3D-OCT对早期原发性青光眼黄斑区视网膜神经节细胞复合体及神经纤维层结构变化的评估

背景 视网膜神经纤维层(RNFL)变薄被认为是能够检测到的青光眼最早期的改变,3D-OCT对黄斑区神经节细胞复合体(mGCC)厚度的检测使得检测黄斑区节细胞的改变成为可能,为更早发现和诊断青光眼提供思路. 目的 利用3D-OCT检查系统检测早期原发性青光眼mGCC厚度及视盘周围RNFL厚度的变化,评估早期原发性青光眼视神经损害的解剖基础. 方法 对2010年12月至2012年12月在中日友好医院眼科就诊的一眼为中晚期而对侧眼为早期的原发性青光眼的10例患者采集的3D-OCT扫描图像进行回顾性分析.所有患者均符合1987年中国青光眼学组推荐的诊断标准,临床检查资料完整.患者均接受常规眼科检查和眼底3D-OCT检查,分别采用3D-macular模式、3D-macular Wide模式和3D-disc模式对原发性青光眼黄斑区、后极部和视盘进行扫描,利用检查系统自带软件对黄斑6 mm×6 mm区域的扫描结果进行分析,由黄斑中心凹向外各方向等距离分成100个小格区,每个格区面积为0.6 mm×0.6 mm,按照mGCC的变薄程度由重到轻依次以红色、黄色和灰色标记,以每个小格中的数字与其正常值比较得到与颜色匹配的、mGCC变薄程度发生的概率值(依次为P＜1％、P＜5％、P≥5％)表示.然后分析视盘旁RNFL厚度和不同部位的厚度曲线改变,并评估视盘生理凹陷的改变. 结果 10例患者患早期青光眼的眼和对侧眼视细胞层和双极细胞层厚度均未发生改变,而患中晚期青光眼的一侧眼视盘周围RNFL厚度概率图呈红色,即视盘周围RNFL层厚度明显变薄,mGCC厚度概率和黄斑区RNFL厚度概率图呈红色,即mGCC和黄斑区RNFL层厚度明显变薄;而患早期青光眼的一侧眼视野均正常,mGCC厚度概率图和黄斑区RNFL区呈黄色,即mGCC和黄斑区RNFL厚度轻微变薄;视盘周围RNFL厚度概率图呈绿色或黄色,即视盘周围RNFL厚度正常或轻微变薄.结论 原发性青光眼mGCC层厚度变薄早于视盘周围RNFL的变薄,提示青光眼视神经结构的损害始于RGCs的细胞体并早于轴突的损伤或丢失.     

OCT检测青光眼视网膜神经纤维层局部缺损的临床研究

背景传统眼底照相的方法诊断视网膜神经纤维层（RNFL）局部缺损依赖于检查者的主观经验,而光学相干断层扫描（OCT）可以客观判断RNFL的局部缺损,新的频域OCT对RNFI,缺损的显示更直观。目的评价频域OCT、时域OCT对青光眼RNFL局部缺损的诊断价值及其与眼底彩色照相的一致性。方法由2位青光跟专家通过眼底彩色照相一致确认存在RNFL局部缺损的青光眼患者55例55眼和正常对照41名41眼纳入研究,分析眼底彩色照相、频域CirrusHD-OCT、时域Stratus OCT分别检测的RNFL局部缺损的位置和宽度,进行三者检测结果的一致性和相关性研究,评价OCT对RNFL局部缺损的诊断价值。结果确认青光眼患者55眼中共有RNFL局部缺损75处,分别位于颞上和颞下象限。CirrusHD-OCT和Stratus OCT检测RNFL损害的灵敏度分别是88．O％和69．3％,特异度分别是927％和97．6％。CirrusHD-OCT和Stratus OCT检测RNFL缺损的位置均与眼底彩色照相结果的检测值呈高度正相关（r=0．993、r=0．992,P〈0．01）;二者检测的RNFL缺损宽度与眼底彩色照相结果的检测值呈正相关（r=0．420、r=0．432,P=0．019、P=0．002）,CirrusHD-OCT和Stratus OCT检测RNFL缺损宽度与眼底彩色照相的检测值比较差异均无统计学意义（CirrusHD-OCT：P=0．114;Stratus OCT：P：0．074）。CirrusHD-OCT和Stratus-OCT检测RNFL缺损宽度值差异有统计学意义（P：0．002）。结论频域OCT和时域OCT均具有较好的诊断RNFL局部缺损的价值,与眼底彩色照相检测值有较好的一致性。     

