合并白内障的原发性急性闭角型青光眼患者手术前后黄斑区微血管的变化:基于OCTA的研究  

Changes of microvasculature in the macular area before and after the surgery of acute primary angle-closure glaucoma complicated by cataract:an optical coherence tomography angiography-based study

作　　者：陈静 胡利[1] 王观峰[1] 王双勇 CHEN Jing;HU Li;WANG Guanfeng;WANG Shuangyong(Department of Ophthalmology,the Third Affiliated Hospital of Guangzhou Medical University&Guangdong Provincial Key Laboratory of Major Obstetric Diseases&Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology,Guangzhou 510150,Guangdong Province,China)

机构地区：[1]广州医科大学附属第三医院眼科,广东省产科重大疾病重点实验室,广东省妇产疾病临床医学研究中心,广东省广州市510150

出　　处：《眼科新进展》2024年第12期967-971,共5页Recent Advances in Ophthalmology

基　　金：国家自然科学基金项目(编号:81870631);广东省自然科学基金项目(编号:2023A1515012571);广州市科技基础研究计划项目(编号:2023A03J0385)。

摘　　要：目的利用光学相干断层扫描血管成像(OCTA)探讨合并白内障的原发性急性闭角型青光眼(APACG)患者手术前后黄斑区微血管的变化。方法本研究为回顾性研究。选取2023月5月至11月我院收治的合并双眼年龄相关性白内障的23例(46眼)APACG患者(一眼处于急性发作期,另一眼处于临床前期)为研究对象;将处于急性发作期的23眼作为观察组,对侧处于临床前期的23眼作为对照组。观察组患眼眼压控制良好后行晶状体超声乳化摘除联合人工晶状体植入和房角分离术;观察组手术2周后对照组患眼行晶状体超声乳化摘除联合人工晶状体植入术。OCTA检测两组患眼手术前后黄斑中心凹无血管区(FAZ)相关参数、黄斑中心凹旁和中心凹周边视网膜内层血管密度、黄斑中心凹脉络膜毛细血管灌注面积,并进行统计学分析。结果术前观察组患眼裸眼视力低于对照组,眼压高于对照组,差异均有统计学意义(均为P<0.01)。两组患眼术后1周、1个月、3个月裸眼视力均高于术前,眼压均低于术前,差异均有统计学意义(均为P<0.05)。术前观察组患眼FAZ面积、周长均大于对照组,圆度指数小于对照组,差异均有统计学意义(均为P<0.05)。术后1周观察组患眼FAZ周长大于对照组,圆度指数小于对照组,差异均有统计学意义(均为P<0.05);两组患眼术后FAZ面积、周长有下降趋势,FAZ圆度指数有升高趋势;术后3个月两组患眼FAZ面积、周长均小于术前,圆度指数均大于术前,差异均有统计学意义(均为P<0.01)。术前及术后不同时间观察组患眼黄斑中心凹旁、黄斑中心凹周边视网膜内层血管密度均低于对照组,差异均有统计学意义(均为P<0.05)。术前及术后不同时间观察组患眼黄斑中心凹脉络膜毛细血管灌注面积均低于对照组,差异均有统计学意义(均为P<0.01)。术后两组患眼黄斑中心凹脉络膜毛细血管灌注面积相对于术前均有所Objective To explore the changes of microvasculature in the macular area before and after the surgery of acute primary angle-closure glaucoma(APACG)complicated by cataract by using optical coherence tomography angiography(OCTA).Methods In this retrospective study,23 patients(46 eyes)with APACG(one eye in acute attack and the other eye in preclinical stage)complicated by age-related cataract in both eyes admitted to our hospital from May to November 2023 were selected as the research subjects.The 23 eyes in the acute attack were taken as the observation group,and the 23 contralateral eyes in the preclinical stage were taken as the control group.After the intraocular pressure was stabilized,eyes in the observation group underwent phacoemulsification with intraocular lens implantation and goniosynechialysis;two weeks later,eyes in the control group underwent phacoemulsification with intraocular lens implantation.The parameters of the foveal avascular zone(FAZ),parafoveal and perifoveal retinal vessel density,and foveal choroidal capillary perfusion area were examined by OCTA before and after surgery.The results were analyzed statistically.Results Before the surgery,the uncorrected visual acuity in the observation group was lower than that in the control group,and the intraocular pressure was higher than that in the control group(both P<0.01).At 1 week,1 month and 3 months after surgery,the uncorrected visual acuity was higher and the intraocular pressure was lower than that before surgery in the two groups(all P<0.05).The FAZ area and perimeter in the observation group were bigger,but the FAZ circularity index was smaller than that in the control group before the surgery(all P<0.05).At 1 week after the surgery,the FAZ perimeter in the observation group was bigger,and the FAZ circularity index in the observation group was smaller than that in the control group(both P<0.05).After the surgery,the FAZ area and perimeter of affected eyes in both groups showed a downward trend,while the FAZ circularity index showed an upw

关 键 词：原发性急性闭角型青光眼 超声乳化 房角分离 光学相干断层扫描血管成像 黄斑 血管密度 中心凹无血管区 

分 类 号：R776.1[医药卫生—眼科]