HD-OCT测量黄斑区神经节细胞层-内丛状层厚度对开角型青光眼诊断的意义

目的：评估利用高分辨率相干光断层扫描( Cirrus-HD OCT)测量黄斑区神经节细胞层-内丛状层( GCIPL)厚度参数对早期和中晚期青光眼的诊断意义。
　　方法：本研究共纳入20例健康个体,26例早期青光眼患者,29例中晚期青光眼患者。对所有纳入个体均测量黄斑区GCIPL厚度参数,视盘( ONH )区参数以及视盘周围神经纤维层( RNFL )厚度参数。最后将所有数据利用SPSS 17.0统计学软件进行分析,分别计算各参数诊断早期和中晚期青光眼的AUC值,以比较和评价各参数的诊断意义。
　　结果：对于早期青光眼组, AUC值最高的为RNFL平均值(0.871)和7：00位值(0.896),GCIPL各参数也表现出较高的AUC值,其中GCIPL平均值和最小值相应的AUC值分别为0.847和0.812。对于中晚期青光眼组,AUC值最高为盘沿面积(0.992),其次为RNFL平均值(0.991),而GCIPL各参数中平均值与最小值的AUC值分别为0.967和0.983。对于早期青光眼诊断,灵敏度最高的指标为RNFL平均值(76.9%),而特异度最高的指标为GCIPL平均值(93.5%)。
　　结论：GCIPL作为诊断青光眼的新指标在诊断早期和中晚期青光眼时,具有与RNFL相似的诊断意义。对于早期青光眼,诊断时应重点观察RNFL平均值,而在筛查时应重点观察GCIPL的平均值。     

频域光学相干断层扫描（OCT）测量视盘参数及视网膜厚度在早期青光眼诊断中的作用

目的　探讨频域光学相干断层扫描（optical coherence tomography,OCT）测量视盘参数及视网膜厚度在早期青光眼诊断中的作用。方法　采用频域OCT测量40例（40眼）健康志愿者（对照组）和85例（85眼）原发性开角型青光眼（primary open angle glaucoma,POAG）患者［早期青光眼亚组（n=36）和进展期青光眼亚组（n=49）］视盘参数及视网膜神经纤维层（retinal nerve fiber layer,RNFL）厚度,比较各组RNFL厚度、视盘参数并与视野平均缺损（mean deviation,MD）值进行相关性分析,采用ROC曲线下面积评估视盘周围区RNFL厚度及视盘参数在青光眼中的诊断效果。结果　POAG组患者颞侧、上方、鼻侧及下方象限RNFL厚度和全周RNFL厚度均显著低于对照组（均为P<0.05）,且与早期青光眼组比较,进展期青光眼组患者颞侧、上方、鼻侧及下方象限RNFL厚度和全周RNFL厚度均显著降低（均为P<0.05）。各组除视盘面积外,其他视盘参数比较差异均具有统计学意义（均为P<0.05）。Pearson相关性分析显示,POAG组患者视盘颞侧、上方、下方象限RNFL厚度及全周RNFL厚度与MD均呈负相关（均为P<0.05）,而视盘参数中视杯容积和视杯/视盘面积比与MD均呈正相关（均为 P<0.05）,盘缘面积、盘缘容积和视盘容积与MD均呈负相关（均为P<0.05）。经ROC曲线分析显示,视盘周围区下方象限RNFL厚度的曲线下面积最大为0.886,其特异度和敏感度分别为0.775和0.924;视盘参数中视杯/视盘面积比曲线下面积最大,其特异度和敏感度分别为0.741和0.815。结论　OCT检测视盘结构和RNFL厚度能够用于青光眼早期诊断,且具有较高敏感度和特异度。     

