频域OCT测量高度近视黄斑区视网膜神经节细胞复合体厚度及视盘周围视网膜神经纤维层厚度

目的：分析高度近视患者黄斑区视网膜神经节细胞复合体（GCC）厚度与视盘周围视网膜神经纤维层（RNFL）厚度的特征。方法：横断面研究。应用RTVue SD-OCT对2015 年11 月至2016 年7 月期间在北京同仁医院眼科就诊的46例（46眼）高度近视患者和31例（31眼）正常对照者进行黄斑区GCC厚度和视盘周围RNFL厚度检测,按照眼轴长度（AL）将高度近视患者分为A组（26 例,26 mm≤AL＜28 mm）、B组（12 例,28 mm≤AL＜30 mm）和C组（8 例,AL≥30 mm）。高度近视组和正常对照组的均数比较采用独立样本t 检验,多组均数间的比较采用非参数Kruskal-Wallis H 检验。高度近视组GCC厚度、RNFL厚度与AL的相关关系采用Pearson相关分析。结果：高度近视患者平均、上方、下方GCC厚度和平均、上方、下方、鼻侧RNFL厚度较正常对照组低（H =20.38、15.65、21.69、31.27、20.10、20.78、11.08,P ＜0.001）,GCC局部丢失体积（FLV）和整体丢失体积（GLV）均较正常对照组大,差异均有统计学意义（H =20.02、27.24,均P ＜0.001）。高度近视患者平均、上方、下方GCC厚度和平均、上方、下方、颞侧RNFL厚度与AL均呈负相关（r=-0.462、-0.422、-0.462、-0.511、-0.502、-0.295、-0.408,均P ＜0.05）,与屈光度均呈正相关（r=0.479、0.469、0.444、0.604、0.535、0.413、0.528,均P ＜0.05）;FLV、GLV与AL均呈正相关（r=0.643、0.590,均P ＜0.001）,与屈光度均呈负相关（r=-0.666、-0.594,均P ＜0.001）。高度近视组RNFL厚度的变化率大于GCC厚度的变化率,差异有统计学意义（P ＜0.001）。结论：高度近视患者黄斑区GCC厚度降低,与AL呈负相关,与屈光度呈正相关。GCC厚度的变化率小于RNFL厚度的变化率。     

不同程度近视患者视网膜神经纤维层厚度和神经节细胞复合体参数的变化

目的:比较低度、中度和高度近视非青光眼受试者通过光谱域光学相干断层扫描技术(SD-OCT)测量的视网膜神经纤维层(RNFL)和黄斑神经节细胞复合体(GCC)参数的变化。方法:选择2019-12/2022-11期间在我院就诊的近视受试者400例400眼参与本研究,根据受试者近视程度分为：低度近视组(142例142眼,35.5%)、中度近视组(139例139眼,34.8%)和高度近视组(119例119眼,29.8%)。测量RNFL厚度,包括均值、上方、下方、鼻侧、颞侧RNFL厚度。测量GCC参数,包括均值、上方、颞上方、下方、颞下方、鼻上方、鼻下方。评估OCT测量的RNFL厚度、GCC参数均值与眼轴长度之间的相关性。结果:低度近视组和中度近视组的上方、下方、鼻侧、平均RNFL厚度明显高于高度近视组,颞侧RNFL厚度明显低于高度近视组(均P<0.05);低度近视组和中度近视组的上方、颞上方、下方、颞下方、鼻上方、鼻下方、平均GCC厚度明显高于高度近视组(均P<0.05);在中度近视组中,RNFL和GCC厚度均值与眼轴长度均呈负相关(r=-0.387、-0.309,均P<0....     

帕金森患者视网膜神经纤维层与神经节细胞复合体的改变

目的：观察帕金森患者视网膜神经纤维层厚度(peripapillary retinal nerve fiber layer thickness,pRNFL)及黄斑区神经节细胞复合体( ganglion cell colplex,GCC)厚度的变化特点。
　　方法：选取2014-07/2015-05北京天坛医院收治的原发性帕金森病( Parkinson’s disease,PD)患者40例80眼,正常对照组30例60眼,使用频域相干光学断层扫描( optic coherence tolography,OCT)对所有受试者进行检查,分别测量眼底pRNFL和GCC厚度。用独立样本t检验比较帕金森组与正常对照组之间各个象限pRNFL厚度的差异,并分析帕金森组的 pRNFL 厚度与 GCC 厚度(包括 Avg、Sup和Inf厚度)的相关性。
　　结果：帕金森组与正常对照组比较, pRNFL 的上方颞侧(ST)、上方鼻侧(SN)、下方鼻侧(IN)、颞侧上方(TU)、下方颞侧( IT )、颞侧下方( TL )象限、pRNFL 上方厚度( Sup)、下方厚度( Inf)和平均厚度( Avg)均具有统计学差异( P<0.05);帕金森组GCC厚度与正常对照组相比,平均厚度、上方和下方厚度均具有统计学差异(P<0.05);并与pRNFL均呈明显正相关(平均：r=0.743, P=0.01;上方：r=0.689,P=0.01;下方：r=0.693,P=0.01)。
　　结论：帕金森患者pRNFL厚度及GCC厚度均较正常人群明显变薄,两者呈正相关。     

