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光相干断层扫描血管成像对青光眼视网膜微循环的评估
陈旭豪
洪颖 [综述]
张纯 [综述]
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20190926-00417
Assessment of retinal microcirculation alterations in glaucoma by optical coherence tomography angiography
Chen Xuhao
Hong Ying
Zhang Chun
Authors Info & Affiliations
Chen Xuhao
Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
Hong Ying
Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
Zhang Chun
Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
·
DOI： 10.3760/cma.j.cn115989-20190926-00417
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摘要

视网膜的微循环改变与青光眼密切相关。光相干断层扫描血管成像(OCTA)是一种无创检查，可同时提供视网膜以及其血管信息，对视网膜各层微循环的检测效果良好，近年被运用到青光眼的研究和监测中。放射状盘周毛细血管(RPC)密度与视网膜神经纤维层厚度呈正相关，因而在青光眼评估中尤为重要。OCTA对视网膜微循环改变的评估主要在视盘旁区和黄斑区。青光眼患者视盘旁区全层和RPC血管密度显著下降，其与视网膜神经纤维层厚度变薄以及视野缺损均匹配，并与疾病严重程度相关；黄斑区则呈现血管密度下降，无血管区面积显著增大的趋势。对比不同类型和阶段的青光眼，晚期青光眼以及正常眼压性青光眼的OCTA改变更显著。OCTA结果可受到高度近视和眼压变化的影响，视盘旁区的OCTA改变对青光眼的诊断价值更高。总体来看，OCTA可以为青光眼视网膜微循环评估提供新的技术手段。本文从视网膜微循环的OCTA表现以及青光眼视网膜微循环的OCTA图像改变，包括青光眼视盘旁区微循环OCTA改变、黄斑区微循环OCTA改变、OCTA评估青光眼黄斑区与视盘旁区微循环的影响因素及诊断价值比较几个方面就OCTA对青光眼视网膜微循环的评估研究进展进行综述。

青光眼/诊断;视网膜;微循环;血管密度;光相干断层扫描
ABSTRACT

Microcirculation alterations of the human retina are of significant relevance with glaucoma.Optical coherence tomography angiography (OCTA) is a non-invasive examination that provides signals of the retina and retinal microcirculation.It is currently widely used in research and screening for glaucoma due to its effective detection of each layer in the retinal microcirculation.Vessel density of radial peripapillary capillary (RPC) is positively correlated with the retinal nerve fiber layer thickness, which is crucial in the assessment of glaucoma.Peripapillary region and macula are regions of interest in OCTA analysis for microcirculation.Vessel density of the whole retina and RPC in the peripapillary region decreases significantly, which matches the thinned retinal fiber layer thickness and visual field defects, and is relevant to the disease severity.As for the macular region, vessel density declines while the area of the foveal avascular zone increases.Greater changes in late-stage glaucoma and normal-tension glaucoma are detected by OCTA compared with other stages and types of glaucoma.OCTA imaging may be influenced by high myopia and intraocular pressure, and the peripapillary region is of greater diagnostic value than macula in microcirculation changes.In conclusion, OCTA can serve as a new technique for the assessment of retinal microcirculation in glaucoma.This review summarized the characteristics of retinal microcirculation in OCTA images and its change in peripapillary and macular region in glaucoma eyes.Influencing factors associated with peripapillary and macular microcirculation changes in OCTA images and evaluation of peripapillary and macular microcirculation in glaucoma by OCTA and their diagnostic values were reviewed.

Glaucoma/diagnosis;Retina;Microcirculation;Vessel density;Tomography, optical coherence
Zhang Chun, Email: mocdef.oabohay1cgnahz
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引用本文

陈旭豪,洪颖,张纯. 光相干断层扫描血管成像对青光眼视网膜微循环的评估[J]. 中华实验眼科杂志,2022,40(04)：371-377.

DOI:10.3760/cma.j.cn115989-20190926-00417

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青光眼是全球主要的不可逆性致盲眼病之一，据统计，2015年我国青光眼预计的总体患病率为2.58%，且预计2050年会达到3.48% [ 1 ]，而在世界范围内，40~80岁人群青光眼的患病率约为3.54% [ 2 ]，因此早期发现青光眼和对疾病进展进行监测显得尤为重要。目前，机械压迫学说是青光眼进展的主要学说，而血流因素作为主要的非压力依赖原因越来越被重视。全身或局部的血流改变均可能引起青光眼的损害 [ 3 ]，而新近研究逐渐聚焦于眼底的微循环病变。随着光相干断层扫描血管成像(optical coherence tomography angiography，OCTA)的引入，我们能对眼球壁各个层面的微循环进行更为清楚的检测和判断。OCTA以光相干断层扫描(optical coherence tomography，OCT)为基础，通过对组织内部物体运动产生的信号波动进行处理，进而对血管进行成像 [ 4 ]。作为一种非侵入性的操作，OCTA的适用人群更广，可对局部进行重复扫描，被用于评价视盘、视盘旁视网膜、黄斑和脉络膜等深部结构的微循环 [ 5 ]。采用OCTA对青光眼和健康人群视盘旁和黄斑区的视网膜血管密度进行评价，发现有显著差异 [ 6 , 7 , 8 , 9 , 10 ]，提示OCTA在青光眼微循环形态评价中具有重要价值。OCTA的结果与青光眼的类型及检查指标相关 [ 11 , 12 ]，本文将阐述视网膜的微循环，以OCTA为手段，从不同部位及形态对青光眼的视网膜微循环改变进行总结。
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张纯，Email： mocdef.oabohay1cgnahz
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