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。     

Effect of Aging on Retinal Nerve Fiber Layer Thickness in Normal Asian Indian Eyes: A Longitudinal Study

Purpose: To determine longitudinal retinal nerve fiber layer (RNFL) thickness measurement change with aging, after a period of 3 years using spectral optical coherence tomography/scanning laser ophthalmoscope (OCT/SLO).

Methods: A total of 50 eyes of 25 normal subjects underwent RNFL thickness measurement in 2008 and again in 2011 by a single operator, using spectral OCT/SLO. Measurements were compared at baseline and at follow-up. Linear mixed model analysis was used to measure the effect of age on RNFL thickness measurements over the 3 years.

Results: Mean RNFL thickness was 107.92 ± 11.1 µm in 2008 and 106.56 ± 10.8 µm in 2011. For every year increase in age, mean RNFL thickness showed a statistically significant decrease by ?0.54 µm (95% confidence interval, ?0.76 to ?0.31; p < 0.0001). There was a statistically significant loss of peripapillary RNFL thickness in most RNFL regions, except for the temporal quadrant (p = 0.37) and corresponding 7, 8, 9, and 10 o’clock hour sectors (p = 0.72, 0.75, 0.17, 0.14, respectively).

Conclusion: RNFL thickness as measured by spectral OCT/SLO decreased significantly with advancing age over a period of 3 years, and was not uniform across the four quadrants. This age-related variation should be taken into account in RNFL thickness measurements when evaluating patients for diagnosis and follow-up of glaucoma.     

基于视网膜神经纤维层厚度及神经节细胞复合体诊断POAG的效能分析

目的：比较原发性开角型青光眼( primary open angle glaucoma,POAG)与正常对照组盘周视网膜神经纤维层厚度( retinal nerve fiber layer thickness,RNFL)及黄斑区神经节细胞复合体( ganglion cell complex,GCC)厚度差异,并评价盘周 RNFL 厚度及黄斑 GCC 厚度在 POAG 中的诊断价值。
　　方法：采用横断面研究。连续的POAG患者56例纳入研究。选择同期年龄、性别、屈光度及眼轴匹配的正常人60名60眼作为正常对照组。用RTVue-100光学相干断层扫描技术( optical coherence tomography,OCT)检测并比较POAG组及对照组盘周RNFL厚度及黄斑GCC厚度。采用受试者工作特征曲线( receiver operating characteristic curve,ROC)及ROC曲线下面积( area under curve,AUC)评价盘周 RNFL 厚度及黄斑 GCC 厚度对青光眼的诊断价值。
　　结果：POAG组患者盘周所有象限RNFL均薄于正常对照组,差异有统计学意义( P<0.001)。 POAG组患者黄斑所有区域GCC厚度均小于正常对照组,差异有统计学意义(P<0.001)。多因素线性回归分析结果,PAOG诊断是盘周RNFL厚度与黄斑GCC厚度的独立相关因素。 ROC及AUC分析提示：杯盘比AUC值最大( AUC=0.936;95%CI=0.903~0.964),其次为上方 RNFL 厚度( AUC=0.910;95%CI=0.889~9.455),诊断价值高,盘周鼻侧,下方,颞侧RNFL厚度以及黄斑上方,下方平均GCC厚度AUC值均大于0.8,具有较好的诊断价值。
　　结论：POAG患者盘周RNFL厚度与黄斑GCC厚度均明显变薄,变薄的盘周RNFL厚度与黄斑GCC厚度与POAG诊断存在相关性。盘周RNFL厚度与黄斑GCC厚度均有较好的诊断价值。     

