Objective: To explore the correlation between the vessel density and the structure and visual function in patients with non-arteritic anterior ischemic optic neuropathy (NAION) in different stages. Methods: This case-control study included 25 NAION patients (28 eyes)of Peking Union Medical College Hospital from November 2017 to May 2018 and 25 healthy controls(HC) (25 eyes) of matched age and gender. General eye examination, visual field examination, and optical coherence tomography angiography were performed to obtain data of blood flow in the macular area and structure such as ganglion cell complex (GCC) and gross loss of volume (GLV), and focal loss of volume (FLV). All affected eyes were divided into the acute group (≤3 weeks), sub-acute group (4 to 12 weeks), and chronic group (>12 weeks) in line with the course of the disease. The group and regional analyses were made to carry out overall differences of blood flows and structures and the correlations with visual function. Results: There were 25 NAION patients with 28 eyes, 16 males and 9 females, aged (55±9) years. The acute group included 8 patients (8 eyes), and the sub-acute group included 10 patients (10 eyes), while the chronic group comprised 7 patients (10 eyes). The overall macular superficial vessel density of patients with NAION was significantly reduced compared with the HC(42.03%±5.70% vs.49.01%±3.34%, t=-5.546, P<0.01), but the deep vessel density was not significantly reduced (P>0.05). The superficial vessel density of the acute group, sub-acute group, and chronic group was significantly decreased(47.41%±3.51% vs. 41.68%±3.09% vs.38.06%±5.93%, all P<0.05). The GCC thickness in patients with NAION were significantly lower than the HC [(88.5±18.2) μm vs. (102.9±5.4)μm, P<0.05]. The GLV and FLV in patients with NAION were significantly higher than the HC (12.733%±11.216% vs. 0.941%±0.852%, 6.295%±4.291% vs. 0.596%±0.460%, both P<0.05). There was a correlation between the macular superficial vessel density and GCC thickness (r=0.606, P=0.001), FLV(r=-0.552, P=0.002), GLV (r=-0.685, P=0.000) and mean sensitivity (r=0.493, P=0.023). Conclusion: Compared with healthy controls, the macular superficial vessel density in NAION patients decreas along with the course of the disease, and its correlation with structural and visual function is revealed. (Chin J Ophthalmol, 2019, 55:195-202).
目的： 探究不同病程非动脉炎性前部缺血性视神经病变（NAION）黄斑区血管密度变化及其与结构和视功能的相关性。 方法： 病例对照研究。纳入2017年11月至2018年5月就诊于北京协和医院眼科门诊临床确诊的NAION患者（NAION组）25例（28只眼）及性别、年龄匹配的健康对照者（健康对照组）25名（25只眼）。行常规眼科检查、视野检查和相干光层析血管成像术（OCTA）检查，获取黄斑图像以及神经节细胞层复合体（GCC）、整体丢失体积（GLV）、局部丢失体积（FLV）等结构信息。所有NAION患者按病程分为急性期亚组（病程≤3周）、亚急性期亚组（病程4~12周）、慢性期亚组（病程>12周）。采用独立t检验比较NAION患者与健康对照之间以及协方差分析比较不同病程分组之间黄斑区血管密度的差异，Pearson相关性分析其与结构指标及视野的相关性。 结果： NAION组25例（28只眼）患者中男性16例，女性9例，年龄（55±9）岁，急性期亚组8例（8只眼），亚急性期亚组10例（10只眼），慢性期亚组7例（10只眼）。NAION组患眼整体黄斑浅层血管密度低于健康对照组（42.03%±5.70%与49.01%±3.34%比较，t=-5.546，P<0.01），局部不同区域黄斑浅层血管密度亦均低于健康对照组，差异均有统计学意义（均P<0.05）；而整体及局部深层血管密度两组间差异均无统计学意义（均P>0.05）。急性期亚组、亚急性期亚组与慢性期亚组整体黄斑浅层血管密度逐渐降低，差异有统计学意义（47.41%±3.51%、41.68%±3.09%、38.06%±5.93%，两两比较均P<0.05）。NAION组患眼GCC厚度低于健康对照组[（88.5±18.2）μm与（102.9±5.4）μm比较]、GLV和FLV高于健康对照组（12.733%±11.216%与0.941%±0.852%比较，6.295%±4.291%与0.596%±0.460%比较），差异均有统计学意义（均P<0.05）。NAION组患眼黄斑浅层血管密度与黄斑GCC厚度（r=0.606，P=0.001）、FLV（r=-0.552，P=0.002）、GLV（r=-0.685，P=0.000）以及视野平均光敏感度（r=0.493，P=0.023）变化均有相关性。 结论： NAION患眼黄斑血管密度比健康人显著降低，且随病程进展降低，同时血流变化与结构和视功能变化均存在相关性。（中华眼科杂志，2019，55：195-202）.
Keywords: Angiography; Blood flow velocity; Macula lutea; Optic neuropathy, ischemic; Tomography, optical coherence.