OCT测量黄斑区神经节细胞复合体厚度在早期原发性开角型青光眼诊断中的作用

目的利用光学相干断层扫描技术(optical coherence tomography,OCT)比较正常人和早期原发性开角型青光眼(primary open-angle glaucoma,POAG)患者黄斑区神经节细胞复合体(ganglion cell complex,GCC)厚度的差异,评价其对早期POAG的诊断价值。方法选取早期POAG患者46例(46眼)为早期POAG组,正常人50人(50眼)为正常组,利用RT-Vue-100FD-OCT GCC程序记录2组黄斑区平均、上方及下方GCC厚度,分析2组黄斑区不同区域GCC厚度差异,确定OCT测量黄斑区GCC厚度值对早期POAG的最佳诊断指标。结果正常组黄斑区平均、上方及下方GCC厚度值分别为(104.76±5.96)μm、(104.89±6.73)μm、(104.61±6.37)μm,各区域厚度值间对比差异无统计学意义(P>0.05);早期POAG组黄斑区平均、上方及下方GCC厚度值分别为(88.81±7.50)μm、(89.04±8.84)μm、(89.07±7.92)μm,各区域GCC厚度值比较差异无统计学意义(P>0.05);早期POAG组黄斑区不同区域GCC厚度值较正常组明显变薄,2组间比较差异均有显著统计学意义(均为P<0.01)。正常人和早期POAG之间黄斑区平均、上方、下方GCC厚度的受试者工作特征曲线下面积分别为0.899、0.894、0.903。结论 OCT测量黄斑区GCC厚度可作为早期POAG的一种辅助诊断方法。     

频域OCT测量正常学龄期儿童黄斑区视网膜厚度

目的　应用频域ＯＣＴ测量正常学龄期儿童的黄斑区视网膜厚度。方法　选取６～１２岁儿童１０８人,以最佳矫正远视力≥１．０、最佳矫正近视力Ｊｒ１、球镜屈光度范围（－１．００～＋１．００Ｄ）、柱镜屈光度范围（－１．００～＋１．００Ｄ）为纳入标准,最终选取２１３眼。应用ＣｉｒｒｕｓＨＤ-ＯＣＴ的２００×２００扫描模式和５１２×２１８扫描模式对受试者双眼黄斑区视网膜进行检查,测量黄斑中心视网膜厚度（ｃｅｎｔｒａｌｓｕｂｆｉｅｌｄｔｈｉｃｋｎｅｓｓ,ＣＳＴ）、黄斑区视网膜容积（ｍａｃｕｌａｒｖｏｌｕｍｅ,ＭＶ）、黄斑区平均视网膜厚度（ａｖｅｒａｇｅｍａｃｕｌａｒｔｈｉｃｋｎｅｓｓ,ＡＭＴ）及九分区模式视网膜厚度。结果　两种扫描模式下黄斑区视网膜厚度值差异均无统计学意义（均为Ｐ＞０．０５）。左右眼差异无统计学意义（均为Ｐ＞０．０５）。男童ＣＳＴ（２４０．６８±１６．５７）μｍ厚于女童（２３４．５１±１８．６５）μｍ（Ｐ＝０．０４０）,且男童内环各分区视网膜厚度均厚于女童（均为Ｐ＜０．０５）。结论　本研究应用ＨＤ-ＯＣＴ测量正常儿童ＡＭＴ,为确定国人学龄期儿童ＡＭＴ正常值及疾病诊断提供参考,提示临床注意性别差异。     

Diagnostic ability of ganglion cell complex thickness to detect glaucoma in high myopia eyes by Fourier domain optical coherence tomography

AIM: To evaluate the ability of macular ganglion cell complex (GCC) thickness using Fourier domain optical coherence tomography (FD-OCT) to detect glaucoma in highly myopic eyes. METHODS: Cross-sectional study. A total of 114 participants, consecutively were enrolled. Macular GCC thickness and peripapillary retinal nerve fiber layer (RNFL) thickness were obtained with RTVue FD-OCT. Receiver operating characteristics curves were constructed for each measurement parameter, and areas under the curves (AUCs) were compared. RESULTS: Both the average GCC and average RNFL thickness showed negative correlations with axial length (rGCC=-0.404, P=0.001; rRNFL=-0.561, P<0.001). The largest AUCs from GCC, and RNFL parameters were 0.968 [global loss volume (GLV)], and 0.855 (average RNFL), respectively. GLV was significantly better for detecting high myopic glaucoma than average RNFL (P<0.001). CONCLUSION: Macular GCC thickness has higher diagnostic power than peripapillary RNFL thickness to discriminate glaucoma patients from non-glaucoma subjects in high myopia.     

