OCTA在区分高度近视合并早期青光眼和生理性大视杯中的应用

doi:10.3760/cma.j.cn115909-20200420-00164

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摘要目的：利用光学相干断层扫描血管成像技术（OCTA）比较高度近视合并早期原发性开角型青光眼（POAG）和生理性大视杯（LPC）的视盘、黄斑血管密度差异，探讨OCTA在区分高度近视合并早期POAG眼和高度近视合并LPC中的作用。方法：病例对照研究。收集2019年1─12月在长沙爱尔眼科医院青光眼专科及屈光专科就诊的高度近视合并早期POAG或LPC患者25例（42眼），其中22只高度近视合并LPC为LPC组；20只高度近视合并早期POAG为POAG组。另随机选取本院年龄相匹配的16只非高度近视健康眼为对照组。采用美国光视OCTA扫描视网膜黄斑区、视盘及视盘旁区，得到血管密度及平均视网膜神经纤维层（RNFL）厚度等参数。运用单因素方差分析比较各组间视盘及视盘旁、黄斑区血管密度，视盘各方向平均RNFL的差异；使用ROC曲线分析各参数的诊断效能。结果：对照组的上方颞侧、下方鼻侧区域RNFL厚度值高于LPC组（均P<0.05），LPC组的上方颞侧、上方鼻侧、下方颞侧、颞侧下方区域RNFL厚度值及平均RNFL值均高于POAG组（均P<0.05）。LPC组视盘及视盘旁全像全部血管密度、全像毛细血管密度、视盘旁全部血管密度、视盘旁毛细血管密度值均高于POAG组（均P<0.05）；对照组黄斑深层的全像血管密度、旁中心凹血管密度、中心凹周边区域血管密度、中心凹周边区域鼻侧血管密度平均值高于LPC组（均P<0.05），LPC组大部分黄斑浅层分区毛细血管密度值均高于POAG组（均P<0.05）。POAG组与LPC组间诊断效能比较发现：视盘内及视盘旁血管密度AUC为视盘旁毛细血管密度最高（0.90，95%CI：0.80～0.99）；黄斑处浅层毛细血管密度AUC平均值（0.74±0.65）比黄斑处深层毛细血管密度AUC平均值（0.61±0.37）高，差异有统计学意义（F=8.32，P<0.001）。结论：OCTA参数可以用于高度近视合并POAG的早期诊断及其与高度近视合并LPC的鉴别诊断。

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关键词 ： , 青光眼, 高度近视, 杯盘比, 视网膜神经纤维层厚度, 光学相干断层扫描血管成像技术

Abstract： Objective: To evaluate the ability of optical coherence tomography angiography (OCTA) for detecting large physiological disc cupping (LPC) from primary open-angle glaucoma (POAG) in highly myopic eyes. Methods: In this case control study, 20 highly myopic eyes with mild primary open-angle glaucoma, 22 highly myopic eyes with large disc cupping and 16 normal, non-highly myopic eyes were included. All of the patients were recruited from Changsha Aier Eye Hospital in 2019. Vessel density (VD) and retinal nerve fiber layer (RNFL) parameters were measured by OCTA. A one-way analysis of variance and Pearson coefficients were used. The areas under the receiver operating characteristic curve (AUC) were calculated. Results: The control group compared with the LPC group as follows: The RNFL thickness of the SN and IN regions was greater than that in the LPC group (all P<0.05); the VD in the deep macular layer of the entire image, including the parafovea, perifovea, and peri-N regions, were greater than that in the LPC group (all P<0.05). The LPC group compared with the POAG group as follows: The RNFL thickness of the ST, SN, IT and TI regions and the average RNFL thickness were greater than that in the POAG group (all P<0.05), the disc and peripapillary VD of the entire image, including the capillary, the entire peripapillary, and peripapillary-capillary regions, were higher than that in the POAG group (all P<0.05); the VDs of the most superficial macular regions were higher than that in the POAG group (all P<0.05). The diagnostic efficacy of the parameters between the POAG and LPC groups showed the following: The highest AUC of the disc and peripapillary disc VD was in the peripapillary-capillary region (0.90, 95%CI: 0.80, 0.99); the AUC (0.74±0.65) of the superficial capillary density in the macular area was higher than that in the AUC (0.61±0.37) of the macular deep capillary density, and the difference was statistically significant (F=8.32, P<0.001). Conclusions: OCTA parameters can be used for early diagnosis of the differences between POAG and LPC in highly myopic eyes.

