Abstract
Purpose. To determine the characteristics of anatomical retinal changes and of the choroidal blood flow in patients with combined pathology: age-related macular degeneration (AMD) and primary open-angle glaucoma (POAG). Materials and methods. We investigated two study groups (SG): SG1 - AMD in association with POAG, 113 patients; SG2 - AMD without glaucomatous nerve damage , 92 patients; mean age - 71.9 ± 9.3 years. Measurements of the neuro-sensory retina (NSR) thickness and of the ganglion cells complex (GCC) thickness by optical coherence tomography (OCT) in manual regimen (42 eyes in SG1, 38 eyes in SG2) and the estimation of choroidal blood flow (HBF) by ultrasonography (18 eyes in SG1, 38 eyes in SG2) were performed in two areas: area I - 4 mm laterally to the optic nerve head; area II - 4 mm medially to the optic nerve head. Results. The GCC thickness in patients with combined pathology (SG1) was significantly lower than in patients with AMD (IG2) in the areas I and II; the thickness index of the GCC was significantly reduced in SG1 in areas I and II, whereas in SG2 this index was increased. Significant differences of HBF in areas I and II in SG1 were found, as well as reduced peak systolic flow velocity, the time-averaged maximum velocity of blood flow, maximum end-diastolic flow velocity, as compared with SG2. The index of peripheral resistance was reduced in SG1 in area I and increased in area II, whereas in SG2 it was increased in area I and reduced in area II. Conclusion. In patients with combined pathology - AMD and POAG - NSR thickness was reduced due to the thinning of the ganglion cell layer and the formation of an ischemic pattern of choroidal blood flow in the macula and medially to the optic nerve head.
Highlights
We investigated two study groups (SG): SG1 — age-related macular degeneration (AMD) in association with primary open-angle glaucoma (POAG), 113 patients; SG2 — AMD without glaucomatous nerve damage, 92 patients; mean age — 71.9 ± 9.3 years
The ganglion cells complex (GCC) thickness in patients with combined pathology (SG1) was significantly lower than in patients with AMD (IG2) in the areas I and II; the thickness index of the GCC was significantly reduced in SG1 in areas I and II, whereas in SG2 this index was increased
The index of peripheral resistance was reduced in SG1 in area I and increased in area II, whereas in SG2 it was increased in area I and reduced in area II
Summary
Морфометрические и гемодинамические особенности течения возрастной макулярной дистрофии при сочетанной патологии: возрастная макулярная дистрофия и глаукома. Проведено измерение толщины нейроэпителия (НЭ) и слоя ганглиозных клеток сетчатки (ГКС) в ручном режиме методом оптической когерентной томографии ОКТ (42 глаза в ИГ1, 38 глаз в ИГ2) и исследование показателей хориоидального кровотока (ХК) ультразвуковым методом (18 глаз в ИГ1, 38 глаз в ИГ2) в двух зонах: на 4 мм латеральнее (зона I) и медиальнее (зона II) диска зрительного нерва. 1. Измерение толщины НЭ (а) и слоя ГКС (б) ма» и 42 глаза с ВМД, «сухая форма» в сочетании с ПОУГ, в контрольную группу включены 15 человек (30 глаз) без признаков патологии макулярной зоны и патологии зрительного нерва старше 50 лет, сопоставимые по возрастному и половому составу. Исследование хориоидального кровотока проведено на 86 глазах: 18 глаз с ВМД, «сухая форма» в сочетании с ПОУГ и 38 глаз с ВМД, «сухая форма», представленная преимущественно мягкими друзами, в контрольную группу включены 15 человек (30 глаз) без признаков патологии макулярной зоны сетчатки и патологии зрительного нерва старше 60 лет, сопоставимые по возрастному и половому составу. Таблица 2 Морфометрические параметры толщины НЭ, ГКС и индекс толщины слоя ганглиозных клеток сетчатки (ТГКС), по данным ОКТ
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