Comparison of peripapillary and macular choroidal thickness and ganglion cell complex thickness in glaucomatous and healthy eyes

AIM: To assess choroidal thickness (CT) and its association with ganglion cell-inner plexiform layer thickness (GCIPLT) and retinal nerve fiber layer thickness (RNFLT) in open angle glaucoma (OAG) comparing with preperimetric glaucoma (PPG) and normal eyes. METHODS: Totally 55 eyes of OAG, 40 eyes of PPG, and 40 eyes of age-matched normal eyes were studied. Peripapillary CT (PCT), macular CT (MCT), RNFLT, and GCIPLT were evaluated. Relationship between the CT with RNFLT and GCIPLT were studied. The correlation between CT and confounding variables as gender, age, intraocular pressure, and visual field mean deviation were analyzed. RESULTS: Mean PCT were 113.6±39.1 μm in OAG, 116.3±42.7 μm in PPG, and 148.9±41.7 μm in normal eyes. PCT and MCT was thinner in OAG compared to healthy eyes. There was a significant correlation for PCT and mean RNFLT in 1, 2, 6, and 7 clock hours of OAG eyes. The difference in PCT remained after adjusting for axial length, age, and disc area (P=0.003). No significant correlation was shown between MCT and mean GCIPLT in all eyes. CONCLUSION: PCT is thinner in OAG and PPG compared with healthy eyes. The correlation of RNFLT and PCT found in OAG and PPG is not revealed in normal eyes.     

三维光学相干断层扫描测量视网膜神经节细胞复合体厚度对原发性开角型青光眼诊断的意义

目的　应用三维光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）测量原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎａｎｇｌｅｇｌａｕｃｏｍａ,ＰＯＡＧ）患者的黄斑区各部位神经节细胞复合体（ｍａｃｕｌａｒｇａｎｇｌｉｏｎｃｅｌｌｃｏｍｐｌｅｘ,ｍＧＣＣ）厚度,评价其在ＰＯＡＧ诊断中的意义。方法　选取早期ＰＯＡＧ患者３０例（３０眼）,中晚期ＰＯＡＧ患者３０例（３０眼）,以正常人３０例（３０眼）作为对照,应用Ｔｏｐ-ｃｏｎ３ＤＯＣＴ-２０００测量并记录所有受试者的视盘周围各部位视网膜神经纤维层（ｐｅｒｉｐａｐｉｌｌａｒｙｒｅｔｉｎａｌｎｅｖｅｒｆｉｂｅｒｌａｙｅｒ,ｐＲＮＦＬ）和ｍＧＣＣ［包括黄斑区视网膜神经纤维层（ｍａｃｕｌａｒｒｅｔｉｎａｌｎｅｖｅｒｆｉｂｅｒｌａｙｅｒ,ｍＲＮＦＬ）、黄斑区神经节细胞层＋内丛状层（ｇａｎｇｌｉｏｎｃｅｌｌｌａｙｅｒｗｉｔｈｔｈｅｉｎｎｅｒｐｌｅｘｉｆｏｒｍｌａｙｅｒ,ＧＣＩＰ）、神经节细胞复合体（ｇａｎｇｌｉｏｎｃｅｌｌｃｏｍｐｌｅｘ,ＧＣＣ）］厚度,并对所有数据进行统计分析,应用受试者工作特征曲线下面积（ａｒｅａｕｎｄｅｒｔｈｅｒｅｃｅｉｖｅｒｏｐｅｒａｔｉｎｇｃｈａｒａｃｔｅｒｉｓｔｉｃｃｕｒｖｅ,ＡＵＲＯＣ）评价各参数对ＰＯＡＧ的诊断效力。结果　早期、中晚期ＰＯＡＧ患者各部位的ｐＲＮＦＬ厚度及ｍＧＣＣ厚度值随着青光眼的严重程度逐渐变薄。早期ＰＯＡＧ患者与正常人相比,除了ｍＲＮＦＬ厚度和部分ｐＲＮＦＬ厚度（鼻侧和颞侧）参数差异无统计学意义（均为Ｐ＞０．０５）外,其余的各项参数间差异均有统计学意义（均为Ｐ＜０．０５）。中晚期ＰＯＡＧ患者与正常人相比、早期ＰＯＡＧ患者与中晚期ＰＯＡＧ患者相比,各项参数间差异均有统计学意义（均为Ｐ＜０．０５）。早期ＰＯＡＧ患者ｍＲＮＦＬ、ＧＣＩＰ、ＧＣＣ、ｐＲＮＦＬ平均值的ＡＵＲＯＣ值分别为０．６４１、０．７３１、０．７２４、０．７７５;中晚期为０．９３１、０．８３０、０．９１５、０．９４７。早期ＰＯＡＧ患者ｍＲＮＦＬ、ＧＣＩＰ、ＧＣＣ最小值的ＡＵＲＯＣ值分别为０．６７４、０．７４６、０．７３２,中晚期为０．９４２、０．８４１、０．９２８,均高于其平均值的ＡＵＲＯＣ值。除了鼻侧及颞侧ｐＲＮＦＬ厚度参数外,其余各项参数均能有效地诊断ＰＯＡＧ,差异均有统计学意义（均为Ｐ＜０．０５）。结论　ｍＧＣＣ厚度参数与ｐＲＮＦＬ厚度参数对ＰＯＡＧ的诊断效力相当,可作为ＰＯＡＧ诊断的一个新指标。     