飞秒激光LASIK手术负压吸引对视网膜厚度的影响

目的 探讨飞秒激光LASIK手术中负压吸引对近视眼黄斑区视网膜厚度和视网膜神经纤维层（RNFL）厚度的影响。设计 前瞻性对照研究。研究对象 接受飞秒激光手术的近视眼患者143例（279眼）。方法 采用相干光断层扫描（OCT）仪对中低度近视组（≥-6.00 D）和高度近视组（<-6.00 D）患者飞秒激光LASIK手术前、手术后1周~1年进行检查,测量以黄斑中心凹为中心3 mm半径内的视网膜平均厚度,以及以视盘为中心直径为3.4 mm的视网膜神经纤维层厚度,并以地形图分4个区域显示。主要指标 黄斑中心凹厚度及视盘周围RNFL厚度。结果 术前两组间各参数比较差异均无统计学意义（P均>0.05）。术后1年中低度近视组黄斑中心凹视网膜平均厚度为（147.2±18.3）μm;视盘鼻侧、颞侧、上方、下方的RNFL厚度分别是（62.4±15.7）μm、（94.3±20.2）μm、（136.4±17.6）μm、（131.3±21.7）μm,与术前比较差异均无统计学意义（P均>0.05）;术后1年高度近视组黄斑中心凹视网膜平均厚度为（149.3±18.7）μm;视盘鼻侧、颞侧、上方、下方的RNFL厚度分别是（59.3±19.0）μm、（90.7±17.2）μm、（129.2±25.1）μm、（123.3±21.8）μm,与术前比较差异均无统计学意义（P均>0.05）。结论 飞秒激光LASIK术中吸力环负压吸引未对视网膜神经纤维层厚度造成明显影响。（眼科, 2012, 21: 340-343）     

频域OCT检测视乳头形态及视网膜神经纤维层厚度在青光眼诊断中的作用

目的 探讨频域相干光断层扫描(OCT)检测视乳头形态及视网膜神经纤维层(RNFL)厚度在青光眼诊断中的作用.方法 为非干预性、观察性研究.应用RTVue OCT检测60例正常人和97例青光眼患者的视乳头各参数,以及平均和各个区域的RNFL厚度.采用单因素方差分析对以上各参数组间进行比较.用受试者工作特性曲线下面积(AUC)和特异性≥80%的敏感性来评价每一个检测参数区分正常与各期青光眼的能力大小.结果 除视乳头面积外,正常人和各期青光眼患者各参数测量值之间差异均有统计学意义(F=1.024,P=0.596;F=36.519,54.464,27.659,36.176,20.562,63.833,30.031, 54.652,98.146,78.705,99.839,43.728,75.720,45.709,39.380, 33.590,66.887,78.335,45.485;P=0.000).其中,平均RNFL厚度正常人为109.950μm,早期青光眼患者为93.313 μm,中期青光眼患者为80.374μm,晚期青光眼患者为65.570 μm.在视乳头周围8个RNFL区域中,正常人最厚的为颞下150.066μm和颞上146.285μm.各期青光眼患者最厚的均为颞上,分别为早期108.569 μm,中期103.420μm,晚期88.708μm,其次为颞下,分别为早期108.201μm,中期102.830 μm,晚期86.369 μm.而鼻侧(NU+NL)和颞侧(TU+TL)无论在正常人还是青光眼患者中均较薄.在视乳头形态各参数中,各期青光眼诊断效能最高的均为垂直杯盘比,其AUC值在早、中、晚期青光眼患者中分别为0.762,0.946和0.988,它们特异性在80%时的敏感性分别为62.2%,76.5%和99.2%.在RNFL厚度参数中,早期青光眼诊断效能最高的是颞上区域RNFL厚度,其AUC值为0.915,特异性在80%时的敏感性为89.5%;中期青光眼诊断效能最高的是下方平均RNFL厚度,其AUC值为0.967,特异性在80%时的敏感性为94.1%;晚期青光眼诊断效能最高的是平均RNFL厚度,其AUC值为0.985,特异性在80%时的敏感性为99.2%.在视乳头周围8个RNFL区域中,诊断效能最高的是颞上区域(ST),其AUC值在早、中、晚期青光眼患者中分别为0.915,0.926和0.966,它们特异性在80%时的敏感性分别为89.5%,88.2%和92.9%.诊断效能较低的是颞侧(TU+TL)和鼻侧(NU+NL).结论 RTVue OCT具有较好的区别正常人和各期青光眼患者的能力,在青光眼诊断方面是一个有用的工具.     

