目的：观察急性原发性闭角型青光眼(APACG)患者黄斑和视盘周围血流密度及其与神经纤维层的相关性。方法：前瞻性纳入2019-03-01/12-31在徐州医科大学附属医院就诊的单眼APACG患者29例，发作眼29眼为试验组，对侧眼29眼为对照组，发作眼行复合式小梁切除术，对侧眼行预防性虹膜周边激光切除术。分别于术前、术后1wk，1、3、6mo行光学相干断层扫描血管成像(OCTA)检查，观察黄斑血流密度(MVD)、视盘周围血流密度(cpVD)及神经纤维层(RNFL)厚度的变化情况。结果：术前试验组上颞、颞上象限视盘cpVD均较对照组低(P<0.01)，术后1wk试验组各象限短暂上升，但上鼻、上颞、颞上象限仍低于对照组(均P<0.05)。术后1、3、6mo时，试验组各象限cpVD和MVD随时间变化呈持续下降趋势，且RNFL厚度在术后6mo内先增厚，后逐渐下降，至术后6mo时均较对照组变薄。相关性分析显示，试验组术后6mo时视盘cpVD与RNFL厚度在上鼻、上颞、颞下、下颞、下鼻、鼻下象限呈正相关关系(均P<0.05)。结论：APACG急性发作后早期患眼RNFL增厚，3～6mo时逐渐变薄，而视盘cpVD持续降低，并在术后6mo时与RNFL厚度存在相关关系。

AIM:To observe circumpapillary and macular vessel density(cpVD/MVD), and to evaluate correlations of cpVD/MVD with retinal nerve fiber layer(RNFL)in patients with acute primary angle-closure glaucoma(APACG).METHODS: Patients with monocular APACG(n=29)visited the Affiliated Hospital of Xuzhou Medical University from March 1, 2019 to December 31, 2019 were prospectively enrolled. Moreover, 29 eyes with APACG attack were included in the experimental group to be performed with combined trabeculectomy, and 29 contralateral eyes were served as the control group to receive preventive laser peripheral iridotomy. Changes in the MVD, the cpVD and the thickness of optic nerve fiber layer(RNFL)before operation and 1wk, 1mo, 3mo and 6mo after operation were observed by oraphyptical coherence tomography angiography(OCTA), respectively.RESULTS: Before operation, the experimental group showed lower cpVD in the superotemporal(ST)quadrant and the temporosuperior(TS)quadrant compared with the control group(all P<0.01). In addition, a brief rise was observed in each quadrant of the experimental group 1wk after operation, but with lower cpVD in the supero-nasal(SN)quadrant, the ST quadrant and the TS quadrant than the control group(all P<0.05). Furthermore, 1mo, 3mo and 6mo after operation, there was a steady downward trend in the cpVD and the MVD in each quadrant of the experimental group over time, and the RNFL thickness was increased at first within 6mo after operation, and then gradually thinned, but the RNFL thickness of the experimental group were thinner than those of the control group 6mo after operation. Correlation analysis showed that there was a positive correlation between the cpVD and the RNFL thickness in the SN, ST, temporoinferior(TI), IT, IN and nasoinferior(NI)quadrants in the experimental group 6mo after operation(all P<0.05). CONCLUSION: The RNFL was thickened in the affected eyes in the early stage after acute attack of APACG, and gradually thinned 3-6mo after operation. However, the cpVD was decreased continuously, and there was a correlation between the RNFL thickness and the cpVD 6mo after operation.

徐州市科技计划项目(No.XM13B089)