Key words： glaucoma myopia cup disc ratio retinal nervous fiber layer optical coherence tomography angiography

收稿日期: 2020-04-20

PACS:

基金资助: 国家自然科学基金面上项目（81670859，81970801）；湖南省自然科学基金（2019JJ40001）；长沙市科技局重点研发项目（kh1801229）；爱尔眼科医院集团科研基金研究所立项项目（AR1906D1，AM1906D2）

通讯作者: 段宣初（ORCID：0000-0003-1101-0602），Email：duanxchu@126.com

引用本文:

欧阳君怡1，2 聂芬3 周丹2 刘艳红2 郭殷杰3 周灯明3 段宣初1，2. OCTA在区分高度近视合并早期青光眼和生理性大视杯中的应用[J]. 中华眼视光学与视觉科学杂志, 2021, 23(2): 89-97. Junyi Ouyang1, 2, Fen Nie3,Dan Zhou2,Yanhong Liu2,Yinjie Guo3,Dengming Zhou3,Xuanchu Duan1, 2. Differentiating Glaucoma from Physiological Optic Disc Cupping with Optical Coherence Tomography Angiography. Chinese Journal of Optometry Ophthalmology and Visual science, 2021, 23(2): 89-97. DOI: 10.3760/cma.j.cn115909-20200420-00164

链接本文:

https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20200420-00164 或 https://www.cjoovs.com/CN/Y2021/V23/I2/89