高度近视性弱视儿童视盘周围视网膜神经纤维层厚度分析

目的：分析高度近视性弱视儿童视盘周围视网膜神经纤维层厚度特点,并探讨与眼轴、年龄的关系。
　　方法：选择收集2014-01/07间在我院眼科门诊就诊的儿童35例59眼,平均年龄9.59±2.90岁,所有受检眼排除眼底的疾病和眼前节的病变。根据扩瞳验光的结果,分成高度近视性弱视组(22眼)、高度近视组(15眼)、正视眼组(22眼),运用频域OCT对视盘周围视网膜神经纤维层进行检测,通过A超测量出所有受检者眼轴长度。对各组视盘周围各方位视网膜神经纤维层厚度进行比较分析,探讨视盘周围各方位视网膜神经纤维层与眼轴、年龄的关系。
　　结果：高度近视性弱视组视盘颞侧RNFL厚度薄于高度
　　近视组,厚于正视眼组;视盘鼻侧、上方、下方、周围平均RNFL厚度与高度近视组、正视眼组相比均最薄,其中视盘下方及周围平均RNFL厚度与高度近视组相比变薄,有统计学差异(P<0.05),视盘鼻侧、上方、下方、周围平均RNFL厚度与正视眼组相比明显变薄,有统计学差异( P<0.01)。高度近视组视盘颞侧RNFL厚度与正视眼组相比明显增厚,视盘鼻侧、上方、下方、周围平均RNFL厚度与正视眼组相比均明显变薄,有统计学差异(P<0.05)。高度近视性弱视组视盘下方RNFL厚度与眼轴呈负相关性( R=0.474, R2=0.225, F=4.933, P=0.040)。高度近视组视盘上方RNFL厚度与眼轴呈负相关性(R=0.642, R2=0.412,F=9.104,P=0.010)。高度近视性弱视组、高度近视组、正视眼组各方位RNFL厚度与年龄均无明显相关性。
　　结论：高度近视性弱视儿童视网膜结构存在异常。     

Thickness of the lamina cribrosa and peripapillary sclera in Rhesus monkeys with nonglaucomatous or glaucomatous optic neuropathy

Purpose: To measure the thickness of the lamina cribrosa and peripapillary sclera in monkeys with a nonglaucomatous optic nerve damage and to compare that with those of monkeys with glaucomatous optic neuropathy. Methods: The study included 22 monkey eyes (Macaca mulatta) which had undergone a temporary experimental central retinal artery occlusion (CRAO) and seven monkey eyes in which experimental glaucoma was unilaterally produced. We measured histomorphometrically the thickness of the lamina cribrosa and peripapillary sclera. Results: The lamina cribrosa was significantly thicker in the CRAO group than in the glaucoma group (central region: 212 ± 46 μm versus 167 ± 17 μm; p = 0.009). The thickness of the peripapillary sclera at the optic disc border (253 ± 39 μm versus 192 ± 21 μm; p = 0.001) and outside of the optic nerve meninges (408 ± 70 μm versus 314 ± 64 μm; p = 0.006) was significantly greater in the CRAO group. Conclusions: In monkey eyes with a temporary CRAO as a model for nonglaucomatous optic nerve damage, the lamina cribrosa is significantly thicker than in monkey eyes with experimental glaucomatous optic nerve damage. It may suggest that the loss of optic nerve fibres might not be the reason for the thinning of the lamina cribrosa in eyes with advanced glaucoma. The thinner peripapillary sclera in the glaucomatous eyes may suggest that the monkey sclera is more vulnerable to stretching with increased intraocular pressure than the human eye for which no glaucoma‐related lengthening of the eyeball and thinning of the peripapillary sclera have been observed.     

Diagnostic capability of optical coherence tomography in evaluating the degree of glaucomatous retinal nerve fiber damage

