傅立叶光学相干断层扫描测量黄斑区节细胞复合体及视网膜神经纤维层厚度对青光眼的诊断意义

目的 探讨黄斑区节细胞复合体（macular ganglion cell complex,mGCC）和视盘周围视网膜神经纤维层（peripapillary retinal nerve fiber layer,pRNFL）厚度在青光眼中的变化情况及诊断能力.方法 选择本院眼科门诊成年患者,所有受试者均接受青光眼常规项目检查.使用傅立叶光学断层扫描（optic coherence tomography,OCT）测量pRNFL及mGCC各参数.结果 受试者共116例（116眼）,包括正常组51例（44.0%）,早期青光眼组30例（30.2%）,进展期青光眼组35例（25.9%）,正常组、早期及进展期青光眼组的pRNFL、mGCC各参数的差异均有统计学意义（F=83.022、97.361、27.899、79.585、140.686、119.166、116.234、90.855、64.341、133.064,P＜0.01）.对于早期青光眼,除鼻侧之外（P＞0.05）,其余pRNFL及所有mCCC参数的受试者曲线下面积（Area under Receive Operated Curve,AROC）差异均有统计学意义（pRNFL：0.796±0.049;mGCC：0.748±0.055,P＜0.05）.对于总体青光眼,所有pRNFL及mGCC参数的AROC差异均有统计学意义（pRNFL：0.889±0.029;mGCC：0.862±0.034,P＜0. 01）.经AROC两两比较,除了颞侧、上方pRN-FL厚度较mGCC中局部丢失体积（focal loss of volume,FLV）具有较好的诊断能力（P＜0.05）,大部分pRNFL及mGCC参数之间的诊断能力差异无统计学意义（P＞0.05）.结论 在傅立叶OCT中,pRNFL仍是青光眼最主要检测方法,mGCC可作为一种有用的青光眼补充诊断手段.

Diagnosis capability of macular ganglion cell complex and retinal nerve fiber layer thickness for glaucoma using Fourier optic coherence tomography

Objective To explore diagnosis capability of macular ganglion cell complex (mGCC)and peripapillary retinal nerve fiber layer(pRNFL) thickness for glancoma. Methods Adult outpatients received ocular regular examinations of glaucoma in our hospital were enrolled in this study. Parameters of pRNFL and mGCC measured by Fourier optic coherence tomography(OCT) were evaluated. Results 116 subjects ( 116 eyes) included 51 (44. 0% ) normal subjects, 30(30. 2% ) early glaucoma patients and 35 (25.9%) advanced glaucoma patients. There were significantly different pRNFL and mGCC thickness among the three groups ( F = 83.022,97. 361,27. 899,79. 585,140. 686,119. 166,116. 234, 90. 855,64. 341,133.064, P ＜0. 0l ). Area under Receive Operated Curve (AROC) of all pRNFL parameters in early glaucoma except nasal ( P ＞ 0. 05 ) and mGCC parameters had significantly diagnostic capability ( Need to be corrected by authors) ( pRNFL:0. 796 ±0. 049;mGCC:0. 748 ±0. 055, P ＜0. 05). As to the whole glaucoma, AROC of pRNFL and mGCC parameters had significantly diagnostic capability ( pRNFL:0. 889 ±0. 029; mGCC: 0. 862 ±0. 034, P ＜0. 01 ). Through AROC pairwise comparisons, the diagnosticpower of almost pRNFL and mGCC parameters had no difference ( P ＞ 0. 05) except that temporal, superior pRNFL thickness were significant higher than focal loss of volume (FLV) of mGCC ( P ＜ 0. 05 ). Conclusion The measurement of pRNFL thickness might still be used as a main method on diagnosis of glaucoma and mGCC could serve as a new beneficial complement tool for detection of glaucoma.