中华眼底病杂志

中华眼底病杂志

非动脉炎性前部缺血性视神经病变光相干断层扫描血管成像特征及其与视野的相关性分析

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目的观察非动脉炎性前部缺血性视神经病变(NAION)患眼光相干断层扫描血管成像(OCTA)影像特征,初步探讨其与视野的相关性。方法病程<3个月的单眼NAION患者12例和同期健康志愿者12名12只眼纳入研究。将患者的患眼、对侧眼分别设为A、B组,均为12例12只眼;健康志愿者设为C组。所有受检者均行最佳矫正视力(BCVA)、眼压、间接检眼镜检查和电脑验光、OCTA检查;NAION患者行视野检查。BCVA统计时换算为最小分辨角对数(logMAR)视力。A、B组受检眼logMAR BCVA、视野平均缺损(MD)和模式标准偏差(PSD)比较,差异有统计学意义(t=3.278、−4.909、4.130,P<0.050);等效球镜度数、眼压、视盘周围神经纤维层(pRNFL)厚度比较,差异无统计学意义(t=0.000、0.890、1.215,P>0.050)。采用OCTA测量受检眼视盘血流面积(FA)、视盘周围放射状毛细血管网FA(RCFA)以及黄斑区浅层、深层FA,无灌注区面积(NFA)、黄斑中心凹旁血流密度(PVD)和血管指数(PVI)。采用Pearson相关性分析视盘FA、视盘周围RCFA与视野、BCVA、pRNFL的相关性。结果OCTA检测结果显示,A、B、C组受检眼视盘FA、视盘周围RCFA比较,差异有统计学意义(F=4.162、3.357,P<0.050)。与B组受检眼比较,A组患眼视盘FA、视盘周围RCFA明显减少,差异有统计学意义(t=−5.822、−7.467,P<0.001);与C组受检眼比较,A组患眼视盘FA、视盘周围RCFA亦明显减少,差异有统计学意义(t=9.435、4.615,P<0.050);部分患眼可见视盘FA象限性减少;B、C组受检眼视盘FA、视盘周围RCFA比较,差异无统计学意义(F=0.004、0.030,P>0.050)。3组受检眼之间黄斑区浅层、深层FA以及NFA、PVD和PVI比较,差异均无统计学意义(F=0.488、1.107、0.493、1.086、1.098、0.093、1.093、1.221,P>0.050)。相关性分析结果显示,视盘FA、视盘周围RCFA与MD呈正相关(r=0.542、0.585,P<0.050),与PSD无相关(r=−0.404、−0.430,P>0.050);与BCVA呈负相关(r=−0.617、−0.596,P<0.050)。视盘FA与pRNFL呈负相关(r=−0.634,P<0.050);视盘周围RCFA与pRNFL无明确相关(r=−0.377,P>0.050)。结论病程<3个月的NAION患眼视盘FA减少,黄斑区血流指标无明显变化;视盘FA与视野缺损呈明显相关。

ObjectiveTo observe the blood perfusion of optic nerve and macular areas and investigate its relationship with visual field defect in nonarteritic anterior ischemic optic neuropathy (NAION).MethodsTwelve consecutive unilateral NAION patients (course of disease <3 months) and 12 healthy Chinese adults were enrolled in the study. The affected eyes and fellow eyes from 12 NAION patients were defined as group A and group B; 12 eyes from 12 healthy adults were defined as group C. Best corrected visual acuity (BCVA), intraocular pressure (IOP), indirect ophthalmoscope and computer optometry were performed on all of the three groups of patients. Visual field (VF) and optical coherence tomography (OCT) were performed on NAION patients. Logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity. Compared to group B, logMAR BCVA, mean deviation (MD) and pattern standard deviation (PSD) in group A were significant decreased (t=3.278, −4.909, 4.130, P<0.05). There was no significant difference in spherical equivalent, IOP, peripapillary retinal nerve fibre layer (pRNFL) between group A and group B (t=0.000, 0.890, 1.215; P>0.05). OCT angiography (OCTA) was used to measure the flow area (FA) at optic disc, flow area at radial peripapillary capillaries (RCFA) and FA, non-perfusion area (NFA), parafoveal vessel density (PVD) and parafoveal vascular index (PVI) in macular area. Pearson correlations between the deficiency of optic blood flow and visual field were analyzed.ResultsThe differences of FA at optic disc and peripapillary RCFA among 3 groups were significant (F=4.162, 3.357; P<0.050). Compared to group B (t=−5.822, −7.467; P<0.001) and C (t=9.435, 4.615, P<0.05), FA at optic disc and peripapillary RCFA in group A was significantly reduced. There is several NAION showed quadrantal FA decreased in optic nerve. However, there was no significant difference in optic disc FA and peripapillar RCFA between group B and C (F=0.004, 0.030; P>0.050). There was no differences of FA, NFA, PVD and PVI among 3 groups (F=0.488, 1.107, 0.493, 1.086, 1.098, 0.093, 1.093, 1.221; P>0.05). Positive correlation between optic disc FA, peripapillary RCFA and MD (r=0.542, 0.585; P<0.05) were observed. However, there was no significant correlation between optic disc FA, peripapillary RCFA and PSD (r=−0.404, −0.430; P>0.05), and negatively correlated to BCVA (r=−0.617, −0.596; P<0.05). PRNFL was negatively correlated to optic disc FA (r=−0.643, P<0.05), but not correlated to peripapillary RCFA (r=−0.377, P>0.05).ConclusionsThe optic disc blood flow reduced in affected eyes of unilateral NAION whose disease course was less than 3 months, while the macular perfusion was normal. There was a positive correlation between optic disc flow and visual field.

关键词: 视神经病变,缺血性; 局部血流; 视野; 体层摄影术,光学相干

Key words: Optic neuropathy, ischemic; Regional blood flow; Visual fields; Tomography, optical coherence

引用本文: 杨沫, 王伟, 魏世辉, 徐全刚. 非动脉炎性前部缺血性视神经病变光相干断层扫描血管成像特征及其与视野的相关性分析. 中华眼底病杂志, 2017, 33(5): 453-457. doi: 10.3760/cma.j.issn.1005-1015.2017.05.004 复制

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