原发性开角型青光眼与24 h眼灌注压的相关研究

doi:10.3969/j.issn.2095-378X.2022.02.001

摘要/Abstract

摘要： 目的探讨原发性开角型青光眼（primary open-angle glaucoma, POAG）患者24 h眼灌注压昼夜变化及其与眼视功能损害的相关性。方法选取2017年3月—2021年12月在复旦大学附属上海市第五人民医院就诊的POAG患者25例和健康志愿者25例, POAG患者为观察组,健康志愿者为对照组,分别于第1天10：00—第2天8：00每隔2 h测眼压和血压,计算平均眼灌注压（mean ocular perfusion pressure, MOPP）、收缩期眼灌注压（systolic ocular perfusion pressure, SOPP）、舒张期眼灌注压（diastolic ocular perfusion pressure, DOPP）及其全天、日间和夜间波动值,并采用Pearson相关性方法检验其与视野平均缺失（mean defect, MD）及图形标准差（pattern standard deviation, PSD）的相关性。结果观察组日间、夜间、全天的MOPP、SOPP、DOPP均值均较对照组低,差异有统计学意义（均P<0.05）。观察组夜间、全天的MOPP、SOPP、DOPP波动值均较对照组高,差异有统计学意义（均P<0.05）。观察组日间MOPP波动值较对照组高,差异有统计学意义（均P<0.05）,日间SOPP和DOPP波动值较对照组比较差异无统计学意义。观察组全天MOPP波动值与MD存在负相关性（r=-0.802,P<0.001）,与PSD存在正相关性（r=0.722,P<0.001）。结论观察组眼灌注压均值均较对照组低,全天、夜间眼灌注压波动幅度均较对照组大,全天MOPP波动值与MD、PSD存在相关性,提示眼灌注压偏低、眼灌注压波动较大可能是青光眼的危险因素。

关键词: 眼灌注压, 原发性开角型青光眼, 视功能

Abstract: Objective To investigate the circadian changes of 24-hour intraocular perfusion pressure in patients with primary open-angle glaucoma （POAG） and its correlation with visual impairment. Methods Twenty-five patients with POAG treated in the Shanghai Fifth People's Hospital Affiliated to Fudan University from March 2017 to December 2021 were selected as the observation group and another 25 healthy volunteers were selected as the control group. Intraocular pressure and blood pressure were measured every 2 h from 10：00 on the first day to 8：00 on the second day, and the mean ocular perfusion pressure （MOPP）, systolic ocular perfusion pressure （SOPP）, diastolic ocular perfusion pressure （DOPP）, and their all-day, daytime, and nighttime fluctuations were calculated. The relationships of the fluctuations with mean defect （MD） and pattern standard deviation （PSD） were tested by Pearson correlation. Results The mean values of all-day, daytime, and nighttime MOPP, SOPP, and DOPP in the observation group were lower than those in the control group （all P<0.05）. The fluctuation values of MOPP, SOPP, and DOPP in the observation group at night and all day were higher than those in the control group （all P<0.05）. The fluctuation value of MOPP in the observation group at daytime was higher than that in the control group （all P<0.05）. There were no significant differences in the fluctuation values of daytime SOPP and DOPP between the observation group and the control group. The fluctuation value of all-day MOPP in the observation group had a negative correlation with MD （r=-0.802, P<0.001） and a positive correlation with PSD （r=0.722, P<0.001）. Conclusion The mean value of intraocular perfusion pressure in the observation group is lower than that in the control group, and the fluctuation ranges of intraocular perfusion pressure in whole day and at night in the observation group are greater than those in the control group. The fluctuation value of MOPP in whole day is correlated with MD and PSD. These findings suggest that low intraocular perfusion pressure and large fluctuation of intraocular perfusion pressure may be the risk factors of glaucoma.

Key words: Intraocular perfusion pressure, Primary open-angle glaucoma, Visual function

中图分类号:

陈冉冉, 廖宇洁, 朱皓皓. 原发性开角型青光眼与24 h眼灌注压的相关研究[J]. 外科研究与新技术, 2022, 11(2): 77-81.

