近视眼患者近视程度对视网膜神经纤维层厚度的影响

目的：探讨不同近视程度对于其视网膜神经纤维层（ RNFL ）厚度的影响。方法选取我院自2014年9月至2015年9月间收治的120例近视患者作为实验对象,对每一位患者进行视力及屈光检测,然后根据测评结果将其分成3组,即低度近视40例,中度近视40例,高度近视40例,选取同期进行视力检测的健康人40例作为对照组,使用OCT对4组受检者的RNFL进行检测,分析不同近视程度对于RNFL厚度的影响。结果低度近视组患者的RNFL数据和对照组差异不具有统计学意义（ P＞0.05）;和其他两组数据对比差异显著（ P ＜0.05）。结论近视程度越高则患者的RNFL厚度逐渐降低。通过对RNFL厚度检测可判断患者的近视程度。     

The retinal nerve fiber layer in normal eyes

The retinal nerve fiber layer is different in normal and glaucomatous eyes. The authors used red-free photographs to examine the retinal nerve fiber layer in 234 normal eyes. The retinal nerve fiber layer was most visible in the inferior temporal arcade, followed by the superior temporal arcade, then by the temporal macular area, and finally the nasal area. This distribution was significantly (P less than 0.0001) correlated to (1) the configuration of the neuroretinal rim, which was significantly broadest at the inferior disc pole followed by the superior one, (2) the juxtapapillary caliber of the retinal vessels, which were significantly wider in the inferior temporal arcade than in the superior temporal arcade, and (3) the location of the foveola 0.53 +/- 0.34 mm inferior to the middle point of the vertical optic disc axis. The retinal nerve fiber layer decreased with age. No correlation occurred with sex or right or left eye. No localized retinal nerve fiber layer defects were seen. These features of the normal retinal nerve fiber layer are important for diagnosis of retinal nerve fiber layer changes secondary to optic nerve damage in the diseased eye.     

儿童单侧高度近视性弱视眼视网膜神经纤维层厚度的分析

目的 探讨儿童单侧高度近视性弱视眼视乳头周围视网膜神经纤维层(RNFL)厚度变化.方法 采用偏振激光扫描测量仪对23例(23只眼)单侧高度近视性弱视儿童的视乳头周围RNF进行检查.计算以视乳头为中心,3.2 mm为外环直径,2.4 mm为内环直径圆周的RNFL相对厚度值,分别与对侧眼,正常眼和单纯高度近视眼比较.组间一般资料的比较采用方差分析;两组间RNFL参数比较采用两样本独立t检验;眼轴与RNFL厚度的相关性采用Spearman相关分析法.结果 高度近视性弱视眼RNF的椭圆平均值、上方平均值及下方平均值分别为56.39±5.69、68.30±10.16及67.34±5.83,与对侧眼(t=2.090,2.243,4.236)和正常眼(t=3.087,1.025,3.481)比较,差异有统计学意义(P<0.05);与单纯高度近视眼比较差异无统计学意义(t=0.872,0.297,0.658;P>0.05);高度近视性弱视眼和单纯高度近视眼RNF椭圆平均值均随着眼轴的增加逐渐变薄,呈负相关(r=-0.462,-0.395;P<0.05).结论 儿童单侧高度近视性弱视眼视乳头周围的RNF厚度较正常眼薄,但与单纯高度近视眼比较改变不明显.单侧高度近视性弱视眼矫正视力低下的原因有待进一步研究.     

应用视神经纤维分析仪检测正常人视网膜神经纤维层厚度

目的 探讨正常人的视网膜神经纤维层厚度及其象限比值与年龄的关系。方法 应用视神经每人义检测１９８例（１９８只眼）正常志愿者,并按年龄分组进行统计分析。结果 ＲＮＦＬＴ与年龄成负相关,上、下方象限厚度较鼻、颞侧大,与年龄相关、鼻、颞侧无此特点。上、下方象限厚度比值平均为１．０４１。结论 ＮＦＡ是测量ＲＮＦＬＴ的可靠方法,正常人的ＲＮＦＬＴ随年龄的增长而减少。     