Retinal nerve fiber layer thinning in Parkinson disease

Retinal dopamine loss in Parkinson disease (PD) is reflected by visual neurophysiological dysfunction. We measured the thickness of the circumpapillary retinal nerve fiber layer (RNFL) in PD patients using optical coherence tomography. The thickness in the inferior quadrant of PD patients (147 +/- 20 microns) was significantly thinner than that of controls (173 +/- 12 microns; p=0.002), while the inferotemporal area was the thinnest (146 +/- 24 vs. 191 +/- 21 microns; p=0.0003). The results show significant loss of RNFL thickness in PD at specific sites.     

Improved reproducibility of retinal nerve fiber layer thickness measurements with the repeat-scan protocol using the Stratus OCT in normal and glaucomatous eyes

Background  Optical coherence tomography has become within the last years an established imaging technique with many applications in ophthalmology, and an important tool which contributes to earlier and more accurate diagnosis of glaucoma. As a consequence, detection sensitivity is highly valued. The aim of this study was to assess the reproducibility of peripapillary retinal nerve fiber layer (RNFL) thickness measurements by the Stratus Optical Coherence Tomograph (OCT) using the Fast- and Repeat-scan protocols in normal and glaucomatous eyes. Methods  In the clinical setting, RNFL thickness measurements were obtained from a control group of 40 subjects, consisting of 20 normal volunteers and 20 glaucoma patients. One eye was randomly chosen from each subject, and underwent five RNFL thickness measurements with the Fast- and five with the Repeat-scan protocol, which was also based on the Fast-scan mode. Reproducibility was assessed by the intraclass correlation coefficient (ICC) and the coefficient of variation (CV) for the overall mean RNFL thickness and for each quadrant and clock hour of the peripapillary area. Results  The Repeat-scan protocol yielded higher ICC and lower CV values in all quadrants and clock hours of the peripapillary area, both in normal and glaucomatous subjects. The difference in CV values between Fast- and Repeat-scan protocol measurements reached statistical significance in the temporal quadrant (P = 0.021) and in clock hour sectors 8, 9 and 12 (P = 0.022, 0.017 and 0.03 respectively). ICC (and CV) for the temporal-, superior-, nasal- and inferior-quadrant RNFL thickness was: for the Fast-scan protocol, 0.913 (7.4%), 0.925 (6.97%), 0.828 (10.31%), 0.964 (4.89%) respectively; and for the Repeat-scan protocol, 0.965 (5.08%), 0.958 (5.26%), 0.906 (8.12%) 0.968 (4.6%) respectively. Conclusions  Reproducibility of RNFL thickness measurements with the Fast- and Repeat-scan protocols by the Stratus OCT is proved to be very high both in normal and glaucomatous subjects. The Repeat-scan protocol shows higher ICC and lower CV values, statistically significant especially on the temporal side of the peripapillary area, which may indicate a higher reproducibility and greater agreement of measurements. These findings support the fact that the Repeat-scan protocol might be considered as a more precise method for evaluation of RNFL thickness. No financial interests in any of the products mentioned in the study.     

Modeling the effects of aging on retinal ganglion cell density and nerve fiber layer thickness

Purpose The effects of aging on retinal nerve fiber layer (RNFL) thickness should reflect the age-related losses in retinal ganglion cells (RGCs), but published data suggest that the relative rate of thinning of RNFL thickness with age is less than predicted by age-related losses of RGCs. Therefore, the present study was undertaken to reconcile the differences in age-dependency on measures of RGCs and axons that are incorporated in normative clinical data. Methods Normative data for RNFL thickness and visual field sensitivities were obtained from the printouts of standard optical coherence tomography (OCT) and standard automated perimetry (SAP) for patients aged between 25 and 95 years, in decade steps. These data were used in models to estimate the number of RGCs underlying each measure. Results The age-related losses of RGCs derived from normative perimetry data agreed closely with published histologic data, without an age-dependent variable in the model. In contrast, the age-related losses of RGCs derived from normative total RNFL thickness data required an age-dependent decrease of 0.007 axons/μm²/year in axon density in the RNFL to account for the relatively slower rate of RNFL thinning than RGC loss. Conclusions The analysis of normative data suggests a model of age-related thinning of RNFL in which the relationship between RNFL thickness and the density of RGC axons varies with the number of neurons that are lost through normal aging. This model posits that the OCT measurement of total RNFL thickness of a normal retina represents two components: 1) an age-dependent population of RNFL axons, and 2) a non-neural component that partially compensates for the age-related decrease in axons in the nerve fiber layer.     

