Parapapillary Deep-Layer Microvasculature Dropout and Visual Field Progression in Glaucoma
Parapapillary Deep-Layer Microvasculature Dropout and Visual Field Progression in Glaucoma
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DOI：
10.1016/j.ajo.2018.12.007
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发表时间：
2019-04-01
影响因子：
4.2
通讯作者：
Suh, Min Hee
中科院分区：
文献类型：
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作者：
Kwon, Ji Min;Weinreb, Robert N.;Suh, Min Hee
目得：为了评价光学相干断层扫描血管造影术（OCT-A）衍生的乳头旁深层微血管脱落和青光眼视野（VF）进展之间的相关性，设计：回顾性队列研究。方法：纳入138例原发性开角型青光眼患者（平均随访时间为5.5年）的138只眼，OCT-A成像前VF ≥ 5。VF进展被定义为基于指导进展分析的“可能进展”事件或显著VF指数（VFI）斜率。基于OCT-A的定性分析，微血管脱落定义为乳头旁深层微血管脱落。结果：55只眼（39.9%）显示VF进展。脱落眼进展的比例高于未脱落眼（50/84眼[59.5%] vs 5/54眼[9.3%]; P <0.001）。在多变量逻辑回归分析中，平均和标准差眼压、视盘出血、局灶性筛板缺损和脱落与既往VF进展显著相关（P <0.05）。脱落眼的VFI进展速度明显快于未脱落眼（分别为-2.23%+/- 3.22%/年vs -0.05% +/- 1.24%/年; P <0.001），脱落和VF进展的位置在空间上相关。通过OCT-A检测到的具有乳头旁深层微血管脱落的眼睛的VF进展率显著高于没有脱落的眼睛。这些发现暗示脱落是提示既往昏迷性VF进展的结构参数。需要进一步的前瞻性纵向研究来阐明深层微血管损伤在青光眼发病机制中的作用。(C)2018爱思唯尔公司All rights reserved.
PURPOSE: To evaluate the association between optical coherence tomography angiography (OCT-A)-derived parapapillary deep-layer microvasculature dropout and glaucomatous visual field (VF) progression.DESIGN: Retrospective, cohort study.METHODS: A total of 138 eyes of 138 patients with primary open-angle glaucoma (mean follow-up, 5.5 years) and with >= 5VFs prior to OCT-A imaging were included. VF progression was defined as either a Guided Progression Analysis-based "likely progression" event or a significant VF index (VFI) slope. Microvasculature dropout was defined as parapapillary deep-layer microvasculature dropout based on a qualitative analysis of OCT-A. Prevalence of dropout was compared between eyes with and without VF progression.RESULTS: Fifty-five eyes (39.9%) demonstrated VF progression. A higher proportion of eyes with dropout progressed than those without dropout (50/84 eyes [59.5%] vs 5/54 eyes [9.3%]; P < .001). In multivariable logistic regression analysis, mean and standard deviation intraocular pressure, optic disc hemorrhage, focal lamina cribrosa defect, and dropout were significantly associated with prior VF progression (P < .05). The VFI progression rate was significantly faster in eyes with dropout than in those without dropout ( - 2.23% +/- 3.22%/year vs -0.05% +/- 1.24%/year, respectively; P < .001), and the location of dropout and VF progression were spatially correlated.CONCLUSIONS: Eyes with parapapillary deep-layer microvasculature dropout detected by OCT-A had a significantly higher rate of VF progression than eyes without dropout. These findings implicate dropout as a structural parameter suggestive of past glaucomatous VF progression. Further prospective longitudinal studies are needed to elucidate the role of deep-layer microvasculature damage in the pathogenesis of glaucoma. (C) 2018 Elsevier Inc. All rights reserved.