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。     

The investigation of retinal nerve fiber layer thickness in eyes with optic nerve head drusen

Purpose: To investigate the effect of optic nerve head drusen (ONHD) on the retinal nerve fiber layer (RNFL) thickness. Patients and methods: Twenty-one nonglaucomatous eyes with various degrees of ONHD and 27 age-matched control eyes were included in the study. Visual fields and RNFL thickness were assessed using Humphrey field analyzer and optical coherence tomography (OCT), respectively. The eyes with various degrees of ONHD and the control eyes were compared with regard to visual field (VF) indices and RNFL thicknesses. Results: VF indices of the eyes with ONHD were significantly different from those of the control eyes (p < 0.05), but no significant difference existed among the eyes with various degrees of ONHD (p > 0.05). The RNFL thicknesses of inferior quadrants of the eyes with ONHD were significantly thinner than those of the control eyes (p < 0.05). A significant thinning of the RNFL in the superior and nasal quadrants was observed in grade II and III discs, while temporal quadrants only in grade III discs presented a similar change (p < 0.05). A comparison between the RNFL thicknesses of various degrees of ONHD did not show a significant statistical difference (p > 0.05) except for the thickness in the temporal RNFL (p < 0.05). Conclusion: We found a significant decrease in the RNFL thickness of ONHD patients compared to that of the control subjects. The measurements of VF indices did not show a significant difference between various degrees of ONHD. In contrast, RNFL thickness was significantly correlated with the amount of ONHD. This suggests that OCT may allow the detection of early changes in RNFL thickness in ONHD patients before observable changes in the visual field are seen.     

屈光不正性弱视患者视网膜厚度的变化

目的:探讨视网膜厚度分析仪(retinalthicknessanalyzer,RTA)对弱视患者的诊断价值。方法:采用RTA测量正常人6例11眼及弱视患者22例31眼,眼后极部视网膜厚度值及厚度地形图,所得数据经SPSS统计软件包进行分析。结果:正常人平均视网膜厚度为172.4±13.4μm,鼻侧较颞侧厚(P<0.05),其中黄斑上方为177.1±9.0μm,黄斑下方为169.9±11.0μm;鼻侧为180.5±1.3μm,颞侧为161.0±9.2μm。弱视患者平均视网膜厚度为176.4±7.4μm。在黄斑中心凹X5区,弱视明显厚于正常人。黄斑上方为178.7±20.2μm,黄斑下方为173.4±26.2μm;鼻侧为177.3±9.6μm,颞侧为173.4±6.2μm。结论:正常眼鼻侧视网膜明显较颞侧厚。弱视眼在黄斑中心凹X5区视网膜厚度明显较正常眼厚。     

Evaluation of the retinal nerve fiber layer thickness in eyes with idiopathic macular holes

PURPOSE: To compare the retinal nerve fiber layer thickness in eyes with idiopathic macular holes and age-matched normal controls using scanning laser polarimeter. METHODS: The retinal nerve fiber layer thickness was measured in 40 eyes of 40 consecutive patients with idiopathic macular hole (stage 1, 10 eyes; stage 2, eight eyes; stage 3, 15 eyes; stage 4, seven eyes) and 40 eyes of 40 age-matched normal controls with a scanning laser polarimeter. The retinal nerve fiber layer thickness within a 10-pixel-wide ellipse located concentrically with the disk and located 1.5-disk diameters from the center of the disk was measured. The mean overall retinal nerve fiber layer thickness of the peripapillary retina, four 90-degree quadrants, and 16 equal sectors of every 22.5 degrees was calculated for both groups. The retinal nerve fiber layer thickness in the two groups was statistically compared. RESULTS: The mean retinal nerve fiber layer thickness measurement for the overall peripapillary retina and for three of the four 90-degree quadrants was not significantly different between the two groups. However, the temporal 90-degree quadrant was significantly thinner in the macular hole group (47.2 versus 54.6 microm, P =.026). For the 16 sectors of 22.5 degrees, the lower three sectors of the four sectors in the temporal quadrant were thinner in the macular hole group (P <.05). CONCLUSIONS: The retinal nerve fiber layer thickness of the papillomacular area is thinner in eyes with idiopathic macular hole than that in normal eyes. The progressive thinning of the retinal nerve fiber layer thickness as the stage of the macular hole advances may suggest that surgery should be done at the earliest stage.     