Age and retinal nerve fiber layer thickness measured by spectral domain optical coherence tomography

Purpose

To evaluate the association between age and peripapillary retinal nerve fiber layer (RNFL) thickness measured by Cirrus high-definition (HD) spectral domain optical coherence tomography (OCT) in healthy Korean subjects.

Methods

A total of 302 eyes from 155 healthy Korean subjects (age range, 20 to 79 years) underwent RNFL thickness measurements using the Cirrus HD-OCT. Average, quadrant, and clock-hour RNFL thickness parameters were analyzed in terms of age using linear mixed effect models.

Results

Average RNFL demonstrated a slope of -2.1 µm per decade of age (p < 0.001). In quadrant analysis, superior (-3.4 µm/decade, p < 0.001) and inferior (-2.9 µm/decade, p < 0.001) quadrants showed steeper slopes, whereas temporal (-1.1 µm/decade, p < 0.001) and nasal (-1.0 µm/decade, p < 0.001) quadrants revealed shallower slopes. Among the 12 clock-hour sectors, clock hours 6 (-4.5 µm/decade, p < 0.001) and 1 (-4.1 µm/decade, p < 0.001) showed the greatest tendency to decline with age; RNFLs of the 3 (-0.2 µm/decade, p = 0.391) and 4 (-0.6 µm/decade, p = 0.052) o''clock hour sectors did not show significant decay.

Conclusions

RNFL thickness was associated with age, especially in superior and inferior areas. The topographic distribution of correlation between age and RNFL thickness was not uniform.     

The effect of various factors on variability of retinal nerve fiber layer thickness measurements using optical coherence tomography

Purpose

To evaluate the effects of various factors on the variability of retinal nerve fiber layer (RNFL) thickness measurements using the Stratus optical coherence tomography (OCT) in normal and glaucomatous eyes.

Methods

Four hundred seventy-four subjects (103 normal eyes and 371 glaucomatous eyes) were scanned to determine the RNFL thickness measurements using the Stratus OCT. Measurements were obtained twice during the same day. The standard deviation (SD) was used to compare the variability in RNFL thickness measurements of the normal subjects to that of the glaucomatous patients. Multivariate regression analysis was used to evaluate which covariates were independent predictors of SD in overall mean RNFL thickness.

Results

The mean SD of all RNFL thickness measurements was larger in the glaucoma group except in one sector. In the multivariate regression analysis, the average signal strength (SS) and the relative SS change (difference in SS between initial and repeat scans, divided by initial SS) were independent predictors of the SD in the RNFL thickness measurements (partial R² = 0.018, 0.013; p = 0.016, 0.040, respectively).

Conclusions

Glaucomatous eyes tend to be more variable than normal eyes in RNFL thickness measurement using the Straus OCT. The average SS and the relative SS changes appear to correlate with the variability in RNFL thickness measurement. Therefore, the results of the RNFL analysis should not be interpreted independently of these factors.     

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。     

Nomogram of peripapillary retinal nerve fiber layer thickness in myopic eyes of north Indian population

