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  

Differentiating Glaucoma from Physiological Optic Disc Cupping with Optical Coherence Tomography Angiography

作　　者：欧阳君怡 聂芬 周丹[2] 刘艳红 郭殷杰 周灯明 段宣初 Junyi Ouyang;Fen Nie;Dan Zhou;Yanhong Liu;Yinjie Guo;Dengming Zhou;Xuanchu Duan(Aier School of Ophthalmology,Central South University,Changsha 410015,China;Aier Glaucoma Research Institute,Changsha Aier Eye Hospital,Changsha 410015,China;Department of Ophthalmology,the Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学爱尔眼科学院,长沙410015 [2]长沙爱尔眼科医院,爱尔青光眼研究所410015 [3]中南大学湘雅二医院眼科,长沙410011

出　　处：《中华眼视光学与视觉科学杂志》2021年第2期89-97,共9页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：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)。

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。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.

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 

分 类 号：R778.11[医药卫生—眼科] R775[医药卫生—临床医学]