鞍结节脑膜瘤患者视盘及视网膜神经纤维层的形态研究

目的 分析鞍结节脑膜瘤患者的视盘参数特征及视盘周围视网膜神经纤维层（pRNFL）厚度的变化。设计 回顾性病例系列。 研究对象 2010年7月至2011年12月北京天坛医院鞍结节脑膜瘤患者40例（80眼）、正常对照40例（80眼）和青光眼患者40例（80眼）。方法 采用眼底照相和相干光断层扫描（OCT）测量视盘及不同象限pRNFL厚度,比较鞍结节脑膜瘤患者与正常对照组和青光眼组的视盘参数及pRNFL厚度,分析视盘参数改变与肿瘤大小的相关性。主要指标 视盘形态、视盘面积、杯盘面积比、水平杯盘比、垂直杯盘比、盘沿面积、视杯面积,视杯体积和不同象限pRNFL厚度。结果 鞍结节脑膜瘤组的杯盘面积比、水平杯盘比、垂直杯盘比、视杯面积和视杯体积与正常对照组相比均明显增大,而盘沿面积明显减小（P均=0.000）;且杯盘面积比、水平杯盘比、盘沿面积和盘沿体积与青光眼组相比均较大,而垂直杯盘比、视杯面积和视杯体积较青光眼组明显减小（P均=0.000）。肿瘤组视盘周围不同象限pRNFL厚度分别为上方颞侧（124.022±26.100）μm,上方鼻侧（105.856±23.410）μm,鼻侧上方（75.784±19.260）μm,鼻侧下方（65.983±15.708）μm,下方鼻侧（105.915±25.526）μm,下方颞侧（133.591±24.429）μm,颞侧下方（76.592±19.679）μm,颞侧上方（77.352±26.100）μm,与正常对照组相比差异均具有统计学意义（P均<0.05）;与青光眼组相比上方鼻侧象限不具有统计学意义（P=1.114）,其余象限均具有统计学意义（P均<0.05）。鞍结节脑膜瘤盘沿体积与肿瘤大小相关（r=0.492,P=0.011）。结论 鞍结节脑膜瘤视盘形态表现为颞侧变窄、颜色变淡,pRNFL厚度与正常人群比较下方鼻侧变薄最明显,与青光眼组相比除上方鼻侧外其他各象限均变薄,下方颞侧最明显。     

剥脱性青光眼视盘视网膜神经纤维层厚度与视野缺损的相关性

探讨不同时期剥脱性青光眼（PXG）患者视盘视网膜神经纤维层（RNFL）厚度与视野缺损的相关性。方法：病例对照研究。连续性选取2013年1月至2018年1月在石家庄市第一医院青光眼科住院治疗的PXG患者97例（97眼），并将其分为早期PXG组28例，中期PXG组27例，晚期PXG组42例。另选择与PXG组匹配的正常志愿者32例（32眼）作为正常对照组。所有纳入对象均采用SD-OCT对视盘各区RNFL厚度进行扫描，采用单因素方差分析比较4组受检者视盘各区RNFL厚度差异，采用 Pearson相关分析对视盘RNFL厚度与视野平均缺损相关性进行分析。结果：正常对照组及早、中、晚期PXG组平均视盘RNFL厚度分别为（104±11）μm，（92±14）μm，（82±12）μm，（54±18）μm。4组受检者鼻侧、鼻上方、颞上方、颞侧、颞下方、鼻下方及平均RNFL厚度总体差异均具有统计学意义（F=24.38、36.40、47.84、8.70、95.46、54.75、82.28，均P<0.001）。进一步两两比较发现，正常对照组与早期PXG组颞上方、颞下方、鼻下方及平均视盘RNFL厚度差异有统计学意义（均P<0.05）；正常对照组与中期PXG组鼻侧、鼻上方、颞上方、颞下方、鼻下方及平均RNFL厚度差异有统计学意义（均P<0.05）；正常对照组与晚期PXG组各区RNFL厚度差异均有统计学意义（均P<0.001）。中、晚期 PXG组视盘平均RNFL厚度与视野平均缺损呈正相关（r=0.404，P=0.037；r=0.582，P<0.001）。结论：中、晚期PXG眼视盘平均RNFL厚度与视野缺损呈正相关，SD-OCT监测视盘RNFL厚度变化可以作为PXG诊断分期和随访的重要参考指标。     

