OCTA在原发性开角型青光眼中的应用

目的:采用光学相干断层扫描血管成像术(OCTA)观察正常人和原发性开角型青光眼(POAG)患者盘周毛细血管(RPC)层的视盘区血管密度情况,探讨该技术对POAG的诊断能力。方法:本研究为横断面研究,纳入明确诊断为POAG患者45例60眼,健康受试者48例60眼为正常对照组。采用OCTA技术对所有受检者视乳头区扫描,测量视乳头区RPC层血管密度和纵行C/D比值。Humphrey视野检测MD、PSD值。分析血管密度和C/D比值的相关性;采用ROC曲线和AUC评价患者血管密度各参数的诊断效能并进行成对比较。结果:血管密度随着青光眼的加重而降低,视盘内毛细血管密度和视盘内血管密度与MD值及PSD值相关性较弱,其它各血管密度参数与MD值及PSD值具有很强的相关性。全区域毛细血管密度、视乳头周围毛细血管密度、全区域血管密度、视乳头周围血管密度AUC>0.9,具有较高的诊断价值,各参数间均无差异(P>0.05);视盘内毛细血管密度、视盘内血管密度的诊断效力明显低于其它参数(均P<0.05),AUC分别为0.85、0.88。结论:与正常对照组相比,POAG组血管密度明显下降,并且随着病情进展而加重;视盘区血管密度是评估POAG患者结构损伤的良好指标,在POAG的诊断和随访中具有重要意义,而视盘内血管密度和毛细血管密度对POAG的诊断效能明显低于其它血管参数。     

A new diagnostic model of primary open angle glaucoma based on FD-OCT parameters

AIM: To build a clinical diagnostic model of primary open angle glaucoma (POAG) using the normal probability chart of frequency-domain optical coherence tomography (FD-OCT). METHODS: This is a cross-sectional study. Total 133 eyes from 133 healthy subjects and 99 eyes from 99 early POAG patients were included in the study. The retinal nerve fibre layer (RNFL) thickness parameters of optic nerve head (ONH) and RNFL3.45 scan were measured in one randomly selected eye of each subject using RTVue-100 FD-OCT. Then, we used these parameters to establish the diagnostic models. Four different diagnostic models based on two different area partition strategies on ONH and RNFL3.45 parameters, including ONH traditional area partition model (ONH-T), ONH new area partition model (ONH-N), RNFL3.45 traditional area partition model (RNFL3.45-T) and RNFL3.45 new area partition model (RNFL3.45-N), were built and tested by cross-validation. RESULTS: The new area partition models had higher area under the receiver operating characteristic (AROC; ONH-N: 0.990; RNFL3.45-N: 0.939) than corresponding traditional area partition models (ONH-T: 0.979; RNFL3.45-T: 0.881). There was no statistical difference among AROC of ONH-T, ONH-N, and RNFL3.45-N. Nevertheless, ONH-N was the simplest model. CONCLUSION: The new area partition models had higher diagnostic accuracy than corresponding traditional area partition models, which can improve the diagnostic ability of early POAG. In particular, the simplest ONH-N diagnostic model may be convenient for clinical application.     

Ganglion cells apoptosis in diabetic rats as early prediction of glaucoma: a study of Brn3b gene expression and association with change of quantity of NO, caspase-3, NF-κB, and TNF-α

AIM: To find a new concept to show whether or not apoptosis of retinal ganglion cells (RGCs) can be determined in the histology of acute hyperglycemia in the role of expressed Brn3b gene related to nitric oxide (NO), caspase-3, nuclear factor kappa-B (NF-κB), and tumor necrosis factor-α (TNF-α) as an early predictor of primary open angle glaucoma (POAG) eyes and their associations.METHODS: Experimental in vivo study was carried out using adult male, white Sprague-Dawley rats aged ≥2mo, weighing 150-200 g. The animals were divided into two groups, one group receiving intraperitoneal injection of streptozotociz 50 mg/kg in 0.01 mol/L citric buffer and pH 4.5 and a comparison made with the control group. Retinal tissue was divided into two parts (both experimental and control groups respectively): a) right retina for immunohistochemistry (IHC; caspase-3 and TNF-α); b) left retina was divided into two parts for the purpose of real-time polymerase chain reaction (PCR) test (RNA extraction for Brn3b gene expression analysis) and ELISA test (NO and NF-κB).RESULTS: The experimental group showed a decrease in Brn3b gene expression compared to the control group (1.3-fold lower in 2nd month; 1.1-fold lower in 4th month and 2.5-fold lower in 6th month). However, there was a decrease of NO, caspase-3, and an increase of NF-κB and TNF-α quantity.CONCLUSION: The expression of mRNA Brn3b gene is inversely proportional to apoptosis in RGCs. The quantity of NO, caspase-3, NF-κB and TNF-α is influential in expression of Brn3b in RGCs caused by hyperglycemia in diabetic rats.     