Purpose:To evaluate peripapillary-RNFL thickness in myopia by Cirrus OCT among north Indian population by spherical equivalent (SE), age, gender, and axial length (AL).Methods:This was a cross-sectional study held during 2019–2020. Patients aged 18–60 years underwent ophthalmic examination including retinoscopy, AL, and OCT RNFL thickness. Persons with previous ocular surgery or ocular ailment other than refractive error were excluded. The peripapillary-RNFL thickness was noted and compared by demographic determinants.Results:We examined 300 eyes of 300 persons (mean age: 30.75 ± 8.57 years; 144 males/156 females). Among them, 224 were myopes and 76 were emmetropes (EM). The mean SE was − 3.3 ± 0.4D (range: −11.0D to + 0.37D). The mean AL was 24.61 ± 1.92 mm (22.1–29.5). Overall temporal, nasal, superior, inferior, and mean peripapillary-RNFL thickness was 66.31 ± 7.58, 78.57 ± 16.00, 120.63 ± 11.69, 116.60 ± 15.80, and 95.50 ± 10.84 mm, respectively. Temporal, nasal, superior, inferior, and mean peripapillary-RNFL thickness was 73.97 ± 8.36, 94.84 ± 7.63, 127.96 ± 8.96, 136.89 ± 6.53, and 108.34 ± 6.28 mm, respectively, in EM eyes as compared to 63.71 ± 6.18, 73.05 ± 14.24, 118.21 ± 11.53, 109.71 ± 11.50, and 91.14 ± 8.31 mm, respectively, in myopic eyes (P < 0.001). Association of peripapillary-RNFL thickness with myopia and its different grades was P < 0.001. Association of mean peripapillary-RNFL thickness with age was P > 0.005 and gender was P = 0.168. Correlation between SE and RNFL thickness was positive and significant. Correlation between AL and RNFL thickness was negative but statistically significant. Association of AL with SE was P < 0.001.Conclusion:We provide normative peripapillary-RNFL thickness in the north Indian population in order to help in screening for myopia with comorbidity such as glaucoma based on RNFL thickness.     

频域OCT检测青光眼视乳头及黄斑区容积改变的初步研究

目的通过比较青光眼和正常人视乳头旁神经纤维层容积及黄斑区神经上皮层容积的差异,分析青光眼患者视乳头和黄斑立体结构特征,探讨频域光学相干断层成像术（ED-OCT）对青光眼的诊断价值。方法采用FD-OCT对33例青光眼患者和33例正常人行视乳头及黄斑区视网膜三维立体扫描,比较青光眼患者和正常人视乳头旁和黄斑区立体结构参数差异;采用直线回归分析各参数与视野平均缺损值的相关性;计算各参数诊断青光眼的受试者工作特征曲线下面积及灵敏度、特异度。结果青光眼组和正常对照组黄斑区容积比较除黄斑中心凹直径1 mm范围内的容积差异无统计学意义外,其余8个区域差异均有统计学意义;视乳头旁神经纤维层容积（mm3）比较颞（青光眼组0.29±0.02,对照组0.32±0.04）、上（青光眼组0.49±0.28,对照组0.55±0.06）、鼻（青光眼组0.34±0.17,对照组0.35±0.05）、下（青光眼组0.47±0.29,对照组0.56±0.06）四个区域差异均有统计学意义。各参数与视野平均缺损的相关性均有统计学意义,相关系数最高的是黄斑区内环下象限的视网膜神经上皮层容积（r=0.58,P〈0.01）;受试者工作特征曲线分析结果显示黄斑区外环下象限视网膜神经上皮层容积（AROC 0.79;敏感度82%）与视乳头旁下象限神经纤维层容积（AROC 0.81;敏感度81%）具有最大面积及最佳敏感度。结论 FD-OCT检测黄斑区及视乳头旁神经纤维层立体结构特征和容积等参数的改变,有助于临床青光眼的诊断。     

单纯性近视鼻侧象限视网膜神经纤维层变薄与眼轴及屈光度的相关性研究

目的通过对单纯性近视眼变薄的鼻侧视网膜神经纤维层（RNFL）厚度与眼轴及屈光度的相关性研究，并探讨其原因。方法选取LASIK术前光学相干断层扫描（OCT）检查中发现鼻侧象限视网膜神经纤维层变薄的患者进行验光检测眼屈光度及眼A超检测眼轴并进行统计学分析。结果103例单纯性近视眼患者206眼中OCT检查发现鼻侧象限RNFL变薄者为31例61眼，占29．6％。其鼻侧象限RNFL厚度与眼轴长度成负相关关系（r=-0．885，p〈0．01）；鼻侧象限RNFL厚度与屈光度成负相关关系（r=-0．747，p〈0．01）。结论单纯性近视眼鼻侧象限RNFL层厚度随眼轴长度及眼屈光度的增加而减少。在出现异常数值时，需考虑其眼轴及屈光度的影响，综合评价数值意义。     

Reproducibility of peripapillary retinal nerve fiber layer thickness measurements with cirrus HD-OCT in glaucomatous eyes