飞秒激光及微型角膜刀制瓣负压吸引对视网膜神经纤维层厚度的影响

目的探讨比较准分子激光原位角膜磨镶术(LASIK)中Femto LDV飞秒激光及微型角膜刀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)的影响。设计前瞻性比较性病例系列。研究对象行Femto LDV飞秒激光和微型角膜刀LASIK手术的近视患者各51例102眼。方法分别在LASIK术前、术后30分钟、术后1天、3天及1周应用傅立叶域相干光断层扫描术(FD-OCT)检测黄斑区总视网膜厚度、黄斑内层视网膜厚度及视乳头旁视网膜神经纤维层厚度,扫描模式分别为黄斑总厚度MM6、黄斑神经节细胞丛GCC及视盘ONH程序。主要指标黄斑区视网膜平均厚度及象限厚度,黄斑内层视网膜厚度,RNFL平均厚度及象限厚度。结果飞秒激光组术后30分钟黄斑中心凹及黄斑中心凹旁平均视网膜厚度(243.19±25.51μm,316.21±14.77μm)较术前(238.62±26.58μm,311.67±15.23μm)明显增厚(t=3.272,3.052,P=0.0020,.003);微型角膜刀组术后30分钟黄斑中心凹及黄斑中心凹旁平均视网膜厚度(249.85±22.41μm,320.21±15.97μm)较术前(241.96±17.09μm,314.71±15.86μm)明显增厚(t=3.72,2.179,P=0.000,0.032);术后30分钟飞秒激光组黄斑中心凹、黄斑中心凹旁平均厚度及各象限厚度均低于微型角膜刀组(P均<0.05),但黄斑周边部两组间比较差异无统计学意义(P=0.624)。飞秒激光组与微型角膜刀组术后30分钟、术后1天、3天和1周,黄斑内层视网膜厚度与术前比较差异均无统计学意义(P均>0.05),两组间比较差异无统计学意义(P均>0.05)。飞秒激光组和微型角膜刀组术后30分钟视乳头旁3.45 mm直径范围内RNFL平均厚度(104.17±9.31μm,105.07±9.78μm)均明显低于术前(106.06±9.70μm1,07.10±10.68μm)(t=2.936,4.559,P=0.004,0.000);组间比较,术后30分钟飞秒激光组颞侧象限RNFL厚度(88.81±14.04μm)明显高于微型角膜刀组(84.45±13.24μm)(t=2.094,P=0.038),其余象限及全周平均RNFL厚度两组间比较差异均无统计学意义(P均>0.05)。结论飞秒激光及微型角膜刀在LASIK术后早期均会引起黄斑区视网膜局限性水肿和RNFL厚度变薄,但飞秒激光对黄斑区及RNFL的影响均小于微型角膜刀组。     

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）     

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.     

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。     

应用光学相干断层成像术测量正常人视网膜神经纤维层厚度

目的 评价光学相干断层成像术（ｏｐｔｉｃａｌ ｃｏｈｅｒｅｎｃｅ ｔｏｍｏｇｒｄｐｈｙ,ＯＣＴ）在正常人视网膜神经纤维层（ｒｅｔｉｎａｌ ｎｅｒｖｅ ｆｉｂｅｒ ｌａｙｅｒ,ＲＮＦＬ）厚度测量中的星夜价值及其测量重复性,探讨正常人各年龄组之间ＲＮＦＬ厚度是否存在差异。方法 用ＯＣＴ对１５２例（１５２只眼）正常人进行以视乳头中点为中尽,直径为３．４６ｍｍ圆周的ＲＮＦＬ厚度测量,将检查者按１０岁为一个     