Flow patterns on spectral‐domain optical coherence tomography reveal flow directions at retinal vessel bifurcations

Purpose:  To study intravascular characteristics of flowing blood in retinal vessels using spectral‐domain optical coherence tomography (SD‐OCT). Methods:  Examination of selected arterial bifurcations and venous sites of confluence in 25 healthy 11‐year‐old children recruited as an ad hoc subsample from the population‐based, observational Copenhagen Child Cohort 2000 study. Results:  The blood stream in retinal arteries maintains a figure‐of‐8 SD‐OCT profile consistent with a laminar flow in concentric sheets and a parabolic velocity distribution up to the point of divergence at arterial bifurcations. In contrast, the blood stream at the site of confluence of two retinal veins remains divided into two parallel sets of sheets with separate velocity distribution for a downstream distance of at least four trunk vessel diameters. Consequently, retinal trunk vessels near bifurcations/confluences have distinctly different internal SD‐OCT profiles, a figure‐of‐8 pattern in arteries and a figure figure‐of‐88 in veins that can be used to distinguish between the two vessel types. Conclusion:  This study verified the hypothesis that directions of blood flow at dichotomous vascular branchings can be determined using SD‐OCT. This feature may assist the identification of flow reversal near sites of vascular occlusion, the analysis of blood flow near vascular malformations and the segmentation of retinal SD‐OCT images.     

频域OCT检测青光眼视网膜神经节细胞复合体厚度的研究

背景 青光眼以视网膜神经节细胞( RGCs)丢失为主要的病理特征,频域光学相干断层扫描(SD-OCT)可以检测黄斑区视网膜神经节细胞复合体(GCC)厚度. 目的 探讨黄斑区视网膜GCC厚度在原发性开角型青光眼(POAG)人群的分布特征. 方法 采用系列病例对照研究设计.利用SD-OCT( RTVue100)和时域OCT(TD-OCT)技术分别检测POAG患者101例101眼和年龄、屈光度相匹配的正常对照者41例41眼视网膜的黄斑区整体平均GCC厚度(GCC-Avg)、上方平均GCC厚度(GCC-Sup)和下方平均GCC厚度(GCC-Inf)及对应区域视盘旁视网膜神经纤维层(RNFL)厚度,按照POAG的程度分为视野损害前POAG组、早期POAG组、进展期POAG组和晚期POAG组,比较各POAG组与正常对照组间上述3个GCC参数的差异,分析GCC厚度和RNFL厚度的相关性以及青光眼患者视野平均缺损值(MD)与GCC厚度的相关性. 结果 视野损害前POAG组、早期POAG组GCC-Avg、GCC-Sup和GCC-Inf值均明显低于正常对照组,差异均有统计学意义( GCC-Avg:t=5.411、10.247,P＜0.01:GCC-Sup:t=6.171、9.484,P＜0.01; GCC-Inf:t=5.281、8.592,P＜0.01).进展期POAG组GCC-Avg、GCC-Sup和GCC-Inf值均明显低于早期POAG组,差异均有统计学意义(GCC-Avg:t =4.246,P＜0.01;GCC-Sup:t=2.419,P=0.019;GCC-Inf:t=4.636,P＜0.01),而晚期POAG组GCC-Avg、GCC-Sup和GCC-Inf值均明显低于进展期POAG组,差异均有统计学意义(GCC-Avg:t=2.095,P=0.040;GCC-Sup:t=2.756,P＜0.01;GCC-Inf:t=2.018,P=0.040).GCC-Sup、GCC-Inf和GCC-Avg值与对应区域平均RNFL厚度值均呈高度正相关(r=0.802、0.825、0.856,P＜0.01),青光眼患者的视野MD值与GCC-Avg值呈正相关( r=0.601,P＜0.01). 结论 SD-OCT能够定量测量并区分青光眼患者与正常人群的黄斑区GCC厚度,GCC厚度随青光眼病情的进展而逐渐变薄,并与RNFL和视野的损害有较好的相关性.     

