原发性开角型青光眼患者视盘旁视网膜劈裂的OCT分型及危险因素

Classification and Risk Factors of Peripapillary Retinoschisis Based on OCT Images in Primary Open-Angle Glaucoma

目的:通过频域光学相干断层扫描(SD-OCT)观察分析原发性开角型青光眼(POAG)患者视盘旁视网膜劈裂(PPRS)的特点,对其进行分型,并探讨不同类型PPRS的危险因素。方法:系列病例研究。连续收集2021年5月至2022年12月于北京大学第三医院眼科中心青光眼门诊就诊的POAG患者101例。对受检者进行完整的眼科检查,包括最佳矫正视力、等效球镜度、眼压、眼轴长度(AL)、眼底照相、视野及SD-OCT等检查。通过SD-OCT围绕Bruch膜开口(BMO)中心的放射状扫描图像判断是否存在PPRS,根据PPRS起源位置与BMO位置关系分为BMO外PPRS与BMO内PPRS 2个亚组,并观察是否存在玻璃体牵拉及筛板缺损。统计分析PPRS的检出率。采用独立样本t检验、单因素方差分析、Kruskal-Wallis秩和检验、Pearson卡方检验对数据进行分析,采用广义估计方程模型评估PPRS的潜在危险因素。结果:最终纳入POAG患者84例(155眼),检出PPRS 32例(44眼),检出率按眼计算为28.4%,其中BMO外PPRS 19眼(12.3%),BMO内PPRS 24眼(15.5%)。多因素广义估计方程分析发现,AL(OR=1.46,P=0.008)、玻璃体牵拉(OR=2.69,P=0.034)、筛板缺损(OR=9.75,P<0.001)是PPRS发生的独立危险因素。进一步分析发现玻璃体牵拉是发生BMO外PPRS的独立危险因素(OR=2.88,P=0.004),筛板缺损是发生BMO内PPRS的独立危险因素(OR=25.91,P<0.001)。结论:POAG患者PPRS的发生主要与AL、玻璃体牵拉及筛板缺损有关。不同OCT分型的PPRS危险因素不同,玻璃体牵拉容易造成BMO以外的PPRS,筛板缺损容易造成BMO以内的PPRS。

Objective:To observe the prevalence of peripapillary retinoschisis(PPRS)in patients with primary open-angle glaucoma(POAG)by spectral domain optical coherence tomography(SD-OCT),classify PPRS according to the characteristics on OCT images,and explore the risk factors for different types of PPRS.Methods:A case series study was conducted.One hundred and one POAG patients who visited the glaucoma clinic of Peking University Third Hospital Eye Center from May 2021 to December 2022 were consecutively collected.The subjects underwent a complete ophthalmic examination,including best-corrected visual acuity,spherical equivalent,intraocular pressure,axial length,fundus photography,visual field,and SD-OCT examination.The presence of PPRS was determined by SD-OCT radial scanning around the center of Bruch's membrane opening(BMO),and was divided into two subgroups(PPRS outside BMO and PPRS inside BMO)according to the relationship between the origin position of PPRS and the position of BMO.Meanwhile,the presence of vitreous traction and lamina cribrosa defect on scanning images were observed.The prevalence of PPRS was calculated,independent sample t-test and one-way analysis of variance,Kruskal-Wallis rank sum test,and Pearson Chi-square test was used to analyze data.The generalized estimation equation model was used to evaluate the potential risk factors of PPRS in multi-factor analysis.Results:A total of 84 cases(155 eyes)of POAG patients were included in this study.PPRS occurred in 32 cases(44 eyes),with a prevalence of 28.4%,including 19 PPRS outside BMO(12.3%)and 24 PPRS inside BMO(15.5%).Generalized estimating equation analysis showed that axial length(OR=1.46,P=0.008),vitreous traction(OR=2.69,P=0.034),and lamina cribrosa defect(OR=9.75,P<0.001)were independent risk factors for PPRS occurrence.While vitreous traction(OR=2.88,P=0.004)was an independent risk factor for the occurrence of PPRS outside BMO and lamina cribrosa defect(OR=25.91,P<0.001)was an independent risk factor for the occurrence of PPRS inside BMO.Conclusions:The occurrence of PPRS in POAG patients is mainly related to axial length,vitreous traction,and lamina cribrosa defect.Different risk factors are associated with PPRS in different subtypes,vitreous traction is more likely to cause PPRS outside BMO and lamina cribrosa defect is more likely to cause PPRS inside BMO.