非动脉炎性前部缺血性视神经病变视盘及黄斑血流灌注变化的观察

摘要

目的 观察非动脉炎性前部缺血性视神经病变(NAION)患者视盘及黄斑区结构损伤与血流灌注的变化特点.方法 回顾性队列研究.2017年11月至2019年1月于武汉大学人民医院眼科中心确诊的NAION患者19例36只眼纳入研究.其中,男性10例,女性9例;平均年龄(55.05±7.11)岁.将患者的患眼、对侧眼分别设为患眼组、对侧眼组,分别为19、17只眼.选取年龄、性别匹配的正常人20名40只眼作为正常对照组.所有受检者均行BCVA、频域OCT及OCT血管成像(OCTA)检查.频域OCT测量视盘周围平均、上半侧(s)、下半侧(i) RNFL厚度,黄斑区平均神经节细胞复合体(GCC)、sGCC、iGCC厚度;OCTA测量视盘放射状毛细血管平均血流密度(RPC)、sRPC、iRPC,黄斑区平均浅层视网膜血流密度(SVD)、sSVD、iSVD,平均深层视网膜血流密度(DVD),黄斑中心凹无血管区面积(FAZ).患者均于初次就诊后1～2周,1～2、3～5个月再次行BCVA、眼底彩色照相、OCT及OCTA检查.对比观察患眼组与对侧眼组、正常对照组之间RNFL、GCC、RPC、SVD、DVD的变化.三组间比较行独立样本t检验、配对样本t检验或两独立样本非参数秩和检验.RNFL与RPC、GCC与SVD、RNFL与GCC、RPC与SVD的相关性行Pearson或Spearman相关性分析.结果 基线时,与正常对照组比较,患眼组平均RNFL显著增厚,平均RPC、DVD显著降低;与对侧眼组比较,平均RNFL显著增厚,平均RPC显著降低.首次就诊后1～2周,1～2、3～5个月,患眼组平均RNFL、RPC、GCC、SVD比较,差异均有统计学意义(P＜0.05).1～2个月,平均sRNFL、sRPC、sGCC、sSVD均显著低于平均iRNFL、iRPC、iGCC、iSVD (P＜0.05).相关性分析结果显示,1～2个月时,平均GCC厚度与平均SVD呈正相关(r=0.482,P=0.037);3～5个月时,平均RNFL厚度与平均RPC呈正相关(r=0.631,P=0.037).结论 NAION患眼视盘RPC及黄斑SVD随病程进展呈象限性降低.%Objective To observe the blood perfusion changes ofperipapillary and macular vessels in patients with nonarteritic anterior ischaemic optic neuropathy (NAION).Methods Retrospective cohort study.Thirty-six eyes (19 affected eyes and 17 fellow eyes) of 19 patients with NAION diagnosed in People's Hospital of Wuhan University from November 2017 to January 2019 were included in this study.There were 1 0 males and 9 females,with the mean age of 55.05 ± 7.11 years.Forty eyes of 20 normal subjects matched with NAION patients were included as controls.BCVA,fundus color photography,SD-OCT and OCT angiography were performed in normal controls and repeated in NAION affected eyes at 1-2 weeks,1-2 months,3-5 months intervals.OCT quantitative measurements:average retinal nerve fiber layer thickness (aRNFL) of the disc and its superior values (sRNFL) and the inferior values (iRNFL),average ganglion cell complex thickness (aGCC) in macular region and its superior values (sGCC) and the inferior values (iGCC).OCTA quantitative measurements:average radial peripapillary capillary density (aRPC) and its superior values (sRPC) and the inferior values (iRPC),average vascular density of superficial retina (aSVD) in macular region and its superior values (sSVD) and the inferior values (iSVD),average vascular density of deep layer retina (aDVD),areas of foveal avascular zone (FAZ).The differences of OCT and OCTA quantitative measurements between NAION eyes and the fellow eyes and normal controls were comparatively analyzed.Independent sample t test,paired sample t test or nonparametric rank sum test were performed for comparison among three groups.Pearson or Spearman correlation analysis were used to analyze the correlation between RNFL and RPC,GCC and SVD,RNFL and GCC,RPC and SVD.Results At baseline,the aRNFL,aRPC and aDVD of NAION patients were significantly higher than those of normal controls.Compared with the fellow eyes,the aRNFL increased significantly and the aRPC decreased significantly in NAION affected eyes.The overall differences of aRNFL,aRPC,aGCC and aSVD at four intervals within NAION affected eyes were statistically significant (P＜0.05).The average sRNFL,sRPC,sGCC and sSVD at 1-2 months interval were significantly lower than the average iRNFL,iRPC,iGCC and iSVD (P＜0.05).Correlation analysis:at 1-2 months interval,aGCC was positively correlated with aSVD (r=0.482,P=0.037);at 3-5 months interval,aRNFL was positively correlated with aRPC (r=0.631,P=0.037).Conclusion There is a sectorial reduction of vascular density of peripapillary RPC and macular SVD with the disease progression of NAION.