Quantification of the Peripapillary Microvasculature in Eyes with Glaucomatous Paracentral Visual Field Loss.
Quantification of the Peripapillary Microvasculature in Eyes with Glaucomatous Paracentral Visual Field Loss.
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DOI：
10.1016/j.ogla.2020.10.009
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发表时间：
2021-05
影响因子：
--
通讯作者：
Shen LQ
中科院分区：
文献类型：
--
作者：
Nascimento E Silva R;Chiou CA;Wang M;Devlin J;Li D;Lovelace S;Wang H;Greenstein SH;Brauner SC;Shen LQ
定量分析原发性开角型青光眼（POAG）和旁中心视野（VF）丧失患者的视乳头周围微血管异常。前瞻性、横断面研究。33例POAG患者，包括15例旁中心VF丧失和18例外周VF丧失，以及31例对照者接受了视乳头周围区域的扫频源光学相干断层扫描血管造影（OCTA）。POAG组间以VF平均差（MD）进行匹配。去除大血管后，在Bruch膜开口周围0.70 mm环内定量从内界膜到视网膜神经纤维层（RNFL）界面的乳头周围微血管。测量血管密度（VD）和通过比率分析信号（IOS）提示血流的积分OCTA。从对应于更严重损失的VF半野的受影响半球测量区域VD和IOS，其用于计算旁中心总偏差（PaTD）或中心10度内的TD。每例受试者包括一只眼睛。中央旁和外周VF丧失组之间乳头周围OCTA测量值的差异以及乳头周围VD和IOS与PaTD的相关性。POAG组的VF MD（中央旁核为−3.1±2.5dB，周围核为−2.3±2.0，P=0.31），平均RNFL厚度无差异（71.1±14.7μm，78.1±15.0 μm，P=0.55）;中央旁组患者年龄小于周围组（59.2±9.6岁，67.4±6.6岁，P=0.02）。与对照组相比，旁中心和外周VF丧失组受累半球的VD（P<0.001和P=0.009）和IOS（分别为P<0.001和P=0.01）均降低。与周边VF丧失的POAG眼相比，旁中央组受累半球的视乳头周围VD（35.0±2.2% vs 38.0± 2.0%，P=0.001）和IOS（40.4±4.0% vs 44.3± 3.1%，P=0.02）降低。在所有POAG眼中，旁中心和周围VF丧失组中，受累半球的视乳头周围VD和IOS与旁中心丧失的功能测量值即PaTD显著相关（分别为r=0.40，P=0.02; r=0.45，P=0.008）。校正年龄后，这些相关性仍然显著（分别为r=0.41，P=0.02; r=0.47，P=0.01）。POAG伴旁中心丢失时，局部视乳头周围微血管密度和血流减少，支持其在该青光眼亚型中的重要性。与周边视野丧失的患者相比，通过光学相干断层扫描血管造影术进行的区域性乳头周围微血管测量结果在中央旁视野丧失的青光眼患者中减少，并且与功能测量结果良好相关。
To quantify abnormalities in the peripapillary microvasculature in eyes with primary open angle glaucomatous (POAG) and paracentral visual field (VF) loss. Prospective, cross-sectional study. 33 POAG patients, including 15 with paracentral VF loss and 18 with peripheral VF loss, and 31 controls underwent swept-source optical coherence tomography angiography (OCTA) of the peripapillary region. POAG groups were matched by VF mean deviation (MD). The peripapillary microvasculature from internal limiting membrane to the retinal nerve fiber layer (RNFL) interface, was quantified within a 0.70-mm annulus around Bruch’s membrane opening after removal of large vessels. Both vessel density (VD) and the integrated OCTA by ratio analysis signal (IOS) suggestive of flow were measured. Regional VD and IOS were measured from the affected hemisphere corresponding to the VF hemifield of more severe loss, which was used to calculate the paracentral total deviation (PaTD), or TD within the central 10 degrees. One eye per subject was included. Difference in peripapillary OCTA measurements between paracentral and peripheral VF loss groups and correlation of peripapillary VD and IOS with PaTD. The POAG groups had matched VF MD (−3.1±2.5dB for paracentral vs. −2.3±2.0 for peripheral, P=0.31) and did not differ in average RNFL thickness (71.1±14.7μm, 78.1±15.0 μm, P=0.55); patients in the paracentral group were younger than the peripheral group (59.2±9.6 years, 67.4±6.6 years, respectively, P=0.02). Compared to controls, both paracentral and peripheral VF loss groups had reduced VD (P<0.001 and P=0.009) and IOS (P<0.001 and P=0.01, respectively) in the affected hemisphere. Compared to POAG eyes with peripheral VF loss, the paracentral group had reduced peripapillary VD (35.0±2.2% vs 38.0±2.0%, P=0.001) and IOS (40.4±4.0% vs 44.3±3.1%, P=0.02) in the affected hemisphere. Among all POAG eyes, paracentral and peripheral VF loss groups, peripapillary VD and IOS of the affected hemisphere significantly correlated with functional measurement of paracentral loss, i.e. PaTD, (r=0.40, P=0.02; r=0.45, P=0.008, respectively). These correlations remained significant after adjusting for age (r=0.41, P=0.02; r=0.47, P=0.01; respectively). Regional peripapillary microvasculature showed decreased vessel density and flow in POAG with paracentral loss, supporting its importance in this glaucoma subtype. Regional peripapillary microvasculature measurements by optical coherence tomography angiography were decreased in glaucomatous eyes with paracentral visual field loss compared to those with peripheral visual field loss and were well correlated with functional measurement.
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