PURPOSE: To evaluate the role and ability of optical coherence tomography (OCT) to detect differences in peripapillary retinal nerve fiber layer (RNFL) thickness between normal and glaucomatous eyes and also between different severities of glaucoma. METHOD: This cross-sectional observational study included 160 eyes of 160 healthy subjects and 134 eyes of 134 patients with primary open-angle glaucoma (POAG). Peripapillary RNFL thickness was measured on OCT using the fast RNFL thickness protocol. The RNFL thickness parameters used for evaluation included average RNFL thickness and inferior, superior, nasal, and temporal RNFL thickness. The glaucomatous eyes were subdivided into three subgroups on the basis of visual field defects and a fourth subgroup of eyes blinded by glaucoma. RNFL thickness parameters were compared among the normal eyes and the glaucoma subgroups. Correlation of global visual field indices with RNFL thickness parameters was also performed. RESULTS: The average RNFL in control subjects, early glaucoma, moderate glaucoma, severe glaucoma, and blind glaucoma were 102.30 +/- 10.34, 77.68 +/- 15.7, 66.07 +/- 15.5, 53.65 +/- 14.2, and 44.93 +/- 4.95 microm, respectively. There was a significant difference in all RNFL thickness parameters between normal and all glaucoma subgroups (P < 0.001). Average and inferior RNFL thicknesses showed the highest area under the receiver operating characteristic curve, with 0.905 and 0.862 for normal versus early glaucoma, 0.705 and 0.722 for early versus moderate glaucoma, 0.737 and 0.717 for moderate versus severe glaucoma, and 0.635 and 0.584 for severe versus blind glaucoma. Both mean deviation (MD) and corrected pattern standard deviation (CPSD) showed a significant correlation with all the RNFL thickness parameters in eyes with glaucoma (P < 0.001). CONCLUSIONS: RNFL thickness measured on OCT may serve as useful adjuncts in accurately and more objectively distinguishing normal from glaucomatous eyes, even in the early stages of glaucoma and may help to differentiate various severities of glaucoma. Average and inferior RNFL thicknesses are among the most efficient parameters for distinguishing such a differentiation. RNFL thicknesses in eyes blinded by glaucoma provide an estimate of the component of the RNFL thickness, which is not related to visual function.     

Comparison of retinal nerve fibre layer thickness and visual field loss between different glaucoma groups

BACKGROUND/AIMS: Scanning laser polarimetry (SLP) uses a confocal scanning laser ophthalmoscope with an integrated polarimeter to evaluate the thickness of the retinal nerve fibre layer (RNFL). The aim of this study was to verify the ability of the SLP to detect differences in RNFL thickness between normal and glaucomatous eyes and between glaucomatous eyes subdivided in groups by the severity of visual field damage. METHODS: This was a cross sectional retrospective study. The charts of 40 healthy subjects and 68 glaucoma patients who underwent complete ophthalmological examination, optic disc stereophotography, peripapillary, and macular SLP imaging were reviewed. The right eye of subjects eligible for the study was enrolled. Only eyes with SLP examinations indicating a minimised effect of anterior segment birefringence based on macular image were included. The ability of retardation parameters to discriminate between healthy and glaucomatous eyes was evaluated. Based on visual field loss, glaucoma patients were subdivided in three subgroups (early, moderate, and severe). RNFL thickness between healthy control group and glaucoma subgroups was compared. RNFL thickness and visual field loss correlation was evaluated. RESULTS: There was a significant difference in superior and inferior maximum RNFL thickness between normal and glaucomatous eyes (p<0.001). With these two parameters, the area under receiver operator characteristic curve was 0.75 and 0.74, respectively. Superior and inferior RNFL thickness was significantly different between healthy control group and all glaucoma subgroups (p<0.001) and between glaucoma subgroups (p<0.05), except for early and moderate glaucoma subgroups (p>0.05). Linear regression showed a weak correlation between RNFL thickness and visual field loss. CONCLUSION: These results suggest that once visual field loss is established, smaller reductions in the RNFL thickness detected by SLP are necessary for a given reduction of mean defect value.     

