Ganglion Cell Complex Thickness and Macular Vessel Density Loss in Primary Open-Angle Glaucoma
Ganglion Cell Complex Thickness and Macular Vessel Density Loss in Primary Open-Angle Glaucoma
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DOI：
10.1016/j.ophtha.2019.12.030
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发表时间：
2020-08-01
期刊：
影响因子：
13.7
通讯作者：
Weinreb, Robert N.
中科院分区：
文献类型：
--
作者：
Hou, Huiyuan;Moghimi, Sasan;Weinreb, Robert N.
目的：目的：研究健康人、视野前青光眼和原发性开角型青光眼（POAG）患者的视网膜神经节细胞复合体（GCC）厚度和黄斑血管密度的变化率。一百三十九只眼睛（23只健康眼，36只青光眼眼，和80只POAG眼）的94名患者中至少有3次就诊。健康眼平均随访2.0年，视野前青光眼眼平均随访2.6年，POAG眼平均随访2.6年。方法：对相同的3x 3-mm（2）GCC扫描板进行基于OCT血管造影（OCTA）的血管密度和基于OCT的结构厚度评估。计算并比较每个诊断组内基于动态范围的血管密度和厚度变化的标准化率。主要观察指标：GCC变薄率和黄斑区血管密度降低率。结果：所有诊断组的GCC变薄率和黄斑区血管密度降低率均显著高于对照组（P均< 0.05）。正常眼和青光眼术前的GCC变薄率和黄斑血管密度降低率无显著性差异（P > 0.1）。相比之下，POAG眼黄斑血管密度降低的标准化速率（平均值，95%置信区间）（-7.12 [-8.36，-5.88]%/年）明显快于GCC变薄（-2.13 [-3.35，-0.90]%/年; P < 0.001）。在POAG组中，超过三分之二的眼睛显示黄斑血管密度下降比GCC变薄更快;更快的黄斑血管密度下降率与更严重的青光眼严重程度显著相关（P = 0.037）。GCC变薄率与青光眼严重程度之间的相关性不显著（P = 0.586）。随访期间的眼压显著影响各组中GCC变薄的比率（均P < 0.05），但与黄斑血管密度降低的比率无相关性。结论：在所有诊断组中，随着时间的推移，GCC变薄和黄斑血管密度降低都是可检测的。在POAG眼中，黄斑血管密度下降比GCC变薄更快，并且与疾病的严重程度相关。黄斑血管密度可用于评估青光眼进展，特别是在更晚期的疾病中。
Purpose: To characterize the change rate of ganglion cell complex (GCC) thickness and macular vessel density in healthy, preperimetric glaucoma and primary open-angle glaucoma (POAG) eyes.Design: Prospective, longitudinal study.Participants: One hundred thirty-nine eyes (23 healthy eyes, 36 preperimetric glaucoma eyes, and 80 POAG eyes) of 94 patients who had at least 3 visits were included from the Diagnostic Innovations in Glaucoma Study. The mean follow-up was 2.0 years for healthy eyes, 2.6 years for preperimetric glaucoma eyes, and 2.6 years for POAG eyes.Methods: OCT angiography (OCTA)-based vessel density and OCT-based structural thickness of the same 3x3-mm(2) GCC scan slab were evaluated. The dynamic range-based normalized rates of vessel density and thickness change were calculated and compared within each diagnostic group. The association between the rates of thickness and vessel density change and potential factors were evaluated.Main Outcome Measures: The rates of GCC thinning and macular vessel density loss.Results: Significant rates of GCC thinning and macular vessel density decrease were detectable in all diagnostic groups (all P < 0.05). In healthy eyes and preperimetric glaucoma eyes, the normalized rates of GCC thinning and macular vessel density decrease were comparable (all P > 0.1). In contrast, the normalized rate (mean, 95% confidence interval) of macular vessel density decrease in the POAG eyes (-7.12 [-8.36, -5.88]%/year) was significantly faster than GCC thinning (-2.13 [-3.35, -0.90]%/year; P < 0.001). In the POAG group, more than two thirds of the eyes showed faster macular vessel density decrease than GCC thinning; faster macular vessel density decrease rate was associated significantly with worse glaucoma severity (P = 0.037). The association between GCC thinning rate and glaucoma severity was not significant (P = 0.586). Intraocular pressure during follow-up significantly affected the rate of GCC thinning in all groups (all P < 0.05) but showed no association with the rate of macular vessel density decrease.Conclusions: Both GCC thinning and macular vessel density decrease were detectable over time in all diagnostic groups. In POAG eyes, macular vessel density decrease was faster than GCC thinning and was associated with severity of disease. Macular vessel density is useful for evaluating glaucoma progression, particularly in more advanced disease.