Yarmohammadi A, Zangwill LM, Diniz-Filho A, et al.
血管 青光眼 断层
目的：旨在评估血管密度（使用光学相干断层扫描血管造影（OCT-A）检测）与原发性开角型青光眼视野损失严重程度之间的关联。设计：观察性，横断面研究。研究对象：研究共有来自31名健康参与者，48名青光眼疑似患者和74名青光眼患者的153只眼。方法：使用OCT-A（Angiovue; Optovue，Fremont，CA），光谱域OCT（Avanti; Optovue）和标准自动视野测量（SAP）检测所有眼。视网膜脉管系统信息被总结为血管密度，选定区域流动血管占据的面积百分比。使用来自视网膜神经纤维层（RNFL）的两个指标：乳头周毛细血管密度（cpVD）（视盘周围750μm宽的椭圆环）和全图像血管密度（wiVD）（整个4.5×4.5mm扫描区）。主要预后指标：视野缺失严重程度（SAP平均偏差（MD）报告）与OCT-A血管密度之间的关系。结果：与青光眼相比，正常眼RNFL内显示更密集的微血管网。正常眼血管密度较高，之后是青光眼疑似患者，轻度青光眼和中度至重度青光眼（wiVD分别为（55.5％，51.3％，48.3％和41.7％）和（cpVD分别为62.8％，61.0％，57.5 ％，49.6％，P <0.001）。 SAP MD与cpVD和wiVD之间的关联(R(2)= 0.54， R(2)= 0.51)比RNFL的SAP MD（R（2）= 0.36）和边缘面积（R（2）= 0.51）之间的关联更强（全部P <0.05）。多变量回归分析显示，wiVD每降低1％，则MD下降0.66dB，cpVD每降低1％，则MD下降0.64dB。此外，即使在控制与结构性缺失的影响后，血管密度和视野损伤严重程度之间仍有显著关联。结论：血管密度下降明显与视野损害严重程度相关，而与结构损失无关。光学相干断层扫描血管造影是青光眼治疗中有前景的技术，可潜在增强对血管系统在疾病病理生理学中的作用的理解。
PURPOSE:To evaluate the association between vessel density measurements using optical coherence tomography angiography (OCT-A) and severity of visual field loss in primary open-angle glaucoma.DESIGN:Observational, cross-sectional study.PARTICIPANTS:A total of 153 eyes from 31 healthy participants, 48 glaucoma suspects, and 74 glaucoma patients enrolled in the Diagnostic Innovations in Glaucoma Study.METHODS:All eyes underwent imaging using OCT-A (Angiovue; Optovue, Fremont, CA), spectral-domain OCT (Avanti; Optovue), and standard automated perimetry (SAP). Retinal vasculature information was summarized as vessel density, the percentage of area occupied by flowing blood vessels in the selected region. Two measurements from the retinal nerve fiber layer (RNFL) were used: circumpapillary vessel density (cpVD) (750-μm-wide elliptical annulus around the optic disc) and whole-image vessel density (wiVD) (entire 4.5×4.5-mm scan field).MAIN OUTCOME MEASURES:Associations between the severity of visual field loss, reported as SAP mean deviation (MD), and OCT-A vessel density.RESULTS:Compared with glaucoma eyes, normal eyes demonstrated a denser microvascular network within the RNFL. Vessel density was higher in normal eyes followed by glaucoma suspects, mild glaucoma, and moderate to severe glaucoma eyes for wiVD (55.5%, 51.3%, 48.3%, and 41.7%, respectively) and for cpVD (62.8%, 61.0%, 57.5%, 49.6%, respectively) (P < 0.001 for both). The association between SAP MD with cpVD and wiVD was stronger (R(2)= 0.54 and R(2)= 0.51, respectively) than the association between SAP MD with RNFL (R(2)= 0.36) and rim area (R(2)= 0.19) (P < 0.05 for all). Multivariate regression analysis showed that each 1% decrease in wiVD was associated with 0.66 decibel (dB) loss in MD and each 1% decrease in cpVD was associated with 0.64 dB loss in MD. In addition, the association between vessel density and severity of visual field damage was found to be significant even after controlling for the effect of structural loss.CONCLUSIONS:Decreased vessel density was significantly associated with the severity of visual field damage independent of the structural loss. Optical coherence tomography angiography is a promising technology in glaucoma management, potentially enhancing the understanding of the role of vasculature in the pathophysiology of the disease.