Comparison of optic disk and retinal nerve fiber layer thickness in nonglaucomatous and glaucomatous patients with high myopia

PURPOSE: To assess the optic nerve head (ONH) by optical coherence tomography (OCT), confocal scanning laser ophthalmoscopy (CSLO), and the retinal nerve fiber layer (RNFL) by OCT and scanning laser polarimetry (GDx) in highly myopic subjects. DESIGN: Observational cross-sectional study. METHODS: Thirty-five eyes of highly myopic individuals without glaucoma and 17 eyes of highly myopic patients with glaucoma were included in this study. All patients had myopia higher than 5.0 diopters and ocular axial length higher than 25 mm. In those patients without glaucoma, the intraocular pressure (IOP) was less than 21 mm Hg. RESULTS: Mean (SD) OCT cup-to-disk area ratio was 0.45 (0.30) and 0.58 (0.29) in the nonglaucomatous and glaucomatous subjects, respectively (P = .22); CSLO cup-to-disk area ratio was 0.27 (0.27) and 0.24 (0.23), respectively (P = .75); and OCT-RNFL was 65.2 (26.2) microm and 56.8 (28.6) microm (P = .43). CONCLUSIONS: OCT, CSLO, and GDx are not useful to discriminate nonglaucomatous and glaucomatous subjects that have high myopia.     

Long term follow-up of retinal nerve fiber layer thickness in eyes with optic nerve head drusen

PURPOSE: To investigate the effect of optic nerve head drusen (ONHD) on the retinal nerve fiber layer (RNFL) thickness during follow-up period. METHODS: Twenty-three non-glaucomatous eyes having clinically visible ONHD confirmed by colored disc photos were studied. RNFL thickness was determined with Optical Coherence Tomography (OCT). Eyes were re-examined after average of 18 months (ranging between 14 and 22 months). Mean RNFL thickness of each quadrant was compared with previous results at each follow-up visit. RESULTS: Mean RNFL thickness was 88.43 +/- 10.2 micron at first visit and 90.35 +/- 6.9 micron at follow-up in eyes with clinically visible ONHD. The difference between the mean RNFL thickness measured from inferior, superior, nasal and temporal quadrant at first and follow-up visits was not significant (paired t-test, p > 0.05). CONCLUSION: The presence of drusen was found to have no effect on RNFL thickness at follow-up visits. OCT may provide a useful means to evaluate and follow up the RNFL thickness in these patients.     

Attenuated age-related thinning of peripapillary retinal nerve fiber layer in long eyes

Purpose

To assess the impact of axial length on the age-related peripapillary retinal nerve fiber layer (RNFL) thinning.

Methods

This cross-sectional observational comparative case series included 172 eyes from 172 healthy Korean subjects. Peripapillary RNFL thickness was measured using an Optic Disc Cube 200 × 200 scan of spectral domain Cirrus HD OCT and the axial length was measured using IOL Master Advanced Technology. In age groups based on decade, the normal ranges of peripapillary RNFL thickness for average, quadrant, and clock-hour sectors were determined with 95% confidence intervals. After dividing the eyes into two groups according to axial length (cut-off, 24.50 mm), the degrees of age-related RNFL thinning were compared.

Results

Among the eyes included in the study, 53 (30.81%) were considered to be long eyes (axial length, 25.04 ± 0.48 µm) and 119 (69.19%) were short-to-normal length eyes (axial length, 23.57 ± 0.60 µm). The decrease in average RNFL thickness with age was less in long eyes (negative slope, -0.12 µm/yr) than in short-to-normal length eyes (negative slope, -0.32 µm/yr) (p < 0.001).

Conclusions

Age-related thinning of peripapillary RNFL thickness is attenuated in long eyes compared to short-to-normal length eyes.     

