光学相干断层扫描血管成像在青光眼小梁切除术后评估中的应用

Evaluation of the microvascular changes at optic nerve head,the peripapillary area and macula after trabeculectomy in glaucoma patients by OCTA

目的采用光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)评价青光眼小梁切除术后视盘及其周围和黄斑区血流密度的变化情况。方法选取2020年1月至2021年6月在河北省秦皇岛市第一医院确诊为原发性青光眼并行现代复合小梁切除术的患者55例(共73眼),所有患眼均在术前和术后7d行眼压、光学相干断层扫描(optical coherence tomography,OCT)及OCTA检查,观察手术前后患眼眼压、视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度、神经节细胞复合体(ganglion cell complex,GCC)厚度、杯盘比(cup to disc ratio,C/D)值及视盘整体血流密度、视盘周围血流密度、视盘周围各区血流密度、浅层黄斑区血流密度、深层黄斑区血流密度的变化情况。结果术后7d患眼眼压为(10.63±2.56)mmHg,明显低于术前的(19.62±3.11)mmHg,差异有显著性(P<0.05)。术后7d患眼的RNFL厚度、GCC厚度、C/D值、浅层黄斑区血流密度和深层黄斑区血流密度与术前相比差异均无显著性(P>0.05)。术后7d视盘整体血流密度及视盘周围血流密度分别为(51.92±6.30)%和(41.59±4.56)%,与术前的(50.82±6.45)%和(40.03±4.37)%相比明显增高,差异均有显著性(P<0.05)。术后7d视盘周围鼻上、鼻侧、鼻下、颞侧和颞下的血流密度与术前相比差异均无显著性(P>0.05)。术后7d颞上血流密度为(43.25±6.56)%,明显高于术前的(42.48±6.48)%,差异有显著性(P<0.05)。Pearson相关分析显示,术后视盘周围血流密度及颞上血流密度的增加仅与术后眼压下降值有相关性,与术前眼压、RNFL厚度、GCC厚度和C/D值无相关性。结论青光眼患者行小梁切除术后,通过OCTA检查发现随着眼压的下降,视盘周围血流密度显著增加。

Objective To observe the microvascular changes at optic nerve head(ONH),the peripapillary area and macular in patients with glaucoma after trabeculectomy using optical coherence tomography anglography(OCTA).Method Totally 55 patients(52 eyes)diagnosed with primary glaucoma and successfully underwent compound trabeculectomy were included in this study.All subjects underwent preoperative and 7-days postoperative measurements of intraocular pressure(IOP),OCT,OCTA.We observed the changes in IOP,retinal nerve fiber layer(RNFL)thickness,ganglion cell complex(GCC)thickness,C/D ratio,the vessel density of whole image,peripapillary vessel density(PvD),PvD in different regions of ONH,superficial macula and deep macula of the affected eyes before and after surgery.Result IOP was(10.63±2.56)mmHg 7-days postoperatively,and the difference was statistically significant compared with IOP(19.62±3.11)mmHg preoperatively(P<0.05).There was no significant difference in RNFL thickness,GCC thickness,C/D ratio,the vessel density of superficial macula and deep macula of affected eyes between the values before and 7-days after the surgery(P>0.05).The whole vessel density and PvD were(51.92±6.30)%and(41.59±4.56)%,respectively 7-days after the surgery,compared with the values(50.82±6.45)%and(40.03±4.37)%preoperatively,and the differences were both statistically significant(P<0.05).Comparing the vessel density of superonasal,nasal,inferonasa,temporal and inferotemporal sectors preoperatively with the values 7-days postoperatively,there was no significant difference(P>0.05).The vessel density of superotemporal sector before and after the surgery were(42.48±6.48)%and(43.25±6.56)%,respectively with significant difference(P<0.05).The increasing vessel density of peripapillary area and superotemporal after the surgery was only related to IOP reduction but preoperative IOP,RNFL thickness,GCC thickness or C/D ratio.Conclusion OCTA examination shows that,with the decreasing of IOP,the PvD of the patients with glaucoma are increased significantly after trabeeulectomy.