高分辨率 OCT测量神经节细胞-内丛状层厚度在青光眼早期诊断中的作用

目的 探讨高分辨率相干光断层扫描（Cirrus-HD OCT）测量黄斑神经节细胞-内丛状层（GCIPL）厚度参数在青光眼早期诊断中的作用。设计 诊断技术评价。研究对象30例早期青光眼患者和56例正常对照者。方法 应用Cirrus-HD OCT进行黄斑区及其分区域GCIPL和视盘周围视网膜神经纤维层（RNFL）厚度参数测量。用受试者工作特性曲线下面积（AUC）来评价各参数区分正常眼与青光眼的能力。主要指标 GCIPL与RNFL的厚度和两者的AUC值。结果 正常人和早期青光眼GCIPL和RNFL各参数测量值之间比较,差异均有统计学意义（P均<0.01）。正常人和早期青光眼患者的平均GCIPL厚度分别为（85.43±5.27）μm和（69.30±7.71）μm;平均RNFL厚度分别为（100.98±7.98）μm和（78.80±10.38）μm（P<0.001）。GCIPL参数中诊断效能最高者是最小值（minimum）和颞上区域（superotemporal）,AUC均为0.985;其他AUC较高的参数依次为平均值（average）（0.971）、下方区域（inferior）（0.941）、颞下区域（superotemporal）（0.934）和鼻上区域（0.907）。视盘周围RNFL参数中诊断效能最高者是平均值（0.990）。结论  Cirrus-HD OCT测得的GCIPL厚度参数与视盘周围RNFL厚度参数类似,具有较好的区分正常人和早期青光眼患者的能力,可作为青光眼早期诊断的有用工具。     

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.     

Comparison of glaucomatous parameters in normal, ocular hypertensive and glaucomatous eyes using optical coherence tomography 3000

This study was performed to evaluate optic disc appearance, retinal nerve fiber layer (RNFL) thickness, and macular thickness in normal, ocular hypertensive (OHT) and glaucomatous eyes using optical coherence tomography (OCT) 3000. One hundred fifty-eight eyes of 167 consecutive subjects were enrolled: 60 normal, 53 OHT, and 54 glaucomatous. OCT topographic parameters of cup diameter, cup area, rim area, and cup/disc area ratio were significantly less in OHT eyes than in normal eyes and were significantly less in glaucomatous eyes than in normal and OHT eyes. RNFL was significantly thinner in OHT eyes than in normal eyes in the inferior quadrant, and in glaucomatous eyes than in OHT and normal eyes in the mean and for all four quadrants. Macular thickness was significantly thinner in glaucomatous eyes than in OHT and normal eyes throughout all subdivisions. Optic disc parameters, and RNFL and macular thickness measurements made with OCT may be useful in the clinical assessment of glaucoma.     

Measurement of Retinal Nerve Fiber Layer Thickness and Macular Volume for Glaucoma Detection Using Optical Coherence Tomography

Purpose

To evaluate retinal nerve fiber layer (RNFL) thickness and macular volume in normal eyes and in the eyes of patients with glaucoma, and to compare the usefulness of these measurements in diagnosing glaucomatous eyes.

Methods

Eighty-one eyes were divided into three groups: normal control (n = 31), early glaucoma [n = 31, mean deviation (MD) ≥ ?6?dB], and advanced glaucoma (n = 19, MD < ?6?dB). The RNFL thickness and macular volume were measured using Stratus OCT (optical coherence tomography). Then, the diagnostic power of these parameters was evaluated.

Results

In eyes with early glaucoma, RNFL thickness was decreased significantly in eight of the 12 peripapillary sectors, and macular volume was decreased significantly in six of the nine macular sectors, compared with normal eyes. In the advanced glaucoma eyes, RNFL and macular volume were decreased throughout, except in RNFL thickness in the papillomacular region, and in retinal thickness in the foveal region. The area under the receiver-operating characteristic curve (AUROC) of the average RNFL (0.963) was larger than the macular volume (0.919).