Differences by quadrant of retinal nerve fiber layer thickness in healthy eyes

PURPOSE: The purpose of this study was to determine the distribution of retinal nerve fiber layer thickness by quadrant in healthy eyes. PATIENTS AND METHODS: Forty subjects with healthy eyes were included in the study. A complete ophthalmic examination was performed, including determination of visual fields by automated perimetry. The subjects had no family history of retinal disease or glaucoma. Forty right eyes and 40 left eyes were measured. Retinal nerve fiber layer thickness was measured using simultaneous stereophotographs with stereophotogrammetry at the disc margin. For the total disc and four quadrants, absolute retinal nerve fiber layer thickness and optic disc area was determined using a magnification correction formula. RESULTS: Comparison of the quadrants showed that the retinal nerve fiber layer thicknesses of the superior, inferior, and nasal quadrants were significantly thicker than the temporal quadrant (P = 0.00006 for right and left eyes). No significant differences were observed between the superior, inferior, and nasal quadrants in the right eye. In the left eye, the superior retinal nerve fiber layer thickness was significantly greater than the inferior (P = 0.028) and nasal retinal nerve fiber layer thicknesses (P = 0.00006), while the inferior was not significantly different from the nasal. No significant difference in quadrant retinal nerve fiber layer thickness was noted between eyes. CONCLUSIONS: Measurements of retinal nerve fiber layer thickness in healthy eyes show the thinnest quadrant to be the temporal, with the other three quadrants having similar thicknesses. This pattern corresponds to the histologic measurements of retinal nerve fiber layer thickness.     

Visual field defects and retinal nerve fiber layer defects in eyes with buried optic nerve drusen

PURPOSE: To evaluate the visual field with the use of automated perimetry and to evaluate the retinal nerve fiber layer (RNFL) with optical coherence tomography (OCT) in patients with buried optic nerve drusen (OND). DESIGN: Observational case control study. METHODS: Eyes with buried OND were defined as eyes with ultrasound-proved drusen that were not visible with indirect slit-lamp biomicroscopy. All eyes underwent automated perimetry. Some eyes underwent OCT to evaluate the RNFL. RESULTS: Fifty-eight eyes of 41 patients with buried OND were evaluated. Three eyes (5%) had inferior arcuate scotomas. The other 55 eyes did not have visual field defects. Twenty-one of the eyes without visual field defects underwent RNFL analysis with OCT. All 21 eyes had normal average RNFL thickness. Some eyes had focal RNFL defects, but it is not clear whether these defects were clinically significant. CONCLUSION: Visual field defects are uncommon in eyes with buried OND. Eyes with buried OND may have focal RNFL defects but have normal average RNFL thickness. In patients with buried OND and a visual field defect, consideration should be given to searching for other causes of the defect, especially if the defect is substantial.     

近视眼视网膜神经纤维层厚度分析

目的:分析近视眼患者与正常人视网膜神经纤维层厚度的差异,探讨近视程度对视网膜神经纤维层厚度的影响。方法:采用视神经分析仪-GDxVCC(美国激光技术诊断公司生产)测量正常人23例42眼和近视眼患者85例166眼视网膜神经纤维层厚度,近视眼患者按等效球镜屈光度分为低、中、高、超高度近视四组,将所得结果用SPSS11.5统计软件包进行统计分析。结果:视乳头周围2.4～3.2mm的环形区域视网膜神经纤维层平均厚度正常人与低、中、高度及超高度近视组比较无显著性差异,不同程度近视眼组两两之间进行比较无显著性差异;上方120°区域视网膜神经纤维层厚度高度、超高度近视眼组与其他各组进行比较有非常显著性差异(P<0.01),高度与超高度近视组之间进行比较有显著性差异(P<0.01),其他各组两两之间进行比较无显著性差异;下方120°区域视网膜神经纤维层厚度各组之间进行比较无显著性差异;环形区域RNFL厚度平均值的标准差超高度近视组与其余各组之间的差异具有显著性(P<0.05);神经纤维指数高度近视组、超高度近视组与其他各组差异有显著性,且与屈光度呈线性关系(P<0.05)。结论:随着近视程度的增加,近视眼患者上方120!范围内视网膜神经纤维层厚度逐渐变薄,神经纤维指数逐渐增加。     

