Choroidal Microvasculature Dropout Is Associated with Progressive Retinal Nerve Fiber Layer Thinning in Glaucoma with Disc Hemorrhage
Choroidal Microvasculature Dropout Is Associated with Progressive Retinal Nerve Fiber Layer Thinning in Glaucoma with Disc Hemorrhage
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DOI：
10.1016/j.ophtha.2018.01.016
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发表时间：
2018-07-01
期刊：
影响因子：
13.7
通讯作者：
Park, Chan Kee
中科院分区：
文献类型：
--
作者：
Lopilly, Hae-Young;Kim, Jin Woo;Park, Chan Kee
目的：应用OCT血管造影（OCT- a）研究伴有或不伴有椎间盘出血（DH）的青光眼患者的乳头旁脉络膜微血管脱落（MvD）及其与视网膜神经纤维层（RNFL）厚度变化的关系。设计：观察性病例对照研究。参与者：包括82只有DH的开角型青光眼和68只无DH的开角型青光眼，均接受了至少4次系列OCT检查。方法：通过视神经头血管密度图的标准化评估，MvD被定义为乳头旁区脉络膜层内微血管的完全丧失。在OCT-A图像上测量MvD的周向范围。采用线性混合模型计算RNFL变薄率。采用Kaplan-Meier生存分析和log-rank检验比较按DH和MvD分层的组间进展的累积风险比。主要观察指标：MvD检出率、MvD角度测量的MvD程度、RNFL变薄率。结果：有DH者有38只（46.3%）眼出现MvD，无DH者仅有20只（29.4%）眼出现MvD，两组差异有统计学意义（P = 0.025）。无论是DH组还是无DH组，进行性青光眼患者的MvD均明显高于稳定患者。Kaplan-Meier分析显示，以DH和MvD存在程度细分的组间差异有统计学意义（log-rank检验，P < 0.001）。复发性DH眼的MvD角度明显大于单发DH眼。DH的存在、复发DH和MvD的存在是与进行性RNFL变薄相关的因素。结论：我们发现在OCT-A脉络膜图上，MvD在进展性OAG眼中较为常见，而在患有DH的眼中，MvD更常见于先前DH位置。这意味着使用OCT-A观察MvD的存在可能提供青光眼进展的生物标志物，特别是在DH的眼睛中。(C) 2018年由美国眼科学会发布
Objective: We used OCT angiography (OCT-A) to investigate parapapillary choroidal microvasculature dropout (MvD) in glaucomatous eyes with or without disc hemorrhage (DH), and the association with changes in retinal nerve fiber layer (RNFL) thickness.Design: An observational case-control study.Participants: Eighty-two open-angle glaucoma (OAG) eyes with DH and 68 OAG eyes without DH that underwent at least 4 serial OCT examinations were included.Methods: MvD was defined as complete loss of microvasculature within the choroidal layer of the parapapillary region, as revealed by standardized assessment of OCTA-derived density maps of the vessels of the optic nerve head. The circumferential extent of MvD was measured on OCT-A images. The RNFL thinning rate was calculated using a linear mixed model. Kaplan-Meier survival analysis and the log-rank test were used to compare the cumulative risk ratio of progression between groups stratified by DH and MvD.Main Outcome Measures: MvD detection rate, the extent of MvD as measured by the MvD angle, and RNFL thinning rate.Results: MvD was found in 38 (46.3%) eyes with DH at the prior DH site, which was found in only 20 (29.4%) eyes without DH, which was significantly different between the 2 groups (P = 0.025). Patients with progressive glaucoma exhibited significantly more MvD than the stable patients in both DH and no-DH groups. There were statistically significant differences between groups subdivided by the presence of DH and MvD as assessed by Kaplan-Meier analysis (log-rank test, P < 0.001). The angle of MvD was significantly greater in eyes with recurrent DH compared with eyes with single DH. Presence of DH, recurrent DH, and presence of MvD were factors associated with progressive RNFL thinning.Conclusions: We found that MvD was frequent in progressive OAG eyes on the choroidal map of OCT-A, which was more frequently found at the prior DH locations in eyes with DH. This means that observing the presence of MvD using OCT-A may provide a biomarker for glaucoma progression, especially in eyes with DH. (C) 2018 by the American Academy of Ophthalmology