OCT测量垂体瘤患者视网膜神经节细胞复合体及神经纤维层厚度的初步探讨

目的通过相关光断层扫描(OCT)测量垂体瘤患者黄斑区视网膜神经节细胞复合体(GCC)及视盘周围视网膜神经纤维层(pRNFL)厚度,初步探讨OCT检测垂体瘤患者视功能损害的意义。设计回顾性病例系列。研究对象2010年5-12月北京天坛医院神经外科诊治的垂体瘤患者61例(122眼)。方法 RTVue 100型傅立叶OCT检测患者黄斑区GCC及pRNFL厚度,并与相应视野平均缺损(MD)、平均敏感度(MS)进行相关性分析。主要指标黄斑区GCC平均厚度、pRNFL平均厚度,Pearson相关系数。结果垂体瘤患者黄斑区GCC薄变者平均厚度为77.2μm(左眼,n=25)、80.3μm(右眼,n=19);pRNFL薄变者平均厚度为86.1μm(左眼,n=24)、89.1μm(右眼,n=21)。平均pRNFL厚度与视野MD的相关系数为0.475~0.596(P=0.000),GCC厚度与视野MD的相关系数为0.437~0.500(P=0.000)。结论傅立叶OCT检测的pRNFL及GCC平均厚度有可能定量反映垂体瘤患者的视功能损害程度。     

Multicenter Spanish study of spectral‐domain optical coherence tomography in normal children

Purpose: To compile a multicenter normative database of retinal nerve fibre layer (RNFL) and macular thicknesses and macular volume values in healthy Caucasian children 4–17 years using spectral‐domain optical coherence tomography (SD‐OCT). To analyse variations in the OCT measurements as a function of age, sex, refraction, and axial length (AL). Methods: An observational, multicenter and cross‐sectional study among 301 healthy Caucasian children recruited at three Spanish centres was performed. To compile the database, each child underwent a dilated eye examination and a cycloplegic refraction, five AL measurements (IOL Master; Carl Zeiss Meditec, Dublin, CA, USA), five OCT scans with Cirrus OCT: three peripapillary RNFL scans (Optic Disc Cube 200X200 protocol) and two macular scans (Macular Cube 512X128 protocol). One eye of each subject was selected randomly for analysis. Results: Two hundred eighty‐three children (117 boys, 41.34%; 166 girls, 58.66%) were included in this study. The mean age of the children was 9.58 ± 3.12 years (range, 4–17). The mean SE was +0.63 ± 1.65 D; (range, ?4.88 to +5.25). The mean AL was 22.94 ± 1.10 mm (range, 20.10–26.27). The mean global RNFL thickness was 97.40 ± 9.0 μm (range, 77–121.7 μm). Multivariate analysis showed a positive correlation between the RNFL and spherical equivalent (SE) (p = 0.014). The mean central macular thickness was 253.85 ± 19.76 μm, the average thickness 283.62 ± 14.08 μm, and the mean macular volume 10.22 ± 0.49 μm³. Multivariate analysis showed a positive correlation between central macular thickness and age (p < 0.001). Boys had a significantly thicker central macula than girls (p < 0.001). Conclusions: Normative paediatric SD‐OCT data might facilitate use of SD‐OCT for assessing childhood ophthalmic diseases. This study provides a multicenter paediatric normative database of SD‐OCT peripapillary RNFL and macular data.     