应用OCT检测乙胺丁醇对视网膜神经纤维层的损害

目的应用OCT测量服用乙胺丁醇的结核患者的视网膜神经纤维层（RNFL）厚度,探讨乙胺丁醇对视神经纤维的影响,以及OCT在诊断中毒性视神经早期病变中的价值。方法横断面研究。分析眼科门诊收集的93例（185眼）服用乙胺丁醇的结核患者,其中短疗程组（服用乙胺丁醇2个月）共49例（97眼）,长疗程组（服乙胺丁醇6个月以上）共44例（88眼）,以未开始抗结核治疗的结核患者作为对照组,共46例（92眼）,应用OCT测量 3组各象限RNFL厚度,并进行单因素方差分析及两两比较,此外对所有患者进行眼科常规检查包括视力、眼压、色觉、裂隙灯、眼底、视野检查。结果短疗程组RNFL厚度：颞侧（90.35±12.58）μm,下方（145.91±17.18）μm,鼻侧（93.18±16.9）μm,上方（139.07±18.65）μm,平均厚度为（117.01±10.14）μm。长疗程组：颞侧（79.75±17.14）μm,下方（135.47±19.14）μm,鼻侧（91.17±20.23）μm,上方（130.44±21.50）μm,平均厚度（109.24±14.36）μm。对照组：颞侧（95.43±15.61）μm,下方（139.92±15.35）μm,鼻侧（90.06±15.61）μm,上方（140.71±19.02）μm,平均厚度为（116.49±11.49）μm。与对照组相比,短疗程组各象限RNFL厚度差异无统计学意义（P>0.05）,而长疗程组的颞侧（P<0.01）、上方（P<0.05）及平均RNFL值（P<0.05）均较对照组薄,差异有统计学意义。在185眼中有6眼诊断为乙胺丁醇中毒性视神经病变,其各象限RNFL较对照组薄。结论短期服用乙胺丁醇（0.75 g·d-1）的患者未出现明显视神经纤维丢失及视功能损害,而长期服药者可出现RNFL的变薄,尤其是颞侧象限,这对诊断乙胺丁醇中毒性视神经早期病变有一定临床意义。     

GCIPL厚度测量在慢性闭角型青光眼诊断中的应用

目的：探讨高分辨率光学相干断层扫描（Cirrus HD OCT）测量黄斑区神经节细胞-内丛状层（GCIPL）厚度参数在慢性闭角型青光眼（CACG）中的诊断价值。方法：描述性研究。收集2014 年12 月至2016 年3 月在长沙爱尔眼科医院就诊的CACG患者66 例（76 眼）作为CACG组,根据Hodapp-Anderson-Parris分期方法,将CACG患者分为早期组（37 眼）、中期组（10 眼）和晚期组（29眼）。另选择与CACG组匹配的正常志愿者30 例（30 眼）作为正常对照组。所有研究对象分别进行Cirrus HD OCT检查与视野检查,测量黄斑区及其各分区域的GCIPL厚度。采用方差分析比较4 组患者各区GCIPL参数差异,采用Pearson相关分析对GCIPL厚度与平均视野缺损的相关性进行分析。结果：正常对照组及早、中、晚期组平均GCIPL分别为（85±14）μm、 （84±9）μm、 （72±21）μm、 （62± 15）μm,4 组间差异有统计学意义（F =15.89,P ＜0.001）,进一步两两比较发现,正常对照组与早期组之间差异无统计学意义（P =0.120）,与中、晚期组之间差异均有统计学意义（P ＜0.001）。CACG组平均GCIPL厚度与平均视野缺损呈正相关（r =0.636,P ＜0.001）。结论：GCIPL厚度参数对中晚期CACG的诊断具有临床价值,联合视野检查可以作为CACG的诊断分期及随访的重要参考指标。     

视网膜神经纤维层三维相干光断层扫描对疑似开角型青光眼甄别的诊断价值

目的探讨高分辨率三维相干光断层扫描（OCT）对疑似原发性开角型青光眼（POAG）甄别的诊断价值。方法采用CarlZeiss公司生产的高分辨率三维频域OCT对正常组94例（188只眼）和试验组（疑似青光眼组）46例（92只眼）进行视网膜神经纤维层厚度（RNFL）的检测,对比分析视盘形态和RNFL厚度值。根据正常人的OCT表现和疑似青光眼患者的OCT图像特征作比较。并做相关性分析。结果正常人视乳头周围RNFL厚度特征：图像表现为上、下象限厚,其次为颞侧、鼻侧最薄,图像曲线表现为双峰形。RNFL与性别、眼别无相关（P〈0.05）。两组研究对象各部分RNFL厚度比较：正常对照组各部位RNFL厚度明显高于试验组,经过独立样本t检验得出差别有统计学意义（P〈0.05）。其中试验组根据高分辨率三维CirrusHD-OCT机所测量的正常人RNFL厚度及图像特征和试验组的OCT图像特征作比较,并根据视野、眼压等将试验组46例（92只眼）诊断为青光眼者24例（48只眼）,大视杯22例（44只眼）,并将试验组青光眼和大视杯分成两个组,两个组各部位RNFL厚度和正常对照组相比较,RNFL厚度均变薄,差别有统计学意义（P〈0.05）;同时大视杯组各部RNFL厚度均高于青光眼组,差别有统计学意义（P〈0.05）。结论 OCT可以清晰显示RNFL变薄的范围和区域,再配合其他检查,即可较准确、快捷诊断、区分POAG、正常眼压性青光眼及生理大陷凹患者。大大提高POAG的早期诊断水平,高分辨率三维CirrusHD-OCT的RNFL的检查对疑似POAG的甄别诊断具有重要诊断价值,是诊断早期青光眼的不可缺少的重要检查方法之一。     