[1]	Ma F, Dai J, Sun X. Progress in understanding the association between high myopia and primary open-angle glaucoma. Clin Exp Ophthalmol, 2014, 42(2): 190-197. DOI: 10.1111/ ceo.12158.
[2]	Ramakrishnan R, Nirmalan PK, Krishnadas R, et al. Glaucoma in a rural population of southern India: The Aravind comprehensive eye survey. Ophthalmology, 2003, 110(8): 1484- 1490. DOI: 10.1016/S0161-6420(03)00564-5.
[3]	周文炳．临床青光眼． 2 版．北京: 北京人民卫生出版社, 2000: 99．
[4]	Prata TS, Dorairaj S, Trancoso L, et al. Eyes with large disc cupping and normal intraocular pressure: Using optical coherence tomography to discriminate those with and without glaucoma. Med Hypothesis Discov Innov Ophthalmol, 2014, 3(3): 91-98.
[5]	Huang D, Jia Y, Gao SS, et al. Optical coherence tomography angiography using the optovue device. Dev Ophthalmol, 2016, 56: 6-12. DOI: 10.1159/000442770.
[6]	Rolle T, Dallorto L, Tavassoli M, et al. Diagnostic ability and discriminant values of OCT-angiography parameters in early glaucoma diagnosis. Ophthalmic Res, 2019, 61(3): 143-152. DOI: 10.1159/000489457.
[7]	Poli M, Cornut PL, Nguyen AM, et al. Accuracy of peripapillary versus macular vessel density in diagnosis of early to advanced primary open angle glaucoma. J Fr Ophtalmol, 2018, 41(7): 619-629. DOI: 10.1016/j.jfo.2018.02.004.
[8]	Chung JK, Hwang YH, Wi JM, et al. Glaucoma diagnostic ability of the optical coherence tomography angiography vessel density parameters. Curr Eye Res, 2017, 42(11): 1458-1467. DOI: 10.1080/02713683.2017.1337157.
[9]	Kwon HJ, Kwon J, Sung KR. Additive role of optical coherence tomography angiography vessel density measurements in glaucoma diagnoses. Korean J Ophthalmol, 2019, 33(4): 315- 325. DOI: 10.3341/kjo.2019.0016 .
[10]	Lee K, Maeng KJ, Kim JY, et al. Diagnostic ability of vessel density measured by spectral-domain optical coherence tomography angiography for glaucoma in patients with high myopia. Sci Rep, 2020, 10(1): 3027. DOI: 10.1038/s41598-020- 60051-0.
[11]	中华医学会眼科学分会青光眼学组.我国原发性青光眼诊断和治疗专家共识（2014年).中华眼科杂志, 2014, 50(5): 382- 383. DOI: 10.3760/cma.j.issn.0412-4081.2014.05.022
[12]	Xu L, Wang Y, Wang S, et al. High myopia and glaucoma susceptibility: The Beijing Eye Study. Ophthalmology, 2007, 114(2): 216-220. DOI: 10.1038/ng.3078.
[13]	Chon B, Qiu M, Lin SC. Myopia and glaucoma in the South Korean population. Invest Ophthamol Vis Sci，2013, 54(10): 6570-6577. DOI: 10.1038/ng.3078.
[14]	Akil H, Huang AS, Francis BA, et al. Retinal vessel density from optical coherence tomography angiography to differentiate early glaucoma, pre-perimetric glaucoma and normal eyes. PLoS One, 2017, 12(2): e0170476. DOI: 10.1371/journal. pone.0170476.
[15]	Lee EJ, Lee KM, Lee SH, et al. OCT angiography of the peripapillary retina in primary open-angle glaucoma.Invest Ophthalmol Vis Sci, 2016, 57(14): 6265-6270. DOI: 10.1167/ iovs.16-20287.
[16]	Yarmohammadi A, Zangwill LM, Diniz-Filho A, et al. Optical coherence tomography angiography vessel density in healthy, glaucoma suspect, and glaucoma eyes. Invest Ophthalmol Vis Sci, 2016, 57: 451-459. DOI: 10.1167/iovs.15-18944.
[17]	Bekkers A, Borren N, Ederveen V, et al. Microvascular damage assessed by optical coherence tomography angiography for glaucoma diagnosis: A systematic review of the most discriminative regions. Acta Ophthalmol, 2020, 98(6): 537-558. DOI: 10.1111/aos.14392.
[18]	Sampson DM, Gong P, An D, et al. Axial length variation impacts on superfificial retinal vessel density and foveal avascular zone area measurements using optical coherence tomography angiography. Invest Ophthalmol Vis Sci, 2017, 58(7): 3065-3072. DOI: 10.1167/iovs.17-21551.
[19]	Xu H, Yu J, Kong X, et al. Macular microvasculature alterations in patients with primary open-angle glaucoma: A cross-sectional study. Medicine (Baltimore), 2016, 95(33): e4341. DOI: 10.1097/MD.0000000000004341.
[20]	王宁利. 中国青光眼临床诊断手册. 科学技术文献出版社, 2019: 185-187.
[21]	Akashi A, Kanamori A, Ueda K, et al. The ability of SDOCT to differentiate early glaucoma with high myopia from highly myopic controls and nonhighly myopic controls. Invest Ophthalmol Vis Sci, 2015, 56(11): 6573-6580. DOI: 10.1167/ iovs.15-17635.
[22]	Alonzo TA, Pepe MS. Distribution-free ROC analysis using binary regression techniques. Biostatistics, 2002, 3(3): 421-432. DOI: 10.1093/biostatistics/3.3.421.
[23]	Holló G. Intrasession and between-visit variability of sector peripapillary angioflow vessel density values measured with the angiovue optical coherence tomograph in different retinal layers in ocular hypertension and glaucoma. PLoS One, 2016, 11(8): e0161631. DOI: 10.1371/journal.pone.0161631.
[24]	Lee EJ, Kim S, Hwang S, et al. Microvascular compromise develops following nerve fiber layer damage in normal-tension glaucoma without choroidal vasculature involvement. Glaucoma, 2017, 26(3): 216-222. DOI: 10.1097/IJG.0000000000000587.