Conclusions

Both peripapillary RNFL thickness and macular volume were decreased even in the early stage of glaucoma. Average RNFL thickness had greater diagnostic power than macular volume.?Jpn J Ophthalmol 2007;51:197–203 © Japanese Ophthalmological Society 2007

     

Comparison of two retinal nerve fibre layer thickness measurement patterns of RTvue optical coherence tomography

Background: To evaluate the agreement and repeatability between operator‐dependent centring and automatic centring retinal nerve fibre layer thickness measurement patterns (RNFL3.45 and NHM4) of RTvue optical coherence tomography in normal and glaucomatous eyes. Design: Cross‐sectional observational study. Participants: A total of 153 eyes from 149 normal subjects and subjects with glaucoma were analysed. Methods: The retinal nerve fibre layer thickness was measured using RNFL3.45 and NHM4 three times on the same day to determine the repeatability and agreement between the two scan patterns. Main Outcome Measures: Student's paired t‐testing, intra‐class correlation coefficient, coefficient of variation, test–retest viability, Pearson's correlation coefficient and Bland–Altman analysis of retinal nerve fibre layer thickness measurements. Results: The difference between RNFL3.45 and NHM4 measurements was statistically significant by paired t‐testing (P = 0.003) only in severe glaucoma group. The Pearson's correlation test showed a high degree of correlation of the mean retinal nerve fibre layer thickness (r = 0.949). Bland–Altman plots showed that the differences between RNFL3.45 and NHM4 were smaller at thicker retinal nerve fibre layer values, but larger at thinner retinal nerve fibre layer values. The intra‐class correlation coefficient for RNFL3.45 (and lower 95% confidence interval) in normal and glaucomatous eyes was 0.990 (0.985 confidence interval) and 0.997 (0.995 confidence interval), respectively. The intra‐class correlation coefficient for NHM4 in normal and glaucomatous eyes was 0.989 (0.983 confidence interval) and 0.995 (0.992 confidence interval), respectively. The test–retest variability for RNFL3.45 and NHM4 ranged from 3.98 to 9.75 µm in normal eyes, and from 4.10 to 13.34 µm in glaucomatous eyes. Conclusion: Measurements of retinal nerve fibre layer thickness by RNFL3.45 and NHM4 are in good agreement.     

阻塞性睡眠呼吸暂停低通气综合征与青光眼性眼底病变关系的初步研究

目的 研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者中青光眼性眼底病变,了解OSAHS对青光眼发病的影响。方法 选取49例OSAHS患者作为OSAHS组,选取30例年龄、性别、屈光情况与OSAHS组相匹配的健康体检者作为正常对照组。对所有研究对象的双眼进行眼压测量、视野检查和光学相干层析成像,比较2组受试者的眼压、视野的平均缺损和模式标准差、视盘三维结构参数、视网膜神经纤维层(RNFL)厚度、脉络膜厚度,分析OSAHS组RNFL厚度与呼吸暂停低通气指数(AHI)、最低氧饱和度的相关性。结果 OSAHS组左、右眼的眼压、视野的平均缺损和模式标准差与对照组相比差异无统计学意义。OSAHS组左、右眼的垂直径杯盘比和视杯容积显著大于正常对照组(P<0.05),平均RNFL厚度、颞侧和下方RNFL厚度显著小于对照组(P<0.05),OSAHS组黄斑中心凹鼻侧/下方0.5、1.0、1.5 mm处的脉络膜厚度均显著小于对照组(P<0.05),OSAHS组视杯颞侧/上方/下方距视盘边缘0.5、1.0、1.5 mm处的脉络膜厚度均显著小于对照组(P<0.05)。OSAHS组左眼的平均RNFL厚度与AHI呈负相关(r=-0.266,P=0.024)。结论 OSAHS患者视盘凹陷扩大加深,眼底RNFL、脉络膜局限性变薄,RNFL变薄与OSAHS严重程度相关,认为OSAHS是引发青光眼的危险因素。     

Retinal and Choroidal Thickness in Adult Patients with Familial Mediterranean Fever

Purpose: We aimed to evaluate changes in retinal, choroidal, ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) thicknesses in genetically diagnosed adult patients with familial Mediterranean fever (FMF).

