原发性开角型青光眼黄斑区视网膜微循环和结构损伤的研究

Study of retinal microvascular perfusion alteration and structural damage at macular region in primary open-angle glaucoma patients

目的探讨POAG患者黄斑区域视网膜微循环状态及其与视网膜结构损伤的关系。方法横断面研究。研究对象为2015年7月至12月在复旦大学附属眼耳鼻喉科医院眼科就诊的POAG患者59例，其中男性35例，女性24例，年龄17~66岁。应用谱域OCT（SD-OCT）结合分光谱振幅去相关血管成像（SSADA）算法系统，对59例入选患者的59只单眼进行OCT扫描（28只眼为早期组、11只眼为中期组、20只眼为晚期组）。采集患眼黄斑区域视网膜微循环血流灌注指标（血流指数和血管密度）以及视网膜厚度值，检测眼部指标并记录一般信息，使用完全随机设计资料的方差分析法和最小显著差数法-t检验分别比较早、中、晚期3组POAG患者的视网膜微循环指标、视网膜厚度及视野损伤程度。使用Pearson偏相关分析方法比较各变量之间的相关强度。结果POAG患眼中期组黄斑区微血管血流指数和血管密度分别为0.05±0.01和60.8%±7.9%，较早期POAG患眼的血流指数0.07±0.01及血管密度71.9%±4.6%明显减小（t=5.11，P=0.001; t=5.05, P〈0.01）；且POAG患眼中期组黄斑区全层及内层视网膜厚度分别为（270.3±24.6）μm和（98.4±13.3）μm，也较POAG患眼早期组的全层（293.0±12.0）μm及内层（113.0±7.4）μm视网膜层厚度明显变薄（t=3.60，P〈0.01；t=4.06，P〈0.01）；以上指标在中期及晚期两组间的差异无统计学意义。Pearson偏相关回归分析显示：黄斑区视网膜微循环的改变与视网膜组织结构的损伤具有正相关性（R=0.35~0.71，所有P均〈0.01）。结论在POAG的早中期，随着病变加重，视网膜厚度变薄，微循环血流减小，但中期和晚期的视网膜厚度及微循环血流指标间的差异无统计学意义。POAG患眼视网膜厚度及微循环血流呈正相关，且视网膜微循环与内层、下方视网膜变薄关系最为密切。

Objective To investigate the alteration of retinal microcirculation and structural damage at macular region and evaluate their associations in primary open angle glaucoma （POAG） eyes. Methods Cross-sectional study. Fifty-nine POAG patients （male/femal=35/24） were recruited from July 2015 to December 2015 in Eye, Ear, Nose and Throat Hospital of Fudan University. Twenty-eight eyes of early-stage POAG group （EG）, 1 l eyes of moderate-stage POAG group （MG） and 20 eyes of severe-stage POAG group （SG） were enrolled in this study. All patients underwent complete ophthalmological examinations and the general information was collected. The macular perfusion parameters （flow index ＆ vessel area density） and the global/hemimacular retina thickness were derived from the 3D angio-retina and retina map procedures in the single optic coherence tomography （OCT） system with split-spectrum amplitude decorrelation angiography （SSADA） algorithm, respectively. One-way ANOVA analysis was conducted to compare the macular perfusion parameters, retinal thickness and visual field defects among three groups.Pearson partial regression analysis was used to calculate the correlations between different variables. Results The mean flow index and vessel area density of MG eyes were 0.05±0.01 and 60.8%±7.9%, which were significantly lower than those indexes （0.06±0.01; 71.9%±4.6%） in EG eyes （t=5.11, P=0.001; t=5.05, P〈0.01）. The full and inner retinal layer thicknesses of MG eyes were （270.3±24.6）μm and （98.4± 13.3） μm, which were obviously thinner than those indexes （293.0±12.0 μm, 113.0±7.4μm） in EG eyes （t=3.60, P〈0.01; t=4.06, P〈0.01）. However, there was no significant alteration of macular perfusion parameters and retinal thickness between MG and SG eyes. Furthermore, there was a significantly positive correlation between macular perfusion （flow index/vessel area density） and the macular retina thickness （full/inner thickness） （R=0.35-0.71, All P〈0.01）. Conclusions The microvascular perfusion and retinal thickness in MG eyes were lower than those in EG eyes. There was significant positive association between the retinal microvascular perfusion and structural damage. Furthermore, the association between microvascular perfusion and inner inferior retinal thickness is the strongest.