原发性青光眼视网膜神经纤维层厚度和视盘周围血管密度分析

Analysis of retinal nerve fiber layer thickness and circumpapillary vascular density in patients with primary glaucoma

目的探讨原发性闭角型青光眼(PACG)和原发性开角型青光眼(POAG)患者视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度、视盘周围血管密度(circumpapillary vascular density,cpVD)及视野平均敏感度(mean sensitivity,MS)之间的关系,以了解两种疾病本质是否有差异。方法选取2016年7月至2018年7月本院就诊的POAG患者120例(120眼)及与POAG患者年龄、视野平均缺损(mean deviation,MD)相匹配的120例(120眼)PACG患者临床资料进行回顾性分析。采用光学相干断层扫描血管成像(OCTA)检测平均RNFL厚度、cpVD及不同方向[上方颞侧(superotemporal,ST)、上方鼻侧(superonasal,SN)、鼻上(nasoupper,NU)、鼻下(nasolower,NL)、下方鼻侧(inferonasal,IN)、下方颞侧(inferotemoporal,IT)、颞下(temporolower,TL)、颞上(temporoupper,TU)]RNFL厚度,采用自动视野计检测总视野MS及不同方向视野MS。分析不同方向RNFL厚度、cpVD和视野MS之间关系及影响cpVD的相关因素。结果PACG组和POAG组患者平均RNFL厚度、平均cpVD、平均视野MS间均相关(均为P<0.05)。PACG组患者RNFL厚度在ST、SN、IT、IN 4个方向上与相应的视野MS均相关(均为P<0.05),cpVD在ST、SN、IT、IN和TL 5个方向上与相应的视野MS均相关(均为P<0.05)。PACG组各方位RNFL厚度与cpVD均相关(均为P<0.05)。POAG组患者在所有方向上cpVD、RNFL厚度、视野MS均两两相关(均为P<0.05)。PACG组眼压和RNFL厚度是影响cpVD的独立危险因素(均为P<0.05);而POAG组仅有RNFL厚度是影响cpVD的独立危险因素(P<0.05)。结论与POAG患者相比,PACG患者中cpVD与视野MS的相关性强,说明两者在血管和功能关系上具有一定差异,可能与两者发病机制不同有关。

Objective To investigate the relationship among retinal nerve fiber layer(RNFL)thickness,circumpapillary vascular density(cpVD)and mean sensitivity(MS)of visual field in patients with primary angle-closure glaucoma(PACG)and primary open-angle glaucoma(POAG),and explore the difference in the nature of the two diseases.Methods The clinical data of 120 POAG patients(120 eyes)and 120 PACG patients(120 eyes)with matched age and MS of visual field who were treated in our hospital from July 2016 to July 2018 were retrospectively analyzed.The mean RNFL thickness,mean cpVD,and[superotemporal(ST),superonasal(SN),nasoupper(NU),nasolower(NL),inferonasal(IN),inferotemoporal(IT),temporolower(TL),temporoupper(TU)]RNFL thickness and cpVD were detected by optical coherence tomography angiography(OCTA).The MS of total visual field and in different directions were detected by an automatic perimeter.The relationship among RNFL thickness,cpVD and MS of visual field in different directions,and related factors affecting cpVD were analyzed.Results There was a correlation among mean RNCL thickness,mean cpVD and mean MS of visual field in PACG group and POAG group(both P<0.05).RNFL thickness in ST,SN,IT and IN four directions were related to corresponding MS of visual field in PACG group(all P<0.05).The cpVD in ST,SN,IT,IN and TL five directions were related to corresponding MS of visual field(all P<0.05).The cpVD in all directions were related to corresponding RNFLT and MS of visual field in POAG group(all P<0.05).The intraocular pressure and RNFL thickness of PACG eyes were independent factors affecting cpVD(P<0.05).Only RNFL thickness of POAG eyes was an independent factor affecting cpVD(P<0.05).Conclusion Compared with POAG patients,cpVD had closer relationship with MS of visual field for PACG patients,indicating difference in terms of blood vessels and function between POAG and PACG,which may be related to their different pathogenesis.