Methods: A total of 50 eyes of 50 genetically diagnosed patients with FMF and 50 eyes of controls were analyzed. Patients were recruited from the Genetic Diagnostic Center of D??kap? Y?ld?r?m Beyaz?t Research and Training Hospital, Turkey. Retinal and choroidal thicknesses were obtained using spectral-domain optical coherence tomography from choroid, retina, GCC, and RNFL.

Results: Average baseline choroidal thickness was statistically significantly thinner in patients with FMF than controls at C_center (325.85 ± 30.8 µm and 338.97 ± 23.9 µm, respectively, p = 0.038), C_nasal500 (328.77 ± 31.6 µm and 349.00 ± 23.3 µm, respectively, p = 0.002), C_nasal1000 (324.97 ± 33.6 µm and 351.23 ± 23.8 µm respectively, p = 0.0001) and C_nasal1500 (324.75 ± 37.1 µm and 344.61 ± 27.3 µm, respectively, p = 0.008). However, there was no significant difference in temporal choroidal thickness (C_temporal500, C_{temporal1000 and} C_temporal1500) in patients with FMF compared to controls (p > 0.05). There were no significant differences in retinal, GCC and RNFL thicknesses between the groups (p > 0.05).

Conclusion: We hypothesize that the chronic inflammation seen in FMF could be the reason for the reduction seen in choroidal thickness in adult patients with FMF. Retinal, GCC and RNFL thicknesses did not differ from controls.     

视盘周围血管密度和视网膜神经纤维层厚度与眼轴长度和屈光度的相关性分析

目的　应用光学相干断层扫描血管成像（optical coherence tomography angiography,OCTA）观察视盘周围血管密度和视网膜神经纤维层（retinal nerve fibre layer,RNFL）厚度与眼轴长度和屈光度之间的关系。方法　纳入受试者40名40眼,测量屈光度和眼轴长度,通过OCTA检查各上方、下方、鼻侧、颞侧四个象限及整体视盘周围血管密度,测量相应区域的视盘周围RNFL厚度,分析两者之间及两者分别与眼轴长度和屈光度之间的相关性。结果　视盘周围整体RNFL厚度与眼轴长度呈显著负相关（r=-0.760,P<0.001）,与屈光度呈显著正相关（r=0.625,P<0.001）。且上方、下方和鼻侧象限的视盘周围RNFL厚度均与眼轴长度呈显著负相关（r=-0.506、-0.667、-0.700,均为P<0.01）,与屈光度呈显著正相关（r=0.409、0.506、0.556,均为P<0.01）。视盘周围整体及颞侧象限的血管密度与眼轴长度均呈显著负相关（均为P<0.05）,与屈光度均呈显著正相关（均为P<0.05）。视盘周围血管密度与RNFL厚度整体上呈显著正相关（r=0.500,P=0.001）,而仅在鼻侧象限发现视盘周围血管密度与RNFL厚度存在显著正相关（r=0.550,P<0.001）。结论　视盘周围血管密度和RNFL厚度与屈光度及眼轴长度相关,且视盘周围血管密度和RNFL厚度具有相关性。     

