helmholtzeyeinstituteРоссийский офтальмологический журналRussian Ophthalmological Journal2072-00762587-5760Real time Publishers10.21516/2072-0076-2021-14-2-14-22helmholtzeyeinstitute-650Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESСтруктурно-функциональные корреляции в препериметрической и начальной стадиях глаукомной оптической нейропатииStructural and functional correlations in the pre-perimetric and the initial stages of glaucomatous optic neuropathyhttps://orcid.org/0000-0002-1813-4408КирилловаМ. О.KirillovaM. O.

 Мария Олеговна Кириллова— аспирант отдела глаукомы

ул. Садовая-Черногрязская, д. 14/19, Москва, 105062

Maria O. Kirillova— PhD student, glaucoma department

14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062

https://orcid.org/0000-0001-8381-2124ЖуравлеваА. Н.ZhuravlevaA. N.

 Анастасия Николаевна Журавлева — канд. мед. наук, научный сотрудник отдела глаукомы

ул. Садовая-Черногрязская, д. 14/19, Москва, 105062

Anastasiya N. Zhuravleva — Cand. of Med. Sci., researcher, glaucoma department

14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062

https://orcid.org/0000-0002-0161-5010ЗуеваМ. В.ZuevaM. V.

 Марина Владимировна Зуева — д-р биол. наук, профессор, начальник отдела клинической физиологии зрения им. С.В. Кравкова

ул. Садовая-Черногрязская, д. 14/19, Москва, 105062

Marina V. Zueva— Dr. of Biol. Sci., professor, head of the department of clinical physiology of vision named after S.V. Kravkov

14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062

visionlab@yandex.ruhttps://orcid.org/0000-0002-0148-8517ЦапенкоИ. В.TsapenkoI. V.

 Ирина Владимировна Цапенко — канд. биол. наук, старший научный сотрудник отдела клинической физиологии зрения им. С.В. Кравкова

ул. Садовая-Черногрязская, д. 14/19, Москва, 105062

Irina V. Tsapenko — Cand. of Biol. Sci., senior researcher, department of clinical physiology of vision named after S.V. Kravkov

14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062

ФГБУ «НМИЦ глазных болезней им. Гельмгольца» Минздрава РоссииРоссияHelmholtz National Medical Research Center of Eye DiseasesRussian Federation2021170620211421422Copyright © Кириллова М.О., Журавлева А.Н., Зуева М.В., Цапенко И.В., 20212021Кириллова М.О., Журавлева А.Н., Зуева М.В., Цапенко И.В.Kirillova M.O., Zhuravleva A.N., Zueva M.V., Tsapenko I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://roj.igb.ru/jour/article/view/650

Цель— изучить морфофункциональные взаимосвязи в ранней и доклинической диагностике глаукомной оптической нейропатии по данным оптической когерентной томографии (ОКТ) сетчатки и лектрофизиологических исследований (ЭФИ). Материал и методы.В двух клинических группах: (I) 35 человек (60 глаз) 49–70 лет (средний возраст — 58,0 ± 5,3 года) с подозрением на глаукому и (II) 21 человек (30 глаз) 46–68 лет (средний возраст — 61,0 ± 4,8 года) с начальной первичной открытоугольной глаукомой (ПОУГ), а также в группе сравнения: 36 относительно здоровых лиц (41 глаз) 54–70 лет (средний возраст — 62,0 ± 4,5 года) — выполнена спектральная ОКТ (OCT Spectralis, Heidelberg Engineering, Германия). Оценивали толщину перипапиллярного слоя нервных волокон сетчатки (пСНВС), минимальную ширину нейроретинального пояска (НРП), толщину слоев сетчатки в макулярной области, составляющих комплекс ганглиозных клеток (КГК). Для выявления корреляций между данными ОКТ и ЭФИ использовали корреляционный анализ по Спирмену. Результаты. У пациентов с подозрением на глаукому изменения параметров транзиентной паттерн-электроретинографии (ПЭРГ) коррелировали с истончением СНВС в макулярной области, внутреннего плексиформного слоя (ВПС) и слоя ганглиозных клеток (ГК) парафовеолярно. В перифовеолярной области подобные корреляции не обнаружены. У пациентов с начальной глаукомой изменения слоев КГК сетчатки отмечены в верхних, нижних и височных квадрантах, в то время как носовые и центральные оставались интактными во всех трех слоях КГК (СНВС, ГК и ВПС). У пациентов с подозрением на глаукому статистически значимые отклонения толщины пСНВС от нормальных величин отсутствовали, в то время как минимальная ширина НРП существенно отличалась от группы сравнения. Наибольшее количество корреляционных взаимосвязей обнаружено между параметрами ЭФИ и толщиной пСНВС. У больных с начальной стадией ПОУГ отмечалось достоверное увеличение толщины СНВС в височном квадранте парамакулярной области сетчатки. Заключение. Обнаружены специфические сочетания изменений структурных параметров сетчатки и диска зрительного нерва, а также временных и амплитудных показателей ПЭРГ и фотопического негативного ответа, которые позволяют использовать их в качестве комбинированных маркеров ранней и доклинической диагностики ПОУГ.

Purpose:to study morphological and functional relationships in the early and preclinical diagnosis of glaucomatous optical neuropathy based on optical coherence tomography (OCT) of the retina and the data of electrophysiological research. Material and methods. Two clinical groups: (I) 35 patients (60 eyes) aged 49–70 (ave. 58.0 ± 5.3 yrs) with suspected glaucoma and (II) 21 patients (30 eyes) aged 46-68 (ave. 61.0 ± 4.8 yrs) with initial primary open-angle glaucoma (POAG), and a comparison group consisting of 36 relativelyhealthy subjects (41 eyes) aged 54–70 (ave. 62.0 ± 4.5 yrs), were subjected to spectral OCT by OСT Spectralis (Heidelberg Engineering, Germany). The thickness of the peripapillary layer of retinal nerve fibers (pRNFL), the minimum rim width (MRW), and the thickness of theretinal layers in the macular region that make up the ganglion cell complex (GCC) were evaluated. Spearman correlation analysis was used to identify correlations between OCT and electroretinography (ERG) data. Results.In patients with suspected glaucoma, changes in the parameters of transient pattern-ERG correlated with RNFL thinning in the macular region, inner plexiform layer (IPL), and ganglion cell layer(GCL) in the parafoveal area. In patients with initial glaucoma, changes in the retinal GCL were detected for the upper, lower, and temporal quadrants, while the nasal and central quadrants remained intact in all three GCC layers (RNFL, GCL, and IPL). In patients with suspected glaucoma, no statistically significant changes in the thickness of the pRNFL as compared with the norm were detected. Yet the MRW differed significantly from the comparison group. The highest number of correlations was found between the parameters of the ERGs and the thickness of the pRNFL. In patients with the initial stage of POAG, there was a significant increase in the thickness of RNFL in the temporal quadrant of the paramacular region. In our opinion, this phenomenon may be associated with the development of reactive gliosis being thereaction of neuroglia in response to changes in vascular and/or dystrophic homeostasis. Conclusion.Specific combinations of changes in the structural parameters of the retina and optic nerve head and the temporal and amplitude indices of the PERG and phototopic negative response have been found, justifying their use as combined markers of early and preclinical diagnosis of POAG.

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The authors declare that there are no conflicts of interest present.