LASIK负压吸引对术后早期视网膜神经纤维层厚度的影响

目的 利用光学相干断层扫描(optical coherence tomography,OCT)比较准分子激光原位角膜磨镶术(laser in situ kera-tomileusis,LASIK)术前与术后早期视盘周围视网膜神经纤维层(retinal nerve fibre layer,RNFL)厚度变化,探讨LASIK对RNFL厚度的影响.方法 对143例286眼拟行LASIK的患者术前及术后1 d进行OCT检查,测量以视盘为中心3.4 mm直径范围内上方、下方、鼻侧、颞侧RNFL厚度变化,所得数据用统计学方法 进行配对t检验.结果 LASIK术后1 d视盘上方及下方RNFL厚度分别为(130.88±13.22)μm及(132.91±14.89)μm,与术前(128.22±13.86)μm、(128.76±14.64)μm相比变厚,差异有统计学意义(t分别为-5.132、-8.744,P均<0.01),其余各区域RNFL厚度与术前相比略有增加,但差异均无统计学意义(P均>0.01).结论 LASIK术后早期视盘上方及下方RNFL变厚,有临床意义.     

Effect of suction on macular thickness and retinal nerve fiber layer thickness during LASIK used femtosecond laser and Moria M2 microkeratome

AIM:To compare the effect of suction on the macular thickness and retinal nerve fiber layer (RNFL) thickness during laser in situ keratomileusis (LASIK) used Ziemer FEMTO LDV femtosecond laser (Ziemer group) and Moria M2 automated microkeratome (Moria group) for flap creation.METHODS: Fourier-domain optical coherence tomography (FD-OCT) was used to measure macular thickness, ganglion cell complex thickness and (RNFL) thickness of 204 eyes of 102 patients with the Ziemer femtosecond laser (102 eyes) and the Moria M2 microkeratome (102 eyes) before surgery and 30min; 1, 3d; 1wk; 1, 3mo; 1y after surgery.RESULTS:The average foveal thickness and parafoveal retinal thickness 30min after the surgery were statistically more than that before surgery (Ziemer P<0.001, P=0.003 and Moria P=0.001, P=0.006) and the effect was less in the Ziemer group than that in the Moria group (P all<0.05). The ganglion cell complex thickness was not significantly changed in both groups (P all>0.05). The RNFL thickness was statistically less 30min after surgery in both groups (P=0.014, P<0.001), but the influence was less in Ziemer group than that in Moria group (P=0.038). However, the RNFL thickness had recovered to the preoperative level only 1d after surgery.CONCLUSION:The suction offemtosecond laser and mechanical microkeratome led to the increase in macular central fovea thickness and the decrease in RNFL thickness values at the early stage after LASIK. The effect of suction on macular and the RNFL thicknesses in Ziemer group is smaller than that in Moria group.     

OCT测量黄斑区GCC与视盘周围RNFL厚度在早期青光眼诊断中的应用

目的:研究OCT测量黄斑区节细胞复合体(macular ganglion cell complex,mGCC)和视盘周围视网膜神经纤维层(peripapillary retinal nerve fiber layer,pRNFL)厚度在青光眼早期诊断中的应用.方法:病例对照研究,选取86例86眼研究对象,其中正常人30眼,疑似原发性开角型青光眼患者27眼,原发性开角型青光眼早期患者29眼.利用光学断层扫描仪技术(optical conherence tomography,OCT)分别测量mGCC和pRNFL厚度,对不同受试者的各项参数做比较,对结果进行比较分析.结果:正常人组、疑似青光眼组和早期青光眼组之间平均pRNFL厚度、上方pRNFL厚度、下方pRNFL厚度差异有统计学意义(P=0.001、0.004、0.011),平均mGCC厚度、上方mGCC厚度、下方mGCC厚度差异有统计学意义(P=0.008、0.002、0.003);三组之间整体丢失体积(general loss of volume,GLV)和局部丢失体积(focal loss of volume,FLV)的差异有统计学意义(P=0.002).疑似青光眼组与正常组比较,所有pRNFL和所有mGCC参数均有较高ROC下面积(area under the receiver operating characteristic,AROC),FLV的AROC最大为0.801,除上方pRNLF的AROC为0.688外,余参数AROC均>0.700.青光眼早期组与正常组相比较,所有pRNFL和mGCC参数有较高AROC,平均mGCC的AROC最大为0.804,除平均pRNFL为0.683外,余参数AROC均>0.700.疑似青光眼组有58%患者有异常mGCC厚度,23%患者有异常的pRNFL厚度;早期青光眼组有98%异常mGCC厚度,90%患者有异常的pRNFL厚度;正常人组有93%异常mGCC厚度,93%患者有异常的pRNFL厚度.三组之间有统计学意义(x2=12.11,P<0.05).结论:OCT测量mGCC厚度和pRNFL厚度在早期青光眼中均有良好的诊断能力,mGCC厚度测量可以作为早期青光眼诊断的有效方法.     