光学相干断层成像术对原发性开角型青光眼视网膜神经纤维层的定性和定量检测

OBJECTIVE: To study the characteristics of optical coherence tomography (OCT) of primary open angle glaucoma (POAG), the difference of retinal nerve fiber layer (RNFL) thickness between normal persons and patients with POAG and the correlation between RNLF and visual field index. METHODS: Eighty-three cases (149 eyes) with POAG and 83 normal persons (150 eyes) were tested by OCT with circular scans around the optic nerve head (diameter = 3.46 mm) to observe the features of OCT. Statistic analysis was taken to compare the difference of RNFL thickness in quadrants and means between normal and glaucomatous group, and the difference of the thickness among the stages in POAG. Linear correlation and regression analysis was used to show the correlation between RNFL thickness and visual field index of 115 eyes of glaucomatous patients. RESULTS: The RNFL thickness measured by OCT in normal subjects is the thickest in superior and inferior quadrants, less in thickness in temporal and the thinnest in nasal quadrant. The curve showed double peaks. The RNFL of glaucomatous patients showed local thinness or defect, diffuse thinness or combination of the above two types. The mean RNFL thickness of normal group was (90.1 +/- 10.8) microm, (140.4 +/- 10.5) microm, (85.2 +/- 14.0) microm, (140.4 +/- 9.7) microm and (114.2 +/- 6.0) microm, of glaucomatous group was (56.0 +/- 31.0) microm, (81.0 +/- 36.3) microm, (47.1 +/- 27.5) microm, (73.4 +/- 38.4) microm and (64.6 +/- 28.8) microm in temporal, superior, nasal, inferior quadrant and the whole area, respectively. There is significant difference of RNFL thickness between the normal and glaucomatous group (P < 0.000), and there are significant differences among the three stages (early, developing and late) of glaucomatous group (P < 0.000). There is a close negative relationship between RNFL thickness and visual field index (r = -0.796, P < 0.0001). The sensitivity and specificity of RNFL thickness measured by OCT were 93.3% and 92.0%, respectively. CONCLUSION: OCT can quantitatively measure the RNFL thickness and show the difference of RNFL between normal persons and glaucomatous patients. The RNFL thickness gradually decreases while visual field defect increases with the development of POAG.     

Quantification of retinal nerve fiber thickness. A comparison of laser scanning ophthalmoscopy, polarimetry and optical coherence tomography in healthy and glaucomatous eyes

Purpose. To evaluate the thickness of the retinal nerve fiber layer (RNFL) in healthy eyes and in eyes of patients with primary open angle glaucoma using the Heidelberg retina tomograph (HRT), the nerve fibre analyser (NFA) and the optical coherence tomograph (OCT). Methods. In this prospective cohort study, 40 normal eyes and 86 eyes of age-matched glaucoma patients were compared by confocal scanning laser tomography using the HRT, scanning laser polarimetry (NFA) and optical coherence tomography (OCT). The RNFL thickness was measured in the superior, inferior, nasal and temporal regions as well as the total circumference. Results. All three methods revealed a statistically significant difference between normal and glaucomatous eyes with respect to the mean RNFL thickness in the inferior and superior regions (p<0.001). The mean RNFL thickness in the superior region was 329 μm (HRT), 87 μm (NFA) and 94 μm (OCT) in healthy volunteers compared to 275 μm (HRT), 72 μm (NFA) and 82 μm (OCT) in the patient group. In the inferior region, it was 323 μm (HRT), 87 μm (NFA) and 93 μm (OCT) in healthy subjects versus 240 μm (HRT), 74 μm (NFA) and 83 μm (OCT) in glaucoma patients. Cut-off points to differentiate between normal and glaucomatous eyes could not be defined. There was no difference in the RNFL thickness of right and left eyes. Conclusions. In RNFL thickness measurements using HRT, NFA and OCT, glaucoma patients showed a significantly thinner RNFL in the superior and inferior areas compared to healthy volunteers. These results confirm the known histological and fundus photographic findings of RNFL thinning near the optic disc in glaucoma patients. Although RNFL thickness cannot be used to diagnose glaucoma in individual patients due to the high interindividual differences, the quantitative assessment of RNFL thickness may complement the diagnostic armamentarium as a sensitive parameter for diagnosing and monitoring glaucomas.     

Peripapillary fundus perimetry in eyes with glaucoma

AIMS: To evaluate, with fundus perimetry, the peripapillary differential light threshold (DLT) in eyes with glaucoma and ocular hypertension (OHT), and compare it with peripapillary retinal nerve fibre layer (RNFL) thickness. METHODS: 35 glaucomatous, 29 OHT and 24 control eyes were included. Peripapillary DLT at 1 degrees from the optic nerve head was quantified with fundus perimetry; peripapillary RNFL thickness was measured over the same area by optical coherence tomography. RESULTS: Mean (SD) peripapillary DLT was 19.2 (1.7), 17.6 (4.2) and 10.1 (6.9) dB in control, OHT and glaucomatous eyes, respectively (p<0.001). Mean (SD) RNFL thickness was 98.4 (35.3), 83.9 (35.1) and 55.8 (28.2) microm, respectively (p<0.001). Mean peripapillary DLT showed higher sensitivity and specificity in differentiating the three groups compared with RNFL thickness. CONCLUSION: Progressive, significant reduction of peripapillary DLT was documented in OHT and glaucomatous eyes compared with controls (p<0.001). DLT reduction parallels RNFL reduction.     