CHEN Ranran, LIAO Yujie, ZHU Haohao. Study on primary open-angle glaucoma and 24-hour intraocular perfusion pressure[J]. Surgical Research and New Technique, 2022, 11(2): 77-81.

参考文献

[1] Kang JM, Tanna AP.Glacoma[J]. Med Clin North Am, 2021, 105(3): 493-510.
[2] Flaxman SR, Bourne RRA, Resnikoff S, et al.Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis[J]. Lancet Glob Health, 2017, 5(12): e1221-1234.
[3] Ch'ng TW, Chua CY, Ummi Kalsom MA, et al. Ocular perfusion pressure and severity of glaucoma: is there a link?[J]. J Curr Glaucoma Pract, 2021, 15(2): 78-85.
[4] Çakmak Aİ, Atalay E, Gültekin Irgat S, et al.Systemic and ocular determinants of mean ocular perfusion pressure in a population-based sample[J]. Jpn J Ophthalmol, 2020, 64(4):392-397.
[5] Vawda N, Munsamy A.The effect of ocular perfusion pressure on retinal thickness in young people with presumed systemic hypotension[J]. Vision (Basel), 2021, 5(3):36.
[6] João BB, Luis AP,Karel VK, et al.Heterogeneity in arterial hypertension and ocular perfusion pressure definitions: Towards a consensus on blood pressure-related parameters for glaucoma studies[J]. Acta Ophthalmol, 2019, 97(4):e487-492.
[7] Tham YC, Lim SH, Gupta P.Inter-relationship between ocular perfusion pressure, blood pressure, intraocular pressure profiles and primary open-angle glaucoma: the Singapore epidemiology of eye diseases study[J]. Br J Ophthalmol, 2018, 102(10): 1402-1406.
[8] Zisapel N.New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation[J]. Br J Pharmacol, 2018, 175(16): 3190-3199.
[9] Smolensky MH, Hermida RC, Portaluppi F.Circadian mechanisms of 24-hour blood pressure regulation and patterning[J]. Sleep Med Rev, 2017, 6(33): 4-16.
[10] Ikegami K, Shigeyoshi Y, Masubuchi S.Circadian regulation of IOP rhythm by dual pathways of glucocorticoids and the sympathetic nervous system[J]. Invest Ophthalmol Vis Sci, 2020, 61(3): 26.
[11] Schuster AK, Wagner FM, Pfeiffer N, et al.Risk factors for open-angle glaucoma and recommendations for glaucoma screening[J]. Ophthalmologe, 2021, 118(2): 145-152.
[12] Kurysheva NI, Parshunina OA, Shatalova EO, et al.Value of structural and hemodynamic parameters for the early detection of primary open-angle glaucoma[J]. Current Eye Research,2017, 42(3): 411-417.
[13] Cakmak A, Eray A, Saadet GI, et al.Systemic and ocular determinants of mean ocular perfusion pressure in a population-based sample[J]. Jpn J Ophthalmol, 2020, 64(4): 392-397.
[14] Ciulla L, Moorthy M, Mathew S, et al.Circadian rhythm and glaucoma: What do we know?[J]. J Glaucoma. 2020, 29(2): 127-132.
[15] Varshav G, Parthav S, Minal K, et al.Relationship between optical perfusion pressure and systemic blood pressure on glaucoma: Case-control study[J]. Oman J Ophthalmol, 2019,12(3): 150-155.
[16] Dinakaran S, Mehta P, Mehta R, et al.Significance of non-intraocular pressure (IOP)-related factors particularly in normal tension glaucoma: Looking beyond IOP[J]. Indian J Ophthalmol, 2022, 70(2): 569-573.
[17] Baek SU, Kim YK, Ha A, et al.Diurnal change of retinal vessel density and mean ocular perfusion pressure in patients with open-angle glaucoma[J]. PLoS One, 2019, 14(4):e0215684.