OCT测量视网膜神经纤维层和黄斑厚度在青光眼早期诊断中的意义

目的应用光学相干断层成像术（optical coherence tomography，OCT）测量青光眼患者的视网膜神经纤维层（retinal nerve fiber layer，RNFL）厚度和黄斑厚度，比较两者在青光眼早期诊断中的作用。方法应用Stratus OCT测量62例（101眼）正常人和41例（64眼）青光眼患者的RNFL厚度和黄斑厚度，比较正常人和青光眼患者之间．正常人和早期青光眼患者之间上、下、鼻、颞四个象限与平均RNFL厚度、黄斑区内外环各象限厚度和总黄斑体积等参数有无统计学差异：用受试者工作特征曲线下面积（area under the receive operating characteristi ccurve，AROC）评价各个参数在青光眼早期诊断中的作用。结果青光眼患者各象限、平均RNFL厚度和各分区黄斑厚度、总黄斑体积均比正常人减少．差异有显著性（P=0．014—0．000），视乳头旁平均RNFL的AROC最大（0．961），其次为下方RNFL（0．928）和上方RNFL（0．924）。黄斑下方外环区AROC最大（0．876）。早期青光眼患者各象限、平均RNFL厚度和黄斑外环各分区、总黄斑体积较正常人减少，差异有显著性（P=0．021～0．000），而黄斑内环各区与正常人差异无显著性。视乳头旁平均RNFL的AROC最大（0．877），其次为上方RNFL（0．783）和下方RNFL（0．767）。黄斑下方外环区AROC最大（0．728）。结论测量RNFL厚度较测量黄斑厚度具有更强的青光眼早期诊断价值。黄斑厚度测量为青光眼的早期诊断提供了一种新的手段。     

Comparisons of ganglion cell-inner plexiform layer loss patterns and its diagnostic performance between normal tension glaucoma and primary open angle glaucoma: a detailed, severity-based study

AIM: To evaluate the patterns of macular ganglion cell-inner plexiform layer (GCIPL) loss in normal tension glaucoma (NTG) and primary open angle glaucoma (POAG) in a detailed, disease severity-matched way; and to assess the diagnostic capabilities of GCIPL thickness parameters in discriminating NTG or POAG from normal subjects. METHODS: A total of 157 eyes of 157 subjects, including 57 normal eyes, 51 eyes with POAG and 49 eyes with NTG were enrolled and strictly matched in age, refraction, and disease severity between POAG and NTG groups. The average, minimum, superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal GCIPL thickness, and the average, superior, temporal, inferior, and nasal retinal nerve fiber layer (RNFL) thickness were obtained by Cirrus optical coherence tomography (OCT). The diagnostic capabilities of OCT parameters were assessed by area under receiver operating characteristic (AUROC) curves. RESULTS: Among all the OCT thickness parameters, no statistical significant difference between NTG group and POAG group was found (all P>0.05). In discriminating NTG or POAG from normal subjects, the average and inferior RNFL thickness, and the minimum GCIPL thickness had better diagnostic capabilities. There was no significant difference in AUROC curve between the best GCIPL thickness parameter (minimum GCIPL) and the best RNFL thickness parameter in discriminating NTG (inferior RNFL; P=0.076) and indiscriminating POAG (average RNFL; P=0.913) from normal eyes. CONCLUSION: Localized GCIPL loss, especially in the inferior and inferotemporal sectors, is more common in NTG than in POAG. Among all the GCIPL thickness parameters, the minimum GCIPL thickness has the best diagnostic performance in differentiating NTG or POAG from normal subjects, which is comparable to that of the average and inferior RNFL thickness.     

