应用光学相干断层扫描血流成像技术分析青光眼的微循环变化
Analysis of Microcirculation Changes in the Macular Area and Optic Disc of Primary Open-Angle Glaucoma Using Optical Coherence Tomograph Angiography

目的：应用光学相干断层扫描血流成像(optical coherence tomography angiography, OCTA)技术定性定量分析原发性开角型青光眼(primary open angle glaucoma, POAG)黄斑区及视盘旁的微循环变化特点，探讨各期开角型青光眼患者黄斑区与视盘旁的微循环变化与视网膜结构损伤与视野损害的关系。方法：选取2018.04~2019.04就诊于深圳爱尔眼科医院确诊为POAG且眼压控制稳定的患者41人(共77眼，其中早期35眼、进展期25眼、晚期17眼)为观察组，选择年龄、性别配对的正常人群23例(43眼)为对照组。应用OCTA技术分别测量黄斑区各象限以及视盘旁平均毛细血管密度，分析其黄斑区及视盘旁微循环变化；同时应用OCT分别测量黄斑区节细胞复合体(retinal ganglion cells, GCC)和视盘旁视网膜神经纤维层(retinal nerve fiber layer, RNFL)平均厚度，并研究各参数与视野MD值的相关性。结果：POAG患者存在眼底微循环异常，黄斑区及视盘旁毛细血管密度低于正常眼，而且随着病情进展，黄斑区(全周、上方、下方)及视盘(全周、上方、下方)毛细血管密度明显减少，且与患眼RNFL和视野的损害有较好的相关性。结论：随着青光眼的进展，视盘及黄斑区的上方与下方微血管微循环容易出现异常而表现相应微血管密度降低。青光眼的严重程度与血管密度有一定关联。
Objective: Qualitatively and quantitatively analyze the characteristics of microcirculation changes in the macular area and the optic disc of primary open angle glaucoma (POAG) using optical coherence tomography angiography (OCTA). To investigate the relationship between the microcirculation changes and the structural damage in the macular area and the optic and visual field damage in patients with POAG at various stages. Methods: The subjects selected from 2018-04 to 2019-04 who were treated at Shenzhen Aier Eye Hospital. 41 patients (77 eyes; in which, 35 eyes with mild glaucoma, 25 eyes with moderated glaucoma and 17 eyes with advanced glaucoma) with POAG and stable intraocular pressure control were enrolled in the observation group. 23 subjects (43 eyes) with matched age and gender were selected as normal group. OCTA technique was used to measure the macular area and the optic disc. The average capillary density of each quadrant was qualitatively and quantitatively analyzed for the characteristics of the macular area and the microcirculation of the optic disc. Cirrus OCT was also used to measure the macular ganglion cell complex (GCC) and the retinal nerve fiber layer (RNFL), Humphrey-HFA3 (24-II) was used to test the visual field of each patient, and the correlation between OCTA parameters and visual field were also analyzed. Results: Abnormal fundus microcirculation was found in the patients with POAG. Capillary density in the macular area and optic disc zone was lower than the normal eyes. With the progression of glaucoma, the capillary density of macular area (total area, upper and lower quadrant) and the optic disc zone (full circumference, upper, lower) decreased. The capillary density correlated with the RNFL thickness and MD value of visual field (p < 0.05). Conclusions: As glaucoma progresses, the vascular microcirculation showed abnormalities. The microvessel density reduced in the area of macular area and optic disc