OCT在区别青光眼性和非青光眼性大视杯中的作用

发布时间：2018-05-07 14:08

本文选题：光学相干断层扫描 + 视网膜神经纤维层　；参考：《新乡医学院》2012年硕士论文

【摘要】：背景随着生活水平的提高及科技的进步,青光眼已成为主要的致盲性眼病。青光眼诊断难点之一就是由其他视神经疾病引起的杯盘比增大及类似青光眼样的生理性大视杯与青光眼性大杯盘比的鉴别诊断。目的利用光学相干断层扫描技术(RTVue-100FD-OCT)比较青光眼性大视杯和生理性大视杯及其他视神经疾病引起的大视杯患者RNFL (Retinal Nerve Fiber Layer,视网膜神经纤维层)各部位厚度,视盘参数及黄斑区GCC (Ganglion Cell Complex,神经节细胞复合体)厚度差异,研究OCT在区分青光眼性大视杯和非青光眼性大视杯中的作用。方法选取青光眼性大视杯18例28眼为青光眼组,生理性大视杯17例24眼为生理性大杯组,其他视神经疾病引起大视杯者15例20眼为视神经疾病组。利用光学相干断层扫描技术RNFL3.45程序,ONH (Optic Nerve Head,视神经乳头)程序及GCC程序的扫描记录青光眼患者,非青光眼者RNFL各部位厚度,黄斑区GCC厚度及各视盘参数值,SPSS16.0统计软件对比各组间RNFL各部位厚度,黄斑区GCC厚度及各视盘参数值有无差异。结果OCT测量青光眼组、视神经疾病组和生理性大视杯组RNFL全周平均RNFL厚度及颞侧、上方、鼻侧、下方RNFL厚度值。青光眼组和视神经疾病组比较,平均RNFL厚度无明显差异(P=0.3430.05),上方,下方象限,颞侧,鼻侧象限两组RNFL厚度均有显著性差异(P0.05),上下方象限,青光眼组RNFL厚度明显小于视神经疾病组,颞鼻侧象限青光眼组RNFL厚度则高于视神经疾病组。青光眼组和视神经疾病组与生理性大视杯组比较,各个部位RNFL厚度均有显著性差异(P0.05)。 OCT测量三组黄斑区Average、Superior Inferior GCC厚度值,各组内平均GCC厚度及上方、下方象限GCC厚度值间对比差异无统计学意义(P0.05)。三组间平均GCC厚度及上方、下方象限GCC厚度值间对比,差异有显著统计学意义(P0.05)。青光眼组和视神经疾病组比较,平均GCC厚度,上方,下方GCC厚度均有明显差异(P0.05),即青光眼组各部位GCC厚度均较视神经疾病组小。青光眼组和视神经疾病组与生理性大视杯组比较,平均GCC厚度,上方,下方GCC厚度均有显著性差异(P0.05),即青光眼组和视神经疾病组平均GCC厚度,上方,下方GCC厚度均较生理性大视杯组降低。视盘参数中,盘沿面积,盘沿容积,杯盘垂直径比青光眼组与视神经疾病组和生理性大视杯组比较差异均有统计学意义(P0.05),视神经疾病组和生理性大杯组间则差异无统计学意义(P0.05),杯盘水平径比三组间两两比较差异均有统计学意义(P0.05),余视盘参数无统计学意义。结论通过OCT的检测能发现青光眼患者和能引起大视杯的其他视神经疾病患者RNFL各个部位厚度,黄斑区GCC厚度及视盘参数之间均有差别,具体结论如下： 1.青光眼疾病上、下象限RNFL极易受损,视神经疾病引起的大视杯颞、鼻象限易受损,两组平均RNFL厚度均降低,即平均RNFL厚度损害不是青光眼所特有的。 2.青光眼和视神经疾病引起的大视杯患者黄斑区GCC厚度均降低,但视神经疾病降低更明显。 3.青光眼的盘沿面积和盘沿容积均减小,非青光眼无明显改变。青光眼和视神经疾病引起的大视杯组视盘容积小于生理性大视杯组。青光眼组的杯盘水平径比小于视神经疾病引起的大视杯组。青光眼组的杯盘垂直径比大于非青光眼性大视杯组。
[Abstract]:Background With the improvement of living standard and the progress of science and technology , glaucoma has become the primary blindness eye disease . One of the difficulties in diagnosis of glaucoma is the differential diagnosis of the ratio of cup - to - disc ratio caused by other optic nerve diseases and the ratio of physiological macrovision cup similar to glaucoma .

Objective To compare the thickness of RNFL ( retinal nerve fiber layer ) , optic disc parameters and the thickness difference of GCC ( Ganglion Cell Complex , Ganglion Cell Complex ) in patients with glaucoma with large visual cup and optic neuropathy caused by optic coherence tomography ( RTVue - 100FD - OCT ) .

Methods 18 eyes of 18 patients with glaucoma were treated with optic coherence tomography ( RNFL 3.45 ) , ONH ( Optic Nerve Head ) program and GCC procedure . The thickness of RNFL , the thickness of GCC and the parameter values of each optic disc were recorded .

Results Compared with the optic neuropathy group , the thickness of RNFL was significantly different between the two groups ( P = 0.3430 . 05 ) . Compared with the optic nerve disease group , the thickness of RNFL in the superior , inferior and inferior quadrants was significantly lower than that in the optic nerve disease group .

The average GCC thickness , upper and lower GCC thickness were significantly different between the three groups ( P0.05 ) . The average GCC thickness , upper and lower GCC thickness were significantly different between the three groups ( P0.05 ) . The average GCC thickness , upper and lower GCC thickness were significantly different between the glaucoma group and the optic nerve disease group ( P0.05 ) .

There was no significant difference between the optic nerve disease group ( P0.05 ) , the optic nerve disease group and the physiological large cup group ( P0.05 ) .

Conclusion The detection of OCT can reveal the difference between the thickness of RNFL , GCC thickness and optic disc parameters in patients with glaucoma and other patients with optic neuropathy which can cause macrovision . The specific conclusions are as follows :

1 . In glaucoma , the RNFL in the lower quadrant is extremely vulnerable , and the temporal and nasal quadrants of the macrovision cup caused by optic neuropathy are easily damaged , and the average RNFL thickness of the two groups is reduced , that is , the average RNFL thickness damage is not characteristic of glaucoma .

2 . The GCC thickness of macular region in patients with glaucoma and optic neuropathy decreased , but optic neuropathy was more pronounced .

3 . The volume of the disc in the glaucoma group and the volume of the disc were both decreased and the non - glaucoma was not changed significantly . The volume of the optic disc of the large - view cup group caused by glaucoma and optic neuropathy was smaller than that of the physiological large - view cup group . The diameter ratio of the cup in the glaucoma group was smaller than that of the large - view cup group caused by optic nerve disease . The vertical diameter ratio of the cup in the glaucoma group was larger than that of the non - glaucoma macrovision cup group .

【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R775.2

【参考文献】