频域OCT视盘形态及神经纤维层厚度参数在青光眼诊断中的作用μ

背景青光眼是一种可引起视神经结构改变,继而导致不可逆视功能损害的一类疾病。光学相干断层扫描（OCT）通过对视盘形态以及神经纤维层的检测,有助于青光眼的早期诊断。目的探讨频域OCT视盘形态及神经纤维层厚度各参数在青光眼诊断中的作用。方法非干预性、横断面研究。应用频域RTVue OCT测量62例正常人和67例青光眼患者的视盘参数,以及视网膜各区域的神经纤维层厚度。用受试者工作特性曲线下面积（ROC）评价OCT每个检测参数区分正常眼与青光眼的能力大小。结果各型青光眼组患者的年龄明显大于正常组,各型青光眼组视野平均缺损（MD）和视野模式标准化差（PSD）值均明显大于正常组,差异均有统计学意义（P〈0．01）。正常组、青光眼组、开角型青光眼组和闭角型青光眼组间视盘面积的总体差异均无统计学意义（P=0．101、0．741、0．652）;正常人平均视网膜神经纤维层厚度为（109．758±9．095）μm,青光眼患者为（79．539±18．986）μm,明显低于正常人（P〈0．01）。在视盘周围8个神经纤维层区域中,正常人最厚的区域在颞下方和颞上方,分别为（150．109±18．007）μm和（146．105±15．529）μm,而青光眼患者最厚处在颞上方和颞下方,分别为（104．354±27．641）μm和（102．436±32．243）μm,但均较正常参数减小。正常人和青光眼患者鼻侧和颞侧视网膜神经纤维层厚度均较薄。视盘参数中,各型青光眼诊断效能最高的是盘沿容积和垂直杯盘比,二者的ROC值在总青光眼患者中分别为0．850和0．840,其特异性在80％时的敏感性分别为73．1％和76．1％,在开角型青光眼患者中分别为0．841和0．849,其特异性在80％时的敏感性分别为73．0％和81．1％,在闭角型青光眼患者中分别为0．862和0．830,其特异性在80％时的敏感性分别为73．3％和70．O％。视网膜神经纤维层厚度各参数中,诊断效能最高的是平均神经纤维层厚度,其ROC值在总青光眼、开角型青光眼、闭角型青光眼中分别为0．925、0．910和0．942,其特异性在80％时的敏感性分别为89．6％、89．2％和90．0％。视盘周围8个神经纤维层区域中,诊断效能最高的是IT区域,诊断效能最低的是TU和TL区域。结论RTVueOCT具有很好地区别正常人和青光眼患者的能力,在青光眼诊断方面是一个较实用的工具。     

Evaluation of spectral domain optical coherence tomography parameters in discriminating preperimetric glaucoma from high myopia

AIM: To evaluate the diagnostic ability of macular ganglion cell-inner plexiform layer (GCIPL) thickness obtained by spectral-domain optical coherence tomography (SD-OCT) in discriminating non-highly myopic eyes with preperimetric glaucoma (PPG) from highly myopic healthy eyes. METHODS: A total of 254 eyes, including 76 normal controls (NC), 116 eyes with high myopia (HM) and 62 non-highly myopic eyes with PPG were enrolled. The diagnostic ability of OCT parameters was accessed by the areas under the receiver operating characteristic (AUROC) curve in two distinguishing groups: PPG eyes with non-glaucomatous eyes including NC and HM (Group 1), and PPG eyes with HM eyes (Group 2). Differences in diagnostic performance between GCIPL and RNFL parameters were evaluated. RESULTS: The minimum (AUROC curve of 0.782), inferotemporal (0.758) and inferior (0.705) GCIPL thickness were the top three GCIPL parameters in discriminating PPG from non-glaucomatous eyes, all of which had statistically significant lower diagnostic ability than average RNFL thickness (0.847). In discriminating PPG from HM, the best GCIPL parameter was minimum (0.689), statistically significant lower in diagnostic ability than average RNFL thickness (0.789) and three other RNFL thickness parameters of temporal and inferotemporal clock-hour sectors. CONCLUSION: The minimum GCIPL thickness is the best GCIPL parameter to detect non-highly myopic PPG from highly myopic eyes, whose diagnostic ability is inferior to that of average RNFL thickness and RNFL thickness of several temporal and inferotemporal clock-hour sectors. The average RNFL thickness is recommended for discriminating PPG from highly myopic healthy eyes in current clinical practice in a Chinese population.     

