood flow.
Juxtapapillary retinal and neuroretinal rim area blood flow were measured by scanning laser Doppler flowmetry (SLDF). This new technique is a combination of a laser Doppler flowmeter with a scanning laser system by which the retinal perfusion is simultaneously quantified in 16,000 sites of a retinal area of 2.7 x 0.7 mm. In study I, retinal and optic nerve head blood flow were evaluated by SLDF in 43 patients with POAG and 43 healthy individuals. The mean age of the POAG group was 56 +/- 12 years and of the control group 42 +/- 15 years. In study II, age-matched normals (n = 21) were compared with glaucoma eyes with topical therapy (n = 30) and with glaucoma eyes without topical therapy (n = 16).
In study I, the eyes with POAG had an average cup/disc ratio (C/D) of 0.75 +/- 0.20, with an average mean defect of the visual field of 5.3 +/- 5.4 dB. The actual intraocular pressure was 17.8 +/- 4.18 mm Hg in the POAG group and 15.45 +/- 1.82 mm Hg in the control group. For statistical analysis, two age-matched groups of 28 normal eyes of 28 persons with 27 glaucomatous eyes of 27 patients were compared. In normals the blood flow of the neuroretinal rim area was significantly higher than that of the juxtapapillary retinal area (+7.73%, p < 0.01). In POAG both juxtapapillary retinal blood flow and neuroretinal rim area blood flow were significantly decreased compared to an age-matched control group: neuroretinal rim area flow -71% and juxtapapillary retina flow -49%. The decrease of neuroretinal rim area blood flow did significantly correlate with C/D. We found no correlation between reduction of juxtapapillary retinal blood flow and C/D or mean defect. Both glaucoma eyes with and glaucoma eyes without topical therapy showed significant decreased juxtapapillary blood flow compared to normals. We found no significant difference in the juxtapapillary blood flow between glaucoma eyes with and without topical therapy.
In POAG, optic nerve head blood flow and juxtapapillary blood flow were significantly decreased.
本研究的目的是通过一种新的非侵入性方法评估原发性开角型青光眼（POAG）患者视乳头旁视网膜和神经视网膜边缘区域的毛细血管血流，该方法可对视网膜和视神经乳头的灌注血管进行高清晰度地形图绘制并同时评估血流。
采用扫描激光多普勒血流仪（SLDF）测量视乳头旁视网膜和神经视网膜边缘区域的血流。这项新技术是激光多普勒血流仪与扫描激光系统的结合，通过该系统可在2.7×0.7mm的视网膜区域的16000个位点同时定量视网膜灌注。在研究I中，通过SLDF评估了43例POAG患者和43名健康个体的视网膜和视神经乳头血流。POAG组的平均年龄为56±12岁，对照组为42±15岁。在研究II中，将年龄匹配的正常受试者（n = 21）与接受局部治疗的青光眼患者（n = 30）和未接受局部治疗的青光眼患者（n = 16）进行了比较。
在研究I中，POAG患者的平均杯盘比（C/D）为0.75±0.20，平均视野缺损为5.3±5.4dB。POAG组的实际眼压为17.8±4.18mmHg，对照组为15.45±1.82mmHg。为进行统计分析，比较了两个年龄匹配组，一组为28名正常人的28只正常眼，另一组为27名患者的27只青光眼眼。在正常人中，神经视网膜边缘区域的血流明显高于视乳头旁视网膜区域（+7.73%，p < 0.01）。与年龄匹配的对照组相比，POAG患者的视乳头旁视网膜血流和神经视网膜边缘区域血流均显著降低：神经视网膜边缘区域血流降低71%，视乳头旁视网膜血流降低49%。神经视网膜边缘区域血流的降低与C/D显著相关。我们发现视乳头旁视网膜血流的减少与C/D或平均缺损之间无相关性。与正常人相比，接受局部治疗和未接受局部治疗的青光眼患者的视乳头旁血流均显著降低。我们发现接受局部治疗和未接受局部治疗的青光眼患者的视乳头旁血流无显著差异。
在POAG患者中，视神经乳头血流和视乳头旁血流均显著降低。
