伴有高度近视的POAG视网膜神经纤维层与视盘血流动力学变化的关系  

Relationship Between Retinal Nerve Fiber Layer and Optic Disc Hemodynamic Changes in POAG with High Myopia

作　　者：傅亦恬 郝燕生 李海霞 FU Yitian;HAO Yansheng;LI Haixia(Xi´an Aier Eye Hospital,Xi´an 710075,China)

机构地区：[1]西安爱尔眼科医院,西安710075

出　　处：《中国中医眼科杂志》2025年第4期322-329,共8页China Journal of Chinese Ophthalmology

摘　　要：目的探讨伴有高度近视(HM)原发性开角型青光眼(POAG)视网膜神经纤维层与视盘血流动力学变化的关系。方法纳入2021年3月—2023年2月就诊于西安爱尔眼科医院的POAG患者87例(168只眼)根据患眼是否合并HM分为HM组38例(73只眼)和非HM组49例(95只眼)。所有患者均进行复合式小梁切除术治疗,分别于术前和术后6个月测量2组患者的最佳矫正视力(BVCA)、眼压、杯盘比(C/D)及黄斑中心凹无血管区(FAZ)面积。于术前、术后7 d,术后1、3、6个月测量2组患者的鼻上(SN)、上鼻(NS)、上颞(ST)、颞上(TS)、下颞(IT)、颞下(TI)、下鼻(IN)、鼻下(NI)的视盘周围血流密度(VD)及RNFL厚度,并分析视盘VD及RNFL厚度的相关性,观察其对患者预后的影响。结果(1)2组BCVA、眼压、C/D和FAZ比较:HM组术前BCVA和眼压均高于非HM组,差异均有统计学意义(t_(BCVA)=5.762、t_(眼压)=5.944,均P=0.000),术后6个月HM组BCVA和眼压仍高于非HM组,差异均有统计学意义(t_(BCVA)=3.960、t_(眼压)=6.799,均P=0.000);2组手术前后的C/D和FAZ比较,差异均无统计学意义(P>0.05)。(2)2组视盘VD及RNFL厚度比较:2组手术前后视盘VD及RNFL厚度比较,均具有时间差异性和组间差异性(P<0.05)。术前HM组各象限的视盘VD均低于非HM组、RNFL厚度均高于非HM组,差异均有统计学意义(P<0.05);术后1周2组TS、IN及NI视盘VD比较,差异无统计学意义(P>0.05),其余各时间点,HM组各象限的视盘VD均低于非HM组,差异均有统计学意义(P<0.05)。HM组术后1周各象限RNFL厚度均高于非HM组,术后1个月及3个月NS、ST象限和术后6个月各象限,HM组RNFL厚度均低于非HM组,差异均有统计学意义(P<0.05)。2组视盘VD均值在术后呈先升高后降低趋势;HM组术后RNFL厚度均值在术后呈先升高后降低趋势,非HM组术后RNFL厚度均值呈先下降后平稳趋势。(3)视盘VD及RNFL厚度的相关性分析:术后6个月各象限两者均呈显著正相关(r_(SN)=0.767、r_OBJECTIVE To explore the relationship between retinal nerve fiber layer(RNFL)and optic disc hemodynamic changes in primary open-angle glaucoma(POAG)with high myopia(HM).METHODS A total of 87 POAG patients(168 eyes)admitted to Xi'an Aier Eye Hospital from March 2021 to February 2023 were enrolled.Based on the presence of HM,the patients were divided into an HM group(38 cases,73 eyes)and a non-HM group(49 cases,95 eyes).All patients underwent combined trabeculectomy.Best-corrected visual acuity(BCVA),intraocular pressure(IOP),cup-to-disc ratio(C/D),peripapillary vessel density(VD),and macular foveal avascular zone(FAZ)area were measured preoperatively and six months postoperatively.Peripapillary RNFL thickness was compared between groups preoperatively and at seven days,one month,three months,and six months postoperatively.The correlation between optic disc VD and RNFL thickness and their impact on prognosis were analyzed.RESULTS(1)BCVA,IOP,C/D,and FAZ:Preoperative BCVA and IOP were significantly higher in the HM group than in the non-HM group(t_(BCVA)=5.762,t_(IOP)=5.944,both P=0.000).At six months postoperatively,BCVA and IOP remained higher in the HM group(t_(BCVA)=3.960,t_(IOP)=6.799,both P=0.000).No significant differences were observed in C/D and FAZ between groups pretoperatively or postoperatively(P>0.05).(2)Optic disc VD and RNFL thickness:The comparison of optic disc VD and RNFL thickness between the two groups before and after surgery revealed both temporal and intergroup differences(P<0.05).Preoperatively,the HM group exhibited significantly lower optic disc VD in all quadrants and higher RNFL thickness compared to the non-HM group(P<0.05).At one week postoperatively,no statistically significant differences were observed in the optic disc VD of the temporal-superior,inferior-nasal,and nasal-inferior quadrants between the two groups(P>0.05).However,at all other time points,the HM group showed significantly lower optic disc VD in all quadrants compared to the non-HM group(P<0.05).Regarding RNFL thickness,

关 键 词：高度近视 开角型青光眼 神经纤维层 视盘血流动力学变化 

分 类 号：R775[医药卫生—眼科]