Glaucomatous damage of the macula.
Glaucomatous damage of the macula.
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DOI：
10.1016/j.preteyeres.2012.08.003
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发表时间：
2013-01
影响因子：
17.8
通讯作者：
Ritch R
中科院分区：
文献类型：
--
作者：
Hood DC;Raza AS;de Moraes CG;Liebmann JM;Ritch R
有越来越多的证据表明，早期青光眼损害涉及黄斑。这种损伤的解剖学基础可以使用频域光学相干断层扫描（fdOCT）来研究，通过频域光学相干断层扫描（fdOCT）可以测量视网膜神经纤维层（RNFL）和局部视网膜神经节细胞加内丛状（RGC+）层的局部厚度。基于健康对照和患者的平均fdOCT结果，我们表明：1。对于健康对照，平均RGC+层厚度与人类组织学数据紧密匹配; 2.对于青光眼患者和怀疑者，平均RGC+层在下视网膜（上级视野（VF））中显示出更大的青光眼性变薄;以及3. 6° VF网格（24-2测试图案）的中心测试点错过了最大RGC+变薄的区域。根据个体患者的fdOCT结果，我们了解到：1.局部RGC+损失与局部VF敏感性损失相关，只要考虑RGC从中央凹中心的位移;以及2.黄斑损伤本质上通常是弓形的，并且通常与椎间盘狭窄区域中的局部RNFL变薄相关，我们称之为黄斑易损区（MVZ）。根据我们的黄斑损伤的示意性模型，黄斑的大部分下部区域投射到MVZ，MVZ主要位于椎间盘的下象限，该区域特别容易受到青光眼损伤。下黄斑的一个小区域（盲中心）和所有的上级黄斑（下VF）都突出到颞象限，这是一个不易受损伤的区域。总的信息是明确的;临床医生需要意识到黄斑部的青光眼性损害是常见的，可以在疾病的早期发生，并且可以被使用6°网格的标准VF测试（例如24-2 VF测试）遗漏和/或低估。
There is a growing body of evidence that early glaucomatous damage involves the macula. The anatomical basis of this damage can be studied using frequency domain optical coherence tomography (fdOCT), by which the local thickness of the retinal nerve fiber layer (RNFL) and local retinal ganglion cell plus inner plexiform (RGC+) layer can be measured. Based upon averaged fdOCT results from healthy controls and patients, we show that: 1. For healthy controls, the average RGC+ layer thickness closely matches human histological data; 2. For glaucoma patients and suspects, the average RGC+ layer shows greater glaucomatous thinning in the inferior retina (superior visual field (VF)); and 3. The central test points of the 6° VF grid (24-2 test pattern) miss the region of greatest RGC+ thinning. Based upon fdOCT results from individual patients, we have learned that: 1. Local RGC+ loss is associated with local VF sensitivity loss as long as the displacement of RGCs from the foveal center is taken into consideration; and 2. Macular damage is typically arcuate in nature and often associated with local RNFL thinning in a narrow region of the disc, which we call the macular vulnerability zone (MVZ). According to our schematic model of macular damage, most of the inferior region of the macula projects to the MVZ, which is located largely in the inferior quadrant of the disc, a region that is particularly susceptible to glaucomatous damage. A small (cecocentral) region of the inferior macula, and all of the superior macula (inferior VF), project to the temporal quadrant, a region that is less susceptible to damage. The overall message is clear; clinicians need to be aware that glaucomatous damage to the macula is common, can occur early in the disease, and can be missed and/or underestimated with standard VF tests that use a 6° grid, such as the 24-2 VF test.
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