原发性急性闭角型青光眼急性发作期视网膜血管密度特征分析

Characteristics of retinal vascular density in acute primary angle-closure glaucoma during attack phase

目的应用光学相干断层血管成像技术(optical coherence tomography angiography,OCTA)观察原发性急性闭角型青光眼(acute primary angle-closure glaucoma,APACG)急性发作后的视网膜血管密度特征。方法回顾性分析2016年9月至2019年1月就诊于福建医科大学附属第一医院的有单侧眼发作病史且经手术治疗后眼压正常的APACG患者30例,按入组标准纳入其急性发作眼30眼,采用OCTA对其视盘旁及浅层黄斑区视网膜血管密度(vascular density,VD)、神经纤维层(retinal nerve fiber layer,RNFL)厚度进行定量测量,观察APACG视网膜各区域的VD特征。结果急性发作眼视盘旁颞侧象限的VD为49.00(37.90,53.00)%,明显大于上方[35.00(25.00,50.00)%]、鼻侧[39.00(32.00,44.50)%]及下方[40.00(26.00,46.75)%](H=9.880,P=0.020)。浅层黄斑区近中心凹四个象限VD差异无统计学意义(H=2.430,P=0.488),而浅层黄斑区旁中心凹鼻侧象限VD 44.80(39.68,47.30)%明显大于上方[41.15(35.00,44.10)%],颞侧[37.85(34.58,40.40)%],下方[39.90(35.18,43.13)%],差异有统计学意义(H=23.412,P<0.001);视盘旁各象限VD均与相应象限的RNFL厚度呈正相关(r上方=0.823,r鼻侧=0.696,r下方=0.840,r颞侧=0.599,P均<0.001)。结论APACG急性发作眼视乳头黄斑神经纤维束所在区域的网膜血供较其他区域丰富,这可能是晚期青光眼仅残存颞侧视岛或者管状视野的原因,今后在这类疾病中也应重视血流因素的作用。

Objective To observe the retinal vascular density(VD)in the acute stage of acute primary angle-closure glaucoma(APACG)using optical coherence tomography angiography(OCTA).Method A retrospective analysis was performed for 30 patients with unilateral APACG whose one eye suffered from acute attack before and obtained normal intraocular pressure after surgical treatment from September 2016 to January 2019.All eyes(n=30)were included according to the enrollment criteria.The retinal VD and retinal nerve fiber layer(RNFL)thickness of the radial peripapillary capillaries and superficial macular regions were quantitatively measured by OCTA to observe the characteristics of the retinal VD of APACG.Result Peripapillary VD of temporal quadrant[49.00(37.90,53.00)%]was significantly higher than those of superior quadrant[35.00(25.00,50.00)%],nasal quadrant[39.00(32.00,44.50)%]and inferior quadrant[40.00(26.00,46.75)%].The differences were statistically significant(H=9.880,P=0.020).While there was no significant difference in VD among the four quadrants of the parafovea area(H=2.430,P=0.488).Perifoveal VD of nasal quadrant[44.80(39.68,47.30)%]was significantly higher than those of superior quadrant[41.15(35.00,44.10)%],temporal quadrant[37.85(34.58,40.40)%]and inferior quadrant[39.90(35.18,43.13)%].The differences were statistically significant(H=23.412,P<0.001).Additionally,there was a positive correlation between VD in each quadrant of the radial peripapillary capillaries and the RNFL thickness in the corresponding quadrant(rsuperior=0.823,rnasal=0.696,rinferior=0.840,rtemple=0.599,all P<0.001).Conclusion The retinal blood supply in papilla-macular nerve fiber bundle of APACG is richer than that in other areas.This may explain why only the temporal lobe or tubular visual field is preserved in the late stages of glaucoma.In the future,greater attention should be paid to VD in understanding in such diseases.