频域-OCT观测原发性闭角型青光眼患者视盘形态、视网膜神经纤维层及神经节细胞复合体的临床意义

发布时间：2018-04-25 05:41

本文选题：原发性闭角型青光眼 + 频域-OCT　；参考：《眼科新进展》2014年10期

【摘要】：目的应用频域-OCT观测原发性闭角型青光眼(primary angle closed glaucoma,PACG)患者视盘形态、视网膜神经纤维层(retinal nerve fiber layer,RNFL)及黄斑区神经节细胞复合体(ganglion cell complex,GCC),分析其与视野平均缺损(mean deviation,MD)的相关性。方法选取35例60眼PACG患者,根据视野损害程度分为早期及中晚期2组,与33例正常人进行频域-OCT对比检查。测量视盘形态学参数、整体平均RNFL厚度(RNFL-Avg)、上方平均RNFL厚度(RNFL-Sup)、下方平均RNFL厚度(RNFL-Inf)、整体平均GCC的厚度(GCC-Avg)、上方平均GCC厚度(GCC-Sup)、下方平均GCC厚度(GCC-Inf),并分析青光眼患者组视野MD与RNFL、GCC的相关性。结果视盘各形态学参数在各期PACG组与正常对照组间的差异具有统计学意义(视盘面积F=14.29、P=0.000;视杯面积F=11.31、P=0.000;盘沿面积F=6.27、P=0.002;盘沿容积F=10.41、P=0.000;视神经盘容积F=3.53、P=0.034;视杯容积F=10.99、P=0.000;杯盘比F=8.64、P=0.000;杯盘纵比F=3.14、P=0.048;杯盘横比F=4.20、P=0.012)。其中视盘面积差异表现为两个PACG组均较正常对照组大,而两个PACG组间差异无统计学意义;其他各参数表现为:中晚期PACG组的视杯面积、视杯容积、杯盘比均比正常对照组显著增大;而盘沿面积、盘沿容积和视神经盘容积均比正常对照组显著减小。增大及缩小的程度与正常对照组比较,差异均具有统计学意义,变化符合PACG神经损害的特点;而早期PACG组在上述参数中与正常对照组之间的差异均无统计学意义(均为P0.05)。对RNFL及GCC的分析中,PACG组与正常对照组间的差异具有统计学意义(RNFL-Avg F=9.79、P=0.000;RNFL-Sup F=6.48、P=0.002;RNFL-Inf F=7.54、P=0.001;GCC-Avg F=6.62、P=0.002;GCC-Sup F=5.69、P=0.005;GCC-Inf F=6.45、P=0.003)。组间两两比较发现:中晚期PACG组上述各参数与正常对照组的差异具有统计学意义(均为P0.05);而早期PACG组各参数与正常对照组间的差异无统计学意义(均为P0.05)。中晚期PACG组RNFL和GCC均与MD呈明显的正相关(r=0.689 5,P=0.001;r=0.527 1,P=0.010);早期PACG组RNFL及GCC与MD无相关性(r=-0.208 4、P=0.244;r=0.200 1、P=0.281)。结论频域-OCT是一种比较敏感的能够观察到视网膜结构改变的检查方法,但其对于早期青光眼的诊断仍具有局限性。
[Abstract]:Objective to observe the morphology of optic disc, retinal nerve fiber layerus (RNFL) and ganglion cell complex (GCCS) in patients with primary angle-closure glaucoma (angle angle closed glaucoma), and to analyze its correlation with mean deviation MDD (mean deviation MDD) in patients with primary angle-closure glaucoma. Methods 35 cases (60 eyes) of PACG were divided into two groups according to the degree of visual field damage. The morphological parameters of optic disk were measured. The overall average RNFL thickness is RNFL-Avgn, the upper average RNFL thickness is RNFL-Supg, the lower average RNFL thickness is RNFL-Infg, the overall average GCC thickness is GCC-Avgn, the upper average GCC thickness is GCC-Supp, the lower average GCC thickness is GCC-Infen, and the correlation between visual field MD and RNFL GCC-InfU in glaucoma patients is analyzed. Results the morphological parameters of the optic disc were significantly different between the PACG group and the normal control group (the optic disc area F _ (14. 29) / P ~ (0.000)); the optic cup area (F ~ (11.31) / P ~ (0.000)); the disc / disc area (F ~ (6.27)) P ~ (+) ~ (0.002); the disc / disc volume: F _ (10. 41) / P ~ (0.000); the optic nerve disc volume: F ~ (3.53N) / P ~ (0.034); the optic cup volume: F ~ (10. 99) / P ~ (0.000); the cup / disc ratio: F = 8.64p ~ (0.000); The ratio of disc to side is 3.14 and the ratio of cup to disc is 0.048, and the ratio of cup to disc is 4.20 to 0.012. The difference of optic disc area between the two PACG groups was larger than that of the normal control group, but the difference between the two PACG groups was not statistically significant, and the other parameters were as follows: the cup area and cup volume of the middle and late PACG group. The ratio of cup to disc was significantly larger than that of the normal control group, while the area of the disc, the volume of the disc and the volume of the optic nerve disc were significantly decreased compared with the control group. Compared with the normal control group, the degree of increase and decrease was statistically significant, and the changes were consistent with the characteristics of PACG nerve damage, but there was no significant difference between the early PACG group and the normal control group (P0.05). In the analysis of RNFL and GCC, the difference between PACG group and normal control group was statistically significant. RNFL-Avg F9.79 P0. 000 RNFL-Sup FU 6.48 P0. 002 RNFL-Inf FU 7.54 ~ 1 GCC-Avg F6.62P0. 002GCC-Sup FU 5.69 P0. 005GCC-Inf FU 6.45P0. 003. It was found that there was significant difference between the two groups (P0.05) between the PACG group and the normal control group (P 0.05), but there was no significant difference between the early PACG group and the normal control group (P0.05%). There was a significant positive correlation between RNFL and GCC in middle and late PACG group and MD, but there was no correlation between RNFL and GCC in early PACG group and MD, and there was no correlation between RNFL and GCC in early PACG group. Conclusion Frequency-domain Oct is a sensitive method to detect the changes of retinal structure, but it is still limited in the diagnosis of early glaucoma.
【作者单位】：解放军306医院眼科;
【分类号】：R775

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