Objective

We used OCT angiography (OCT-A) to investigate parapapillary choroidal microvasculature dropout (MvD) in glaucomatous eyes with or without disc hemorrhage (DH), and the association with changes in retinal nerve fiber layer (RNFL) thickness.

Design

An observational case-control study.

Participants

Eighty-two open-angle glaucoma (OAG) eyes with DH and 68 OAG eyes without DH that underwent at least 4 serial OCT examinations were included.

Methods

MvD was defined as complete loss of microvasculature within the choroidal layer of the parapapillary region, as revealed by standardized assessment of OCTA-derived density maps of the vessels of the optic nerve head. The circumferential extent of MvD was measured on OCT-A images. The RNFL thinning rate was calculated using a linear mixed model. Kaplan-Meier survival analysis and the log-rank test were used to compare the cumulative risk ratio of progression between groups stratified by DH and MvD.

Main Outcome Measures

MvD detection rate, the extent of MvD as measured by the MvD angle, and RNFL thinning rate.

Results

MvD was found in 38 (46.3%) eyes with DH at the prior DH site, which was found in only 20 (29.4%) eyes without DH, which was significantly different between the 2 groups (P = 0.025). Patients with progressive glaucoma exhibited significantly more MvD than the stable patients in both DH and no-DH groups. There were statistically significant differences between groups subdivided by the presence of DH and MvD as assessed by Kaplan-Meier analysis (log-rank test, P < 0.001). The angle of MvD was significantly greater in eyes with recurrent DH compared with eyes with single DH. Presence of DH, recurrent DH, and presence of MvD were factors associated with progressive RNFL thinning.

Conclusions

We found that MvD was frequent in progressive OAG eyes on the choroidal map of OCT-A, which was more frequently found at the prior DH locations in eyes with DH. This means that observing the presence of MvD using OCT-A may provide a biomarker for glaucoma progression, especially in eyes with DH.

中文翻译：

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伴有椎间盘出血的青光眼的脉络膜微脉管系统脱落与进行性视网膜神经纤维层变薄相关

客观的

我们使用OCT血管造影术（OCT-A）来研究青光眼有或无椎间盘出血（DH）的瞳孔旁脉络膜微脉管系统（MvD）脱落，以及其与视网膜神经纤维层（RNFL）厚度变化的关系。

设计

观察性病例对照研究。

参加者

包括至少进行了4次连续OCT检查的具有DH的八十二个开角型青光眼（OAG）眼和不具有DH的68个OAG眼。

方法

MvD被定义为乳头旁区域脉络膜层内微血管的完全丧失，这是通过对OCTA衍生的视神经乳头血管密度图的标准化评估所揭示的。在OCT-A图像上测量了MvD的圆周范围。使用线性混合模型计算RNFL稀化率。用Kaplan-Meier生存分析和log-rank检验比较DH和MvD分层组之间进展的累积风险比率。

主要观察指标

MvD检测率，通过MvD角度测量的MvD程度和RNFL稀化率。

结果

在先前的DH部位有DH的38只眼中发现了MvD，在没有DH的只有20片（29.4％）眼中发现了MvD，两组之间存在显着差异（P  = 0.025）。在DH组和非DH组中，进行性青光眼患者的MvD均显着高于稳定患者。根据Kaplan-Meier分析（对数秩检验，P <0.001）评估，按DH和MvD的存在细分的组之间存在统计学上的显着差异。复发性DH的眼中MvD的角度明显大于单一DH的眼。DH的存在，DH的复发和MvD的存在是与进行性RNFL变薄相关的因素。

结论

我们在OCT-A的脉络膜图中发现MvD在渐进性OAG眼中很常见，而在DH眼中先前的DH位置更常见。这意味着使用OCT-A观察MvD的存在可能为青光眼的进展提供生物标记，尤其是在患有DH的眼睛中。