Influence of axial length on ganglion cell complex (GCC) thickness and on GCC thickness to retinal thickness ratios in young adults

Purpose

The present study was designed to investigate the influence of axial length on macular ganglion cell complex (GCC) thickness and two ratio parameters—the GCC thickness to macular total retinal thickness (G/T) ratio and the GCC thickness to macular outer retinal thickness (G/O) ratio—using spectral-domain optical coherence tomography (OCT).

Methods

In this prospective case series, 74 eyes of 74 healthy Japanese study participants with varying degrees of myopia were recruited. GCC, outer retinal, and total retinal thicknesses were measured with the RTVue-100 system. The G/T and G/O ratios were also calculated. The axial length was determined using the IOLMaster. The correlation between the OCT measurements and axial length was evaluated.

Results

The average axial length was 25.05 ± 1.38 mm. The GCC thickness was significantly correlated with axial length (r = ?0.384, P = 0.001). The outer retinal thickness and the total retinal thickness were significantly correlated with axial length (r = ?0.444, P < 0.001 and r = ?0.493, P < 0.001, respectively), but the G/T and G/O ratios were not (r = ?0.093, P = 0.428 and r = ?0.091, P = 0.440, respectively).

Conclusions

GCC thickness is affected by axial length. Because the prevalence of myopia is high in Japan, when determining the GCC thickness of Japanese individuals, it seems necessary to consider the axial length as well. To take account of individual variation in axial length, we propose the ratio parameters as a suitable parameter.     

RNFL和GCC在早期慢性原发性闭角型青光眼诊断的临床意义

目的：观察视网膜视盘周围视网膜神经纤维层( retina nerve fiber layer, RNFL )厚度和神经节细胞复合体( ganglion cell complex,GCC)厚度对慢性原发性闭角型青光眼( chronic primary angle-closure glaucoma,CPACG)的诊断价值,研究其和平均视野缺损( MD)的相关性。
　　方法：选取早期 CPACG 患者21例38眼,疑似青光眼( suspected glaucoma, SG)患者25例46眼和正常对照25例49眼进行 SD-OCT 检查,测量平均及各个象限的RNFL厚度和GCC厚度,分析RNFL厚度和GCC厚度与视野MD的相关性。
　　结果：CPACG组的平均和各象限RNFL厚度和GCC厚度与正常对照存在显著性差异(P<0.01),与SG组比较,平均及上方(P<0.01)、下方(P<0.05)RNFL厚度存在显著性差异,平均和各象限 GCC 厚度存在显著性差异( P<0.01)。 CPACG组RNFL(r=0.65)、GCC(r=0.72)均与MD呈明显的正相关。
　　结论：RNFL厚度和GCC厚度对早期CPACG的诊断和病情监测中具有临床价值,GCC厚度的临床意义可能更佳。     

Factors influencing corneal flap thickness in laser in situ keratomileusis with a femtosecond laser

Purpose

To evaluate factors responsible for the variability between intended and achieved corneal-flap thickness during femtosecond laser-assisted laser in situ keratomileusis (LASIK).

Methods

A prospective, nonrandomized, case study was performed on 35 eyes of 18 consecutive patients who underwent LASIK surgery using the 60 kHz femtosecond laser microkeratome. Eyes were assigned to three different thickness groups, with 110-, 120-, or 130-µm cut depths. Anterior segment optical coherence tomography was used to assess the morphology of 35 LASIK flaps at postoperative one week postoperatively. The flap thickness was assessed at seven measuring points across each flap. Patient age, preoperative spherical equivalent, manual keratometry, preoperative central pachymetry, and regional variability of the cornea were evaluated to determine where they influenced the achieved corneal flap thickness.

Results

Cuttings of all flaps were easily performed without any intraoperative complications. Flap-thickness measurements had a mean of 115.21 ± 4.98 µm (intended thickness, 110 µm), 121.90 ± 5.79 µm (intended, 120 µm), and 134.38 ± 5.04 µm (intended, 130 µm), respectively. There was no significant difference between the 110-µm and 120-µm groups when compared with the 130-µm group (one-way analysis of variance test, p > 0.05). Patients'' age, preoperative spherical equivalent, manual keratometry, and preoperative central pachymetry did not affect the achieved flap thickness (Pearson correlations test, p > 0.05). The reproducibility of flap thickness in the central 1.5-mm radius area was more accurate than that in the peripheral 3.0 to 4.0-mm radius area (paired samples t-test, p < 0.05).

Conclusions

Femtosecond laser-assisted LASIK is likely to reproduce a reliable thickness of the corneal flap, which is independent of corneal shape factors or refractive status. Future studies should focus on variations in corneal biomechanical factors, which may also play an important role in determining flap thickness.