原发性开角型青光眼诊断的研究现状

青光眼是一种以视功能损害为特征的全球性致盲性眼病。原发性开角型青光眼(POAG)也称慢性开角型青光眼,其发生和发展的早期阶段往往不容易被察觉从而耽误了治疗。对该疾病的早期诊断有助于降低其致盲率。近年来POAG的诊断在光学相干断层扫描技术、深度学习算法和生物标记等方面有了新的进展。本文将对此作一综述。     

Clock-hour laminar displacement and age in primary open-angle glaucoma and normal tension glaucoma

Background: To find out the relationship between laminar displacement and age between patients with primary open‐angle glaucoma and normal tension glaucoma. Design: Retrospective study conducted at a tertiary university hospital Participants or Samples: Twenty‐six eyes of 26 primary open‐angle glaucoma patients and 52 eyes of 52 normal tension glaucoma patients. Methods: Patients were scanned with a Stratus optical coherence tomography apparatus to measure the retinal nerve fibre layer thickness and to visualize the cross‐sectional laminar displacement of 12 clock‐hour segments, 30 degrees each. Depth1 was defined as the longest distance between the retinal pigment epithelium and the anterior laminar cribrosa surface, which represents the amount of laminar displacement. Main Outcome Measure: Partial correlation coefficients adjusted by mean deviation and intraocular pressure between (i) retinal nerve fibre layer thickness and age, and (ii) Depth1 and age. Results: In the primary open‐angle glaucoma group, strong negative correlations (approximately ?0.343 ～ ?0.738) were found between Depth1 and age. Eight of 12 clock‐hour segments' correlations were significant after Bonferroni correction (α = 0.0021; 24 comparisons). However, no significant correlations were found between Depth1 and age in the normal tension glaucoma group. When the correlation coefficients were compared between the two groups, eight clock‐hour segments showed significant differences after Bonferroni correction. Conclusions: The significantly different correlation between laminar displacement and age between primary open‐angle glaucoma and normal tension glaucoma patients may suggest a different role of the lamina cribrosa to the disease.     

应用SD-OCT纵向比较正常人群和青光眼进展及非进展人群的RNFL厚度

目的：应用频域光学相干断层扫描（ spectral－domain optical coherence tomography ,SD－OCT）纵向比较正常人群、青光眼进展及非进展人群的视网膜神经纤维层（ retinal nerve fiber layer ,RNFL）厚度。方法：应用SD－OCT对36例POAG患者和24例正常人监测RNFL厚度。受试者行视盘OCT、眼底照相及视野检查,每6mo一次,随访2a,至少有4次可信的OCT检查结果。根据视野及眼底照相结果将POAG患者划分为进展组和非进展组。分析各组RNFL厚度变化差异,同视野参数变化值做相关性分析。结果：平均随访2．1±0．3 a。17例被确定为POAG进展组。POAG进展组平均RNFL厚度损失速率明显高于POAG非进展组（2．46μm／a vs 1．21μm／a,P＜0．001）。下方RNFL厚度变化同视野平均偏差（ mean deviation ,MD）变化相关性最佳（r＝0．423,P＝0．03）。结论：应用SD－OCT纵向监测RNFL厚度, POAG进展者RNFL厚度丢失速率明显增高,下方RNFL厚度参数变化可能在监测中意义较大。     

Comparing glaucomatous optic neuropathy in primary open angle and chronic primary angle closure glaucoma eyes by optical coherence tomography