频域OCT对正常中青年人黄斑区视网膜厚度的测量研究

目的研究频域Cirrus HD-OCT测量中青年人黄斑区视网膜厚度正常值。设计横断面研究。研究对象18～36岁的正常人98例196眼。方法用Cirrus HD-OCT的512×128及200×200两种扫描模式对受试者双眼黄斑区进行检测。主要指标黄斑中心区视网膜厚度,黄斑区视网膜体积,黄斑区平均视网膜厚度。结果采用512×128扫描模式,黄斑中心区视网膜厚度为(242.41±20.02)μm,黄斑区视网膜体积为(10.01±0.60)mm3,黄斑区平均视网膜厚度为(280.71±12.41)μm。九个分区视网膜平均厚度之间除了内环上方与内环鼻侧及内环颞侧与外环鼻侧之间无显著性差异外,其余各区之间均有显著性差异。左右眼之间差异无统计学意义。采用512×128及200×200两种扫描模式所测结果差异无统计学意义。结论频域Cirrus HD-OCT测量的正常中青年人黄斑区视网膜厚度较文献报告的Stratus OCT约厚50μm,在临床上进行比较时应注意仪器差异。     

Unilateral choroidal excavation in the macula detected by spectral‐domain optical coherence tomography

Purpose: To report clinical findings of three patients with unilateral peculiar choroidal excavation in the macula detected by spectral‐domain (SD) optical coherence tomography (OCT). Methods: Three cases with unilateral choroidal excavation in the macula detected by SD OCT. Fluorescein angiography (FA), indocyanine green angiography (IA), ultrasonography, visual field tests and multifocal electroretinography (mfERG) were performed. Results: Although all three patients complained of metamorphopsia, visual acuity and central visual field were normal in the affected eyes. SD OCT demonstrated choroidal excavation in the macula despite a normal foveal contour along the inner retinal surface. The excavation involved the outer retinal layers up to the external limiting membrane in cases 1 and 2, while only the retinal pigment epithelium was involved in case 3. The excavation corresponded to foveal pigment mottling in cases 1 and 2 and to a parafoveal yellowish fusiform lesion in case 3. The lesions appeared hypoautofluorescent and unremarkable in FA except for circumferential hyperfluorescence in case 3 and hypofluorescent in IA. B‐scan ultrasonography was unremarkable. MfERG in cases 1 and 2 was normal. Conclusions: SD OCT demonstrated two types of choroidal excavation in the macula. More case accumulation and a longer follow‐up will elucidate the pathogenesis and prognosis of the lesions.     

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。     

Retinal ganglion cell complex changes using spectral domain optical coherence tomography in diabetic patients without retinopathy

AIM: To assess the ganglion cell complex (GCC) thickness in diabetic eyes without retinopathy. METHODS: Two groups included 45 diabetic eyes without retinopathy and 21 non diabetic eyes. All subjects underwent full medical and ophthalmological history, full ophthalmological examination, measuring GCC thickness and central foveal thickness (CFT) using the RTVue® spectral domain-optical coherence tomography (SD-OCT), and HbA1C level. RESULTS: GCC focal loss volume (FLV%) was significantly more in diabetic eyes (22.2% below normal) than normal eyes (P=0.024). No statistically significant difference was found between the diabetic group and the control group regarding GCC global loss volume (GLV%) (P=0.160). CFT was positively correlated to the average, superior and inferior GCC (P=0.001, 0.000 and 0.001 respectively) and negatively correlated to GLV% and FLV% (P=0.002 and 0.031 respectively) in diabetic eyes. C/D ratio in diabetic eyes was negatively correlated to average, superior and inferior GCC (P=0.015, 0.007 and 0.017 respectively). The FLV% was negatively correlated to the refraction and level of HbA1c (P=0.019 and 0.013 respectively) and positively correlated to the best corrected visual acuity (BCVA) in logMAR in diabetic group (P=0.004). CONCLUSION: Significant GCC thinning in diabetes predates retinal vasculopathy, which is mainly focal rather than diffuse. It has no preference to either the superior or inferior halves of the macula. Increase of myopic error is significantly accompanied with increased focal GCC loss. GCC loss is accompanied with increased C/D ratio in diabetic eyes.