电刺激小脑顶核对原发性开角型青光眼视网膜血氧的影响

Effect of Electrical Fastigial Nucleus Stimulation on Retinal Vessel Oxygen Saturation in Primary Open-Angle Glaucoma

摘要: 目的：探讨电刺激小脑顶核(Electrical fastigial nucleus stimulation, FNS)对原发性开角型青光眼(Primary open-angle glaucoma, POAG)患者视网膜血管血氧饱和度和直径的影响。方法：同济医院眼科门诊顺序就诊的POAG患者24名24只眼(平均年龄41.0 ± 10.2岁)和年龄、性别相匹配的健康自愿者26名26只眼(平均年龄38.7 ± 12.8岁)纳入研究。所有受检者接受30 min电刺激小脑顶核。采用视网膜血氧饱和度分析仪(Oxymap T1)检测刺激前后视网膜颞上动脉及颞上静脉的血氧饱和度和直径的变化。比较两组受试者接受FNS刺激后视网膜血管血氧饱和度及直径的变化情况。结果：电刺激小脑顶核30 min后，只有POAG患者SaO2较刺激前升高，其差异有统计学意义(t = −2.484, p = 0.021)。同时，FNS诱发的POAG患者的视网膜动脉和静脉直径的扩张均有统计学意义(t = −2.330, −2.113, p = 0.029, 0.046)。在正常对照组，FNS刺激后，SaO2、SvO2和AVD均没有显著性变化(all p > 0.05)，只有视网膜静脉直径的扩张有统计学意义(t = −2.629, p = 0.014)。结论：电刺激小脑顶核轻度扩张POAG患者视网膜动静脉血管直径，并增加视网膜血氧供应，为青光眼的抗缺血视神经保护治疗提供新思路和理论基础。

Abstract: Aim: To determine how electrical fastigial nucleus electrical stimulation (FNS) affects the supply of oxygen to the retina in primary open-angle glaucoma (POAG). Methods: Twenty-four patients (mean age 41.0 ± 10.2 years) with POAG and 26 healthy volunteers (mean age 38.7 ± 12.8 years) were included. Both patients and volunteers received 30 minutes of FNS. Oxygen saturation and the diameters of one major temporal artery and vein were measured using a spectrophotometric retinal oximeter (Oxymap T1). Oximetry was performed at baseline and after stimulation. Retinal arterial (SaO2) and venous (SvO2) oxygen saturation were evaluated according to the difference of the extinction spectra of haemoglobin and oxyhaemoglobin. The arterio-venous difference (AVD) was calculated by (SaO2 - SvO2). Statistical analysis was performed to investigate the difference in reaction to FNS between the two groups. Results: A significant increase in oxygen saturation caused by FNS was only found in the retinal artery of patients with POAG (t = −2.484, p = 0.021). Further, stimulation induced both arterial and venous vasodilation in patients with POAG (t = −2.330, −2.113; p = 0.029, 0.046, respectively). In healthy controls, there was no FNS-induced change in oxygen saturation (all p > 0.05) and significant vasodilation induced by FNS only occurred in the retina veins (t = −2.629; p = 0.014). Conclusion: FNS induces an increasein retinal blood flow and retinal oxygen saturation in patients with POAG. It may offer a new approach to providing neuroprotection in patients with POAG or other ischemic optic neuropathy.