频域OCT对原发性闭角型青光眼的诊断价值

目的 观察频域OCT （spectral domain optic coherence tomography SD-OCT）各参数对不同类型原发性闭角型青光眼（primary angle closure glaucoma PACG）的诊断价值。方法 选取2014年1月~2016年12月在笔者医院就诊的PACG患者108例108眼，其中急性原发性闭角型青光眼（acute primary angle closure glaucoma，APACG）56例56眼，慢性原发性闭角型青光眼（chronic primary angle closure glaucoma，CPACG）52例52眼及健康人30例60眼进行SD-OCT检查，测量视盘形态学参数、整体平均RNFL （retinal nerve fiber layer，RNFL）厚度、上方平均RNFL厚度、下方平均RNFL厚度、整体平均GCC （ganglion cell complex，GCC）厚度、上方平均GCC厚度、下方平均GCC厚度。测量结果通过ROC （receiver operating characteristic，ROC）曲线分析判断频域OCT各指标对PACG的诊断价值。结果 在APACG组中，除上方平均GCC外（AUC=0.621，P=0.030），其他各SD-OCT参数均无明显的诊断意义，敏感度19.2%~35.7%。在CPACG组中，除视盘面积（AUC=0.468，P=0.561）外，其他各SD-OCT参数对于CPACG均有较高的诊断价值（P<0.01），其中除视杯面积（AUC=0.772）和视杯容积（AUC=0.736）外，其他各参数的的AUC均在0.8以上，敏感度为55.4%~82.8%，提示SD-OCT对CPACG有较高的诊断价值。结论 作为客观的形态学检查方法，SD-OCT能够敏感的监测到视盘及视网膜神经纤维层损害的改变，APACG及CPACG虽同属于闭角型青光眼，但其临床表现及病情转归都有很大的不同。在OCT的形态学检查方面，也有不同的表现。OCT的表现为分析不同类型青光眼病情提供了有力的形态学依据。

Diagnostic Value of Spectral Domain Optic Coherence Tomography in Patients of Primary Angle Closure Glaucoma

Objective To observe the diagnostic value of spectral domain optic coherence tomography in the patients of different kinds of primary angle closure glaucoma. Methods Totally 108 eyes of 108 PACG patients (56 APACGs and 52 CPACGs) and 60 eyes of 30 normal were enrolled in the study. Optic disc parameter, RNFL and GCC were measured by SD-OCT. ROC curve were made to evaluated the diagnostic value of each parameter. Results No diagnostic value were showed in all the parameters, except superior GCC(AUC=0.621,P=0.030)in APACG group(P>0.05). The sensitivity was 19.2%-35.7%. On the contrary, all the parameters showed high diagnostic value in CPACG(P<0.01) group except optic disc area(AUC=0.468,P=0.561).The AUC of these parameters in CPACG group were more than 0.8 except optic cup area(AUC=0.772) and optic cup volume(AUC=0.736), and the sensitivity was 55.4%-82.8%, which mean high diagnostic value in CPACG. Conclusion SD-OCT was an objective morphologic method with high diagnostic value. APACG and CPACG showed the significant differences in SD-OCT, even though they belong to the same type of glaucoma. SD-OCT provided an efficient morphologic method in the analysis of PACG.