AIM: To assess the reproducibility of Cirrus high-definition optical coherence tomography (HD-OCT; Carl Zeiss Meditec, Dublin, CA, USA) for analysis of peripapillary retinal nerve fiber layer (RNFL) thickness in glaucomatous eyes METHODS: Forty-five eyes (one eye from each glaucomatous patient) were imaged with Cirrus HD-OCT. Each eye was imaged three times by two separate operators. Intraclass correlation coefficient (ICC), coefficient of variation (CV), and test-retest variability were evaluated for both intraobserver and interobsever measurements RESULTS: In intraobserver measurements, the average RNFL thickness ICC was 0.983. CV and test-retest variability were 2.3% and 4.4 μm respectively. In quadrants ICC ranged from 0.886 to 0.956, the lowest associated with nasal quadrant and CV ranged from 3.6% to 7.7%. In interobsever measurements, the average RNFL thickness ICC was 0.979. CV and test-retest variability were 2.4% and 4.5 μm respectively. In quadrants ICC ranged from 0.886 to 0.957, the lowest associated with nasal quadrant and CV ranged from 3.8% to 8.6%. CONCLUSION: The reproducibility of Cirrus OCT for RNFL thickness is sufficiently good to be useful clinically as a measure of glaucoma progression.     

糖尿病患者早期视盘周围视网膜神经纤维层厚度及全视野闪光视网膜电图观察

目的 探讨无明显糖尿病视网膜病变(NDR)及轻、中度非增生性糖尿病视网膜病变患者(NPDR)视盘周围视网膜神经纤维层(RNFL)厚度及全视野闪光视网膜电图(ERG)的变化及其之间的关系.方法 选择在河北沧州眼科医院门诊普查的2型糖尿病(DM)患者128例(256只眼),依据检查结果按照糖尿病视网膜病变国际分期标准分为NDR组及轻、中度NPDR共3组,选择年龄相匹配的正常人38名(76只眼)作为对照组,所有受检者瞳孔散大后均行全视野闪光ERG检查判断视网膜功能并用光学相干断层扫描(OCT)对视盘周围RNFL厚度进行扫描.结果 与对照组相比,暗适应3.0反应DM各组振荡电位反应,轻、中度NPDR组b波振幅,中度NPDR组a波振幅及明适应3.0反应中度NPDR组b波振幅均下降(P＜0.05),各组明、暗适应3.0反应b波及轻、中度NPDR组暗适应3.0反应a波潜伏期均延迟(P＜0.05);DM患者视盘周围RNFL厚度较正常对照组均较薄,NDR组上方象限,轻度NPDR组上、下象限和中度NPDR组各象限及全周平均RNFL厚度与正常对照组差异有统计学意义(P＜0.05).结论 随着DM患者视网膜病变程度的增加,视网膜功能受损逐渐加重,视盘周围RNFL厚度逐渐降低,ERG与OCT两者相结合,为判断视网膜功能及预后、定量检测RNFL厚度变化提供可靠的检测依据.     

原发性慢性闭角型青光眼视网膜神经纤维层损害及相关因素研究

目的 观察原发性慢性闭角型青光眼患者(chronic primary angle closure glaucoma,CACG)活体视网膜神经纤维层(retinal nerve fiberlayer thickness,RNFL)损害;分析CACG不同房角粘连程度间RNFL差异及平均RNFL厚度和视野平均缺损(mean visual fielddefects,MD)的相关性.方法 对CACG患者36例(64只眼)和正常人82名(82只眼)用光学相干断层扫描仪(optical coherence tomography,OCT)测量RNFL厚度,比较两者间的差异;比较CACG中无房角粘连、房角粘连范嗣＜1/2和≥1/2圆周眼的RNFL损害的差异;对CACG平均RNFL与相应视野的MD值进行Pearson直线相关分析.结果 CACG平均RNFL(80.61±23.96)μm与正常人(103.7±9.92)μm比较有统计学差异(P＜0.05);CACG平均RNFL厚度在无房角粘连眼(98.46±12.34)μm、粘连范围＜1/2(93.93±14.78)μm和粘连≥1,2圆周眼(69.78±23.82)μm的RNFL的差异有统计学意义(P＜0.05).CACG平均RNFL厚度与视野缺损(MD值)呈正相关(r=0.652,P＜0.001).结论 CACG的RNFL较正常人明显减少;随着CACG病程的发展,平均RNFL厚度减少,视野平均缺损增加.     