Early detection of thinning of retinal nerve fiber layer in glaucomatous eyes by optical coherence tomography 3000: analysis of retinal nerve fiber layer corresponding to the preserved hemivisual field

The retinal nerve fiber layer (RNFL) thickness was measured with the optical coherence tomography using version 3.0 software (OCT3000) in 153 eyes of 153 normal subjects. The mean of the average RNFL thickness over the entire 360 degrees in the control group was 92.5 +/- 12.9 microm which was significantly thinner than the normative data of 95.9 +/- 11.4 microm included with the OCT3000 (p < 0.01). The RNFL thickness decreased with increasing age (p < 0.01, r = -0.395). The RNFL thickness was also measured in 53 eyes of 53 patients with glaucoma whose superior (13 eyes) or inferior (40 eyes) perimetric hemifields were normal. Only the RNFL thickness corresponding to the preserved perimetric hemifields were measured by OCT3000 and scanning laser ophthalmoscopy (SLO). The RNFL thickness in the superior and inferior 30 degrees sectors, the maximum and average RNFL thickness in the superior (S(max) and S(avg)), and inferior quadrants (I(max) and I(avg)) were analyzed.The S(max), S(avg), I(max), I(avg), and the RNFL thickness in the superior (p < 0.05), superotemporal and inferotemporal sectors (p < 0.01) in the glaucoma patients without a nerve fiber layer defect (SLO) were significantly thinner than in the control subjects in same age. OCT3000 measurements showed that the RNFL thickness in glaucomatous eyes with normal perimetric visual fields and SLO was significantly thinner than the RNFL thickness in normal eyes.     

Morphometric analysis of human peripapillary retinal nerve fiber layer thickness

PURPOSE: The peripapillary retinal nerve fiber layer (RNFL) thickness pattern in the normal human eye has been well characterized using data obtained with scanning laser polarimetry and optical coherence tomography. The authors sought to characterize the normative peripapillary RNFL thickness and pattern using histologic sections obtained from healthy postmortem human eyes. METHODS: Seventeen unpaired normal postmortem eyes were recruited into this study. Each eye was sectioned using the "umbrella technique" to obtain four concentric peripapillary rings, each centered on the optic disc, with diameters of 3.0, 3.5, 4.0, and 4.5 mm. RNFL thickness data along each ring section was measured at 100 equidistant locations. Thickness data, for each ring diameter, across all eyes were averaged to arrive at normative thickness values for the peripapillary RNFL thickness in eyes processed using this technique. RESULTS: Average RNFL thicknesses (+/-SD) for the 3.5-mm diameter ring were as follows: overall, 60.3 +/- 19.5 microm; superior, 75.3 +/- 26.5 mum; inferior, 69.4 +/- 22.4 microm; nasal, 48.1 +/- 15 microm; temporal, 49.2 +/- 26.4 microm. Qualitatively, the RNFL thickness showed a double-hump pattern with relatively similar superior and inferior peaks and with temporal and nasal troughs. Progressively larger peripapillary rings showed progressively thinner RNFL thickness at all quadrants. In contrast, the relative thickness percentage for each quadrant remained unchanged among the four different diameter rings. CONCLUSIONS: Histologic data from a group of healthy postmortem eyes demonstrate the pattern of RNFL thickness in normal eyes. These data corroborate imaging findings of peripapillary RNFL thickness patterns obtained using commercially available RNFL imaging devices.