Сравнительное исследование структурных, функциональных и микроциркуляторных параметров в диагностике глаукомы

ЦЕЛЬ. Сравнение диагностической значимости структурных параметров, плотности капиллярного русла, измеряемой с помощью оптической когерентной томографии с функцией ангиографии (ОКТ-А), и электрофизиологических исследований в диагностике первичной открытоугольной глаукомы (ПОУГ).

МЕТОДЫ. Относительная плотность капилляров (VD) для полного анфас-изображения (далее — полная относительная плотность капилляров wiVD) диска зрительного нерва (ДЗН), относительная плотность капилляров для различных сегментов перипапиллярной и макулярной области, толщина слоя нервных волокон сетчатки (СНВС), средняя толщина ганглиозного клеточного комплекса (ГКК), паттерн-электроретинограммы (ПЭРГ) и паттерн-вызванные зрительные потенциалы (ПЗВП) были измерены у 35 здоровых участников и 90 пациентов с ПОУГ. С целью дифференциации глаз с ПОУГ на ранней стадии от здоровых глаз и между стадиями заболевания проводилась оценка площади под ROC-кривой.

РЕЗУЛЬТАТЫ. Глаза с начальной ПОУГ наиболее значимо отличались от здоровых глаз по следующим параметрам: амплитуде P50 транзиторной ПЭРГ, 1˚ (площадь под ROC-кривой 0,93, p=0,002), компоненту P1 ПЭРГ устойчивого состояния (площадь под ROC-кривой 0,92, p=0,003), амплитуде P100 ПЗВП, 1˚ (площадь под ROC-кривой 0,84,p=0,013), полной относительной плотности капиллярной сети (wiVD) в поверхностном плексусе фовеа и парафовеа (площадь под ROC-кривой 0,80, p=0,001), полной относительной плотности капиллярной сети в ДЗН и перипапиллярной сетчатке (площадь под ROC-кривой 0,74, p=0,016) и толщиной ГКК (площадь под ROC-кривой 0,74, p=0,016). Глаза с начальной ПОУГ отличались от ПОУГ в развитой и далеко зашедшей стадии по следующим параметрам: плотности капиллярной сети в нижневисочной зоне перипапиллярной сетчатки (площадь под ROC-кривой 0,94, p<0,0001) и объему фокальных потерь ГКК (площадь под ROC-кривой 0,92, p<0,001).

ЗАКЛЮЧЕНИЕ. Полученные результаты показывают важность измерения параметров микроциркуляции в ма- кулярной области наряду с ПЭРГ и ПЗВП для ранней диагностики глаукомы. Плотность капиллярной сети в нижневисочной области перипапиллярной сетчатки и объем фокальных потерь ГКК являются важными показателями для мониторинга заболевания. Включение ОКТ-А, ПЭРГ и ПЗВП в диагностику глаукомы может способствовать раннему выявлению и мониторингу заболевания.

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