正常人视盘周围不同直径的神经纤维层厚度测量

目的采用相干光断层扫描（OCT）观察正常人环绕视乳头周围2．4mm直径和3．4mm直径视网膜神经纤维层（RNFL）厚度,评价两者之间的差异及其临床意义。方法采用波兰哥白尼SOCT对正常人72例（118只眼）,分别进行以视乳头为中心2．4mm直径和3．4mm直径的圆周环形扫描,结果用RNFL thickness graph程序分析RNFL厚度。结果正常人常规2．4mm直径扫描的颞、上、鼻、下象限、平均RNFL厚度分别为（73．12±12．15）μm、（121．97±15．65）μm、（70．13±10．64）μm、（127．78±13．90）μm、（98．25±8．49）μm。正常人常规3．4mm直径扫描的颞、上、鼻、下象限、平均RNFL厚度分别为（54．92±8．93）μm、（96．50±11．51）μm、（55．81±8．89）μm、（97．28±9．98）μm、（76．13±6．18）μm。以年龄分组,在两种扫描直径下测得的各个象限RNFL数值及平均值比较,2．4mm直径扫描下上方,下方象限及平均数值有显著差异（P=0．024,P=O．035,P=0．024）。3．4mm直径扫描下上方象限数值有显著差异（P=0．012）。以性别和眼别分组,在两种扫描直径下测得的各个象限RNFL数值及平均值比较无统计学意义。2．4mm直径扫描下各象限与3．4mm直径扫描下各象限数值有非常显著的差异（P〈0．000）,2．4mm直径扫描下上下象限数值有非常显著性差异,鼻颞侧象限数值之间无统计学意义。3．4mm直径扫描下上下象限数值之间和鼻颞侧象限数值之间无统计学意义。结论OCT定量检测正常人RNFL厚度重复性好,采用不同的扫描直径可提供不同的RNFL厚度值,为临床诊断提供依据。     

原发性急性闭角型青光眼视网膜神经纤维层厚度变化研究

目的 观察原发性急性闭角型青光眼(APACG)首次发作后6个月内视网膜神经纤维层厚度(RNFLT)变化规律.方法 用光学相干断层扫描仪(OCT)测量首次单侧发作的APACG患者(24例)在眼压控制后3 d内、2周、1月、3月和6月时的双眼RNFLT,比较双眼各时间点RNFLT.对侧眼在发作眼眼压控制后3d内及6月时的RNFLT与正常人(55名55只眼)比较.结果 发作眼平均RNFLT在眼压控制后3 d内(121.49±23.84)μm,较对侧眼明显增加(P＜0.01);2周(107.22±24.72)μm和1月(93.58±18.37)μm与对侧眼的差异无统计学意义(P=0.31和0.08);3月(84.10±19.89)μm和6月(78.98±19.17)μm较对侧眼明显减少(P＜0.01).发作眼不同时间点的RNFLT变化均有统计学意义(P＜0.01～0.048).对侧眼在发作眼眼压控制后3 d内及6月的RNFLT和正常人比较差异无统计学意义(P=0.13～0.98).结论 APACG发作后RNFL厚度即有明显增加,发作后2周至1个月RNFL厚度趋向正常,1个月后RNFL厚度逐渐变薄,至术后6个月RNFL厚度较对侧眼和正常人明显减少.     

白内障对 OCT视网膜神经纤维层厚度测量影响的初步分析

目的：探讨白内障混浊程度对相干光断层扫描（ OCT）进行视网膜神经纤维层（ RNFL）厚度测量的影响。方法根据Emery晶状体核硬度分级标准,将核型年龄相关性白内障患者分为Ⅱ级核、Ⅲ级核、Ⅳ级核组,每组入选20只眼,分析白内障术前术后RNFL厚度测量值的差异与晶状体密度值的相关性。结果晶状体密度值每两组之间差异具有统计学意义（ P ＜0．05）。随着晶状体核混浊程度加重,晶状体密度值逐渐增加。各组间术后RNFL厚度测量值在上象限、下象限及全周平均值分别对比均无统计学意义（ P ＞0．05）。Ⅱ级核组无论上象限、下象限还是全周平均RNFL厚度测量值,手术前后分别对比均无明显差异（ P ＞0．05）。Ⅲ级核组上象限、下象限、全周平均RNFL厚度测量值术前术后分别对比具有差异性（ P ＜0．05）,其晶状体密度值与差异值均具有线性正相关（上象限r ＝0．654, P ＜0．05,下象限r ＝0．636, P ＜0．05,全周平均值r ＝0．661, P ＜0．05）。Ⅳ级核组手术前后上象限、全周平均RNFL厚度测量值具有显著性差异（ P ＜0．01）,下象限RNFL厚度测量值同样具有差异性（ P＜0．05）。晶状体密度值与RNFL术前术后差异值在下象限、全周平均值具有显著线性正相关（下象限r ＝0．811, P ＜0．01,全周平均值r ＝0．777, P ＜0．01）,在上象限具有相关性（ r ＝0．713, P ＜0．05）。结论当晶状体核混浊达到Ⅲ级以上程度时,OCT测量RNFL厚度结果可能出现误差,不能准确反映RNFL真实厚度。     