Structural measurements and vessel density of spectral-domain optic coherence tomography in early, moderate, and severe primary angle-closure glaucoma

AIM: To compare the macular ganglion cell-inner plexiform layer (GCIPL) thickness, retinal nerve fiber layer (RNFL) thickness, optic nerve head (ONH) parameters, and retinal vessel density (VD) measured by spectral-domain optical coherence tomography (SD-OCT) and analyze the correlations between them in the early, moderate, severe primary angle-closure glaucoma (PACG) and normal eyes. METHODS: Totally 70 PACG eyes and 20 normal eyes were recruited for this retrospective analysis. PACG eyes were further separated into early, moderate, or severe PACG eyes using the Enhanced Glaucoma Staging System (GSS2). The GCIPL thickness, RNFL thickness, ONH parameters, and retinal VD were measured by SD-OCT, differences among the groups and correlations within the same group were calculated. RESULTS: The inferior and superotemporal sectors of the GCIPL thickness, rim area of ONH, average and inferior sector of the retinal VD were significantly reduced (all P<0.05) in the early PACG eyes compared to the normal and the optic disc area, cup to disc ratio (C/D), and cup volume were significantly higher (all P<0.05); but the RNFL was not significant changes in early and moderate PACG. In severe group, the GCIPL and RNFL thickness were obvious thinning with retinal VD were decreasing as well as C/D and cup volume increasing than other three groups (all P<0.01). In the early PACG subgroup, there were significant positive correlations between retinal VD and GCIPL thickness (except superonasal and inferonasal sectors, r=0.573 to 0.641, all P<0.05), superior sectors of RNFL thickness (r=0.055, P=0.049). More obvious significant positive correlations were existed in moderate PACG eyes between retinal VD and superior sectors of RNFL thickness (r=0.650, P=0.022), and temporal sectors of RNFL thickness (r=0.740, P=0.006). In the severe PACG eyes, neither GCIPL nor RNFL thickness was associated with retinal VD. CONCLUSION: The ONH damage and retinal VD loss appears earlier than RNFL thickness loss in PACG eyes. As the PACG disease progressed from the early to the moderate stage, the correlations between the retinal VD and RNFL thickness increases.     

Retinal nerve fiber layer measurement by optical coherence tomography in glaucoma suspects with short-wavelength perimetry abnormalities

PURPOSE: To compare retinal nerve fiber layer (RNFL) measurements in normal and glaucoma subjects with short-wavelength automatic perimetry (SWAP) abnormalities and in chronic primary open-angle glaucoma (CPOAG) patients using optical coherence tomography (OCT). METHODS: Forty-eight eyes of normal subjects, 34 eyes of glaucoma suspects with SWAP abnormalities, and 38 eyes of early CPOAG subjects were recruited. All normal and glaucoma suspects had normal conventional automated perimetry visual field results. All participants underwent full clinical ophthalmologic evaluation followed by OCT RNFL measurements. RESULTS: Compared with normal controls, OCT RNFL thickness was significantly lower in glaucoma suspects with abnormal SWAP (inferotemporal and superotemporal thickness values) and CPOAG patients (average, superior, inferior, inferotemporal, and superotemporal thickness values) (P < 0.01). Some parameters were found to be significantly lower in CPOAG patients than the glaucoma suspects with abnormal SWAP (average, inferior, inferotemporal, and superotemporal thickness values) (P < 0.01). CONCLUSIONS: OCT RNFL measurements appear to correlate well with SWAP abnormalities in glaucoma, and may detect glaucomatous damage earlier than standard conventional automated perimetry. This study suggests that OCT may recognize the earliest evidence of structure alterations in CPOAG.     

频域光学相干断层扫描在视网膜神经纤维层厚度测量中的应用

目的应用频域光学相干断层扫描（OCT）测量非青光眼受试者和青光眼患者的视盘周视网膜神经纤维层（RNFL）厚度,并对测量结果进行重复性检验。方法非青光眼受试者和青光眼患者各30例纳入研究,随机选取受试者一侧眼的数据进行统计分析。应用Spectralis OCT对每位受试者进行视盘周RNFL厚度测量,应用“随诊”模式进行3次扫描。计算出受试者内部标准筹（Sw）、变异系数（CV）和同类相关系数（ICC）,以评价该仪器测量的可重复性。应用Spearman秩相关系数分析评估每位受试者RNFL厚度平均数值与其3次测量的标准差之间的天系。结果非青光眼受试者的CV数值范围为1．44％（全周厚度平均值）～2．58％（颞侧象限）,青光眼患者的CV为1．73％（全周）～3．24％（颞侧象限）;非青光眼受试者的ICC数值范围为0．977（颞侧象限）～0．990（鼻下45。扇形区）,青光眼患者的ICC数值范围为0．981（颞侧象限）～0．997（下方象限）;非青光眼受试者的Sw为1．33μm（全周）～2．36μm（颞上45°扇形区）,青光眼患者的Sw为1．13μm（全周）～2．26μm（鼻上45。扇形区）;RNFL厚度数值与测量变异性间无明显相关性（P〉0．05）。结论高速扫描和眼跟踪系统使Spectralis OCT在测量非青光眼受试者和青光眼患者的视盘周RNFL厚度均有良好的可重复性,是青光眼长期随诊中对于其结构性损害可信赖的影像学检查技术。     