Nerve fiber analyzer measuring retinal nerve fiber layer thickness in normal and glaucomatous eyes

目的客观测量和比较青光眼病人与正常人视网膜神经纤维层（ＲＮＦＬ）厚度。方法用神经纤维分析仪（ＮＦＡ）对１５例（２５眼）开角青光眼病人及２５例（４２眼）正常人视盘区神经纤维层厚度进行测量,然后经计算机自动分析求出上、下、颞、鼻４个区ＲＮＦＬ厚度及平均厚度,所得数据经统计学分析。结果青光眼患者上、下区域ＲＮＦＬ平均厚度分别为（８４．４７±１２．０９）μｍ和（７７．４９±１６．６３）μｍ,总平均厚度（７２．５１±１２．０９）μｍ,均低于正常人［分别为（１０４．９２±２０．５６）μｍ,（９５．４８±１５．６２）μｍ和（８６．１５±１４．７５）μｍ）］,统计学差异有显著意义（Ｐ＜０．０１）;颞、鼻侧厚度与正常人差异不明显。结论ＲＮＦＬ厚度分析可望作为青光眼早期诊断依据之一。     

近视对OCT测量视网膜神经纤维层厚度的影响

目的探讨近视对光学相干断层扫描(OCT)测量视网膜神经纤维层厚度(retinal nerve fiber layer thickness,RNFLT)的影响。方法选取近视患者77例133眼分别行OCT氉测量RNFLT与屈光度测量,各测量3次,对屈光度与全周RNFLT进行简单相关分析与直线回归分析,对全周RNFLT与屈光度、年龄进行偏相关分析。结果屈光度的绝对值与全周RNFLT呈负相关。进一步进行两者的回归分析,回归方程为:RNFLT=-0.954×屈光度的绝对值+107.472。对全周RNFLT与屈光度、年龄进行多重线性回归分析,回归方程为:RNFLT=-0.800×屈光度绝对值-0.16 6×年龄+111.707。结论屈光度的绝对值与RNFLT呈负相关,近视度数每增加1.0D,全周RNFLT减少0.800μm,年龄每增加1岁,全周RNFLT减少0.166μm。     

视网膜神经纤维层检测在诊断青光眼及近视合并青光眼中的价值

视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度的现代检测手段主要有海德堡视网膜断层扫描仪、光学相干断层成像术和偏振激光扫描仪等。检测RNFL厚度可以对青光眼的早期诊断提供依据。与青光眼一样,近视眼的RNFL也会变薄。所以近视合并青光眼时经常容易被误诊而延误青光眼的治疗时机。因此我们必须将单纯近视眼与近视合并青光眼区别开来。对RNFL的检测能否将单纯近视眼及近视合并青光眼区别开,国内外学者存在不同观点,现综述如下。     

高度近视眼后极部视网膜厚度的光学相干断层成像测量

目的 应用光学相干断层成像(OCT)技术探讨高度近视眼黄斑区及视盘周围视网膜神经纤维层(RNFL)的厚度变化 方法 前瞻性病例对照研究随机选取2011年3月至2011年8月在金华市中心医院眼科就诊并行OCT检查的高度近视患者33例(33眼)和正常对照者35例(35眼),分别测量其黄斑中心凹和距中心凹750μm处的四q个方向上的RNFL厚度,并测量视盘周围12个钟点方向上的RNFL厚度,比较两组之间有无显著性差异.两组间的比较采用独立样本t检验 结果 高度近视眼组黄斑区各方向RNFL.厚度均明显小于正常对照组(t=3.08,P＜0.01),而视盘周围RNFL厚度较正常对照组有变薄趋势,但差异无统计学意义 结论 高度近视眼黄斑区RNFL厚度明显低于正常眼视盘周围的RNFL厚度有变薄的趋势,因此在对合并高度近视的青光眼眼患者进行视盘周围RNFL厚度评价时,需持谨慎的态度,0CT能够精确量化RNFL厚度,可重复性好.