Changes in retinal thickness are correlated with alterations of electroretinogram in eyes with central retinal artery occlusion

BACKGROUND: We investigated the relationship between the retinal thickness and electroretinogram (ERG) components in patients with central retinal artery occlusion (CRAO). METHODS: The optical coherence tomographic (OCT) images and ERGs of the nine patients (six men and three women; mean age, 61.8 years) were retrospectively analyzed. The thickness of the inner and outer retinal layers at 1 and 2 mm nasal and temporal to the fovea was measured in the horizontally scanned OCT images. The ratio of the inner layer thickness/sensory retinal thickness (IT/ST ratio) was calculated. The amplitudes of the a- and b-waves of the mixed rod-cone ERGs and the photopic negative response (PhNR) of the photopic ERGs were analyzed. The ratio of the amplitude of each component in the affected eye to that of the healthy fellow eye (a/f ratio) was calculated. RESULTS: In the chronic phase (1 to 8 months after onset, eight eyes), the inner layer was significantly thinner than that in the acute phase (P = 0.0147, 0.0076, 0.002, and 0.0003 for 2 mm nasal, 1 mm nasal, 1 mm temporal, and 2 mm temporal respectively, within 5 days of onset, six eyes), while the thickness of outer layer was not significantly changed. The ERGs were recorded 6.4 +/- 1.5 days after the onset of CRAO. The median of the a/f ratio was 0.84 in the a-wave, 0.56 in the b-wave, and 0.27 in the PhNR. The IT/ST in the chronic phase was positively correlated with the a/f ratio of the amplitude of the PhNR. CONCLUSIONS: Measurement of retinal thickness by OCT can be useful for monitoring the changes following CRAO. The correlation between the retinal thickness, especially inner layer thickness, and the ERG components was determined, suggesting that the PhNR in the acute phase might be a good indicator for predicting the thinning of the damaged retina in the chronic phase.     

Inter-device agreement of retinal nerve fiber layer thickness measurements using spectral domain cirrus HD OCT

Purpose

To assess the inter-device agreement of peripapillary retinal nerve fiber layer (RNFL) thickness measurements by 2 spectral domain Cirrus HD optical coherence tomography (OCT) devices in healthy Korean subjects.

Methods

Eleven eyes of 11 healthy volunteers were enrolled in the present study. Each eye was scanned with the Optic Disc Cube 200 × 200 scan of 2 Cirrus HD OCT devices for peripapillary RNFL thickness calculation. The inter-device agreements of the 2 Cirrus HD OCTs for average, quadrant, and clock-hour RNFL thickness values were determined with Wilcoxon signed rank test, Friedman test, Cronbach''s alpha (α), intraclass correlation coefficient (ICC), coefficient of variation (COV), and Bland-Altman plot.

Results

The mean age of the participants was 25.82 ± 3.28 years and all had a 0.00 logarithm of the minimum angle of resolution of best-corrected visual acuity. The signal strengths of scans from the 2 Cirrus HD OCT were not significantly different (p = 0.317). The inter-device agreement of average RNFL thickness was excellent (α, 0.940; ICC, 0.945; COV, 2.45 ± 1.52%). However, the agreement of nasal quadrant RNFL thickness was not very good (α, 0.715; ICC, 0.716; COV, 5.72 ± 4.64%). Additionally, on the Bland-Atman plot, the extent of agreement of the 2 Cirrus HD OCTs for RNFL thickness was variable according to scanned sectors.

Conclusions

The inter-device agreement of 2 spectral domain Cirrus HD OCT devices for peripapillary RNFL thickness measurements was generally excellent but variable according to the scanned area. Thus, physicians should consider this fact before judging a change of RNFL thicknesses if they were measured by different OCT devices.