Increasing scans per examination improves the reproducibility on retinal nerve fiber layer measurements by optical coherence tomography.

PURPOSE: To investigate whether increasing the number of scans per examination would improve the reproducibility of retinal nerve fiber layer (RNFL) measurements by optical coherence tomography (OCT) in healthy and glaucomatous eyes. METHODS: A total of 28 eyes of 28 healthy subjects and 20 eyes of 20 patients with primary chronic open-angle glaucoma were recruited. OCT RNFL assessments were obtained in one randomly selected eye. Each subject underwent seven scans on five separate occasions within a 1-month period. RESULTS: In the healthy group, the intervisit mean coefficient of variations (COV's) for the average RNFL thickness (100 sampling points) and the quadrant RNFL measurements (25 sampling points) were similar in a series of three, five, and seven scans per examination (p > 0.05), but COV's for the two clock-hour segment measurements (seven sampling points, superotemporal and inferotemporal) were significantly lower in a series of five and seven scans per examination than that of three scans per examinations (p < 0.01). In the glaucoma groups, COV's for the two quadrant (superior and inferior) and five clock-hour segment RNFL measurements (superior, superotemporal, temporal, inferotemporal, and superonasal) were significantly lower in a series of five and seven scans per examination than that of three scans per examination (p < 0.01). There was no statistical difference in the COV's between a series of five scans and that of seven scans per examination in all OCT RNFL thickness parameters in healthy and glaucomatous eyes (p > 0.05). Similar results were observed with intravisit COV comparisons. CONCLUSION: Increasing the number of scans per examination may improve the reproducibility of quadrant and clock-hour segment OCT RNFL measurements in healthy and glaucomatous eyes. A series of five scans per examination is recommended for OCT RNFL measurements.     

青光眼患者小梁切除术后视盘及其周围血流密度的变化

目的　应用光学相干断层扫描血管成像（optical coherence tomography angiography,OCTA）观察青光眼患者小梁切除术后视盘和视盘周围血流密度的变化。方法　前瞻性纳入确诊为原发性青光眼并顺利完成现代复合小梁切除术的34例（52眼）患者为研究对象。对所有患眼术前及术后1周行眼压、OCT和OCTA等检查。观察手术前后患眼的眼压、视网膜神经纤维层（retinal nerve fiber layer,RNFL）厚度、神经节细胞复合体厚度、C/D值及视盘整体血流密度、视盘周围血流密度、视盘周围不同区域血流密度的变化。结果　术后1周眼压为（10.88±4.26）mmHg（1 kPa=7.5 mmHg）,与术前的（19.88±5.22）mmHg相比,差异具有统计学意义（P=0.002）。术后1周患眼C/D值、RNFL厚度和神经节细胞复合体厚度与术前相比,差异均无统计学意义（均为P>0.05）。术后1周视盘整体血流密度和视盘周围血流密度分别为（50.73±5.74）%和（42.77±4.32）%,与术前的（49.34±7.27）%和（39.38±2.75）%相比,差异均有统计学意义（P=0.028、0.021）。术后视盘周围鼻上、鼻侧、鼻下、颞侧和颞下血流密度与术前相比,差异均无统计学意义（均为P>0.05）;颞上血流密度术前及术后1周分别为（42.72±6.89）%和（43.09±6.83）%,差异有统计学意义（P=0.033）。术后视盘整体血流密度和视盘周围血流密度的增加仅与术后眼压下降值有关,与年龄、术前眼压、C/D值、神经节细胞复合体厚度及RNFL厚度均无相关性。结论　青光眼患者小梁切除术后OCTA检查提示,随着眼压的下降,视盘区整体血流密度以及视盘周围血流密度显著增加。