中心视野缺损与周边视野缺损的早期原发性开角型青光眼黄斑区血管密度变化比较

Comparison of macular vessel density changes in early primary open-angle glaucoma with central visual field defects and peripheral visual field defects

目的比较伴有中心视野缺损(CVFDs)与周边视野缺损(PVFDs)的早期原发性开角型青光眼(POAG)患者黄斑区血管密度变化。方法采用横断面研究方法,连续纳入2020年6—12月首次在首都医科大学附属北京同仁医院确诊的早期POAG患者66例66眼,根据视野缺损部位不同将患者分为CVFDs组25例25眼和PVFDs组41例41眼,同期纳入性别、年龄和屈光度匹配的健康志愿者55人55眼作为健康对照组。所有受试者均接受常规眼科检查,采用Humphrey视野计进行24-2视野检查;采用光相干断层扫描血管成像(OCTA)检测黄斑区6 mm×6 mm范围内的血管密度和灌注密度,根据ETDRS环将视网膜分为3个环9个区域,测定中心、内环(上方、下方、颞侧和鼻侧)和外环(上方、下方、颞侧和鼻侧)血流参数。评估并比较CVFDs组与PVFDs组患者黄斑区微血管血流变化及其与视野缺损部位的关联。结果健康对照组、CVFDs组和PVFDs组受检眼黄斑区总体血管密度分别为18.20(17.50,18.50)、17.10(16.30,17.85)和17.20(16.25,17.90)mm/mm^(2),总体灌注密度分别为0.45(0.43,0.46)、0.42(0.40,0.44)和0.43(0.40,0.44)mm^(2)/mm^(2),总体比较差异均有统计学意义(H=20.84、16.15,均P<0.001),其中CVFDs组和PVFDs组黄斑区总体血管密度和灌注密度均明显低于健康对照组,差异均有统计学意义(均P<0.05)。3个组患者受检眼黄斑区外环上方、下方、颞侧和鼻侧血管密度和灌注密度总体比较,差异均有统计学意义(均P<0.05),其中与健康对照组比较,CVFDs组受检眼外环各区血管密度和外环上方、下方及鼻侧灌注密度均下降,PVFDs组外环上方、下方和颞侧血管密度和灌注密度均下降,差异均有统计学意义(均P<0.05);CVFDs组外环鼻侧灌注密度低于PVFDs组,差异有统计学意义(P=0.035)。结论早期POAG患者黄斑区血管密度和灌注密度均明显降低,具有CVFDs的早期POAG患者黄斑区外环鼻侧灌注密度低于PVFDs者。

Objective To compare the change of macular microvasculature in early primary open-angle glaucoma(POAG)patients with central visual field defects(CVFDs)and peripheral visual field defects(PVFDs).Methods A cross-sectional study was performed.Sixty-six eyes of 66 consecutive patients with early POAG were enrolled in Beijing Tongren Hospital from June to December 2020.The patients were divided into CVFDs group(25 eyes)and PVFDs group(41 eyes)according to their visual field defect.Another 55 eyes of 55 age-,gender-and spherical equivalent-matched healthy people were set as a normal control group.All subjects underwent routine ophthalmic examination.Humphrey 24-2 visual field test was carried out.Macular vessel density(VD)and perfusion density(PD)of an area of 6 mm×6 mm were measured by optical coherence tomography angiography(OCTA),and the area was divided into 3 rings and 9 zones,including center,inner ring(superior,inferior,temporal and nasal sectors),and outer ring(superior,inferior,temporal and nasal sectors)according to ETDRS ring.The relationship among VD,PD,and visual field defect was analyzed.This study adhered to the Declaration of Helsinki.The research protocol was approved by an Ethics Committee of Beijing Tongren Hospital,Capital Medical University(No.TRECKY2020-103).Written informed consent was obtained from each subject before any examination.Results The total macular VD of normal control group,CVFDs group and PVFDs group was 18.20(17.50,18.50),17.10(16.30,17.85),and 17.20(16.25,17.90)mm/mm^(2),respectively,and there was a significant difference(H=20.84;P<0.001).The total macular PD of normal control group,CVFDs group and PVFDs group was 0.45(0.43,0.46),0.42(0.40,0.44),and 0.43(0.40,0.44)mm^(2)/mm^(2),respectively,with a significant difference(H=16.15;P<0.001).The total macular VD and PD of CVFDs and PVFDs groups were significantly lower than those of normal control group,with statistically significant differences(all at P<0.05).Significant differences were found in VD and PD of superior,inferior,temporal,and nasal sectors of the outer ring among three groups(all at P<0.05).VD of the outer ring and PD of superior,inferior,and nasal sectors of the outer ring were reduced in CVFDs group than normal control group,showing significant differences(all at P<0.05).VD and PD of the superior,inferior,and temporal sectors of the outer ring were reduced in PVFDs group compared with normal control group,with significant differences(all at P<0.05).A significant difference was found in macular PD of the outer-nasal sector between CVFDs and PVFDs groups(P=0.035).Conclusions Macular VD and PD are reduced in early POAG.Compared with POAG patients with CVFDs,the macular PD of the outer-nasal sector of POAG patients with CVFDs is lower.