PURPOSE: To comparatively evaluate the optic nerve head (ONH) using Optical Coherence Tomography (OCT) in normal subjects, primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) patients. METHODS: A total of 138 normal eyes (138 subjects) and 139 glaucomatous eyes (139 patients), were evaluated in this cross-sectional observational study. The ONH was imaged on OCT using the optic disc scan. Disc area, cup area, rim area, vertical integrated rim area (VIRA), rim volume (horizontal integrated rim volume), average cup/disc ratio, horizontal and vertical cup/disc ratios, and cup volume were evaluated. Additionally, cup depth and slope of the temporal ONH were also measured. These ONH parameters were compared between normal subjects and eyes with early POAG and CPACG. Correlation of mean deviation and corrected pattern standard deviation on full threshold 30-2 perimetry, with measured ONH parameters was carried out amongst the two groups. RESULTS: There was a significant difference in disc area (2.38 +/- 0.5, 2.77 +/- 0.4, 2.62 +/- 0.4 mm(2), p < 0.01), cup area (0.88 +/- 0.6, 1.99 +/- 0.7, 1.60 +/- 0.7 mm(2), p < 0.01), rim area (1.48 +/- 0.4, 0.86 +/- 0.4, 0.96 +/- 0.4 mm(2), p < 0.01), VIRA (1.64 +/- 0.3, 1.23 +/- 0.3, 1.22 +/- 0.4 mm(2), p < 0.01), rim volume (0.34 +/- 0.2, 0.1 +/- 0.1, 0.15 +/- 0.1 mm(3), p < 0.01) and cup/disc ratio (0.36 +/- 0.2, 0.69 +/- 0.1, 0.63 +/- 0.2, p < 0.01) in normal vs POAG vs CPACG eyes respectively. A comparison of ONH parameters between early POAG and early CPACG showed a significant difference in the disc area (2.85 +/- 0.3, 2.57 +/- 0.4 mm(2), p = 0.03), cup area (2 +/- 0.5, 1.34 +/- 0.5 mm(2), p < 0.01), rim area (0.96 +/- 0.4, 1.21 +/- 0.5 mm(2), p = 0.009), rim volume (0.12 +/- 0.1, 0.18 +/- 0.1 mm(3), p < 0.01) and cup/disc ratio (0.67 +/- 0.1, 0.53 +/- 0.2, p < 0.01). The parameters with the highest area under the receiver operator characteristic (AROC) curves for differentiating normal and early POAG eyes were rim volume, 0.89, VIRA, 0.84, and rim area, 0.76. The AROC values (normal vs early CPACG eyes) were 0.75 for rim volume, 0.72 for VIRA, and 0.66 for rim area. CONCLUSION: OCT may serve as a useful diagnostic modality in distinguishing a normal optic disc from a glaucomatous one, even in the early stages of glaucoma. Rim volume, VIRA and rim area can be used to differentiate normal from early glaucoma (both early POAG and CPACG), and most efficiently early POAG eyes. CPACG eyes have smaller discs, a smaller cup, smaller cup/disc ratio, and a larger rim area when compared with eyes with POAG.     

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。     

OCTA技术在原发性青光眼中的应用研究进展

随着科学的发展和社会的进步,近年关于原发性青光眼眼底血流动力学的研究有了革命性的突破,诞生了一种非侵入性的影像学辅助检查方法—光学相干断层扫描血管成像技术(OCTA)。该技术与传统的检查方法相比具有很多优点,其利用分频谱振幅去相关血管成像(SSADA)的方式获取眼底三维立体血流图像,可以分层并量化眼底血流密度,具有无创、迅速、可重复、分层成像和高分辨率等特点,可用于监测青光眼眼底血流的早期改变、病情进展及疗效评估。但OCTA在临床实际应用中目前还存在一定的缺陷,需要进一步研究,才能更广泛地应用于青光眼疾病的更多领域,本文就OCTA技术在原发性青光眼中的应用及研究进展做一综述。     

原发性开角型青光眼患者视网膜神经纤维层厚度与视野缺损的相关性研究

目的　探讨原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎａｎｇｌｅｇｌａｕｃｏｍａ,ＰＯＡＧ）患者视网膜神经纤维层（ｒｅｔｉｎａｌｎｅｒｖｅｆｉｂｅｒｌａｙｅｒ,ＲＮＦＬ）厚度与视野缺损的相关性。方法　选取２０１３年４月至２０１４年５月我院收治的３０例（３０眼）ＰＯＡＧ患者作为观察组,另选取同期于我院体检的３０名健康者作为对照组,检测两组受试者的ＲＮＦＬ厚度及视野缺损情况。结果　观察组上方、下方、颞侧、鼻侧四个象限的ＲＮＦＬ厚度分别为（９２．５３±１０．７２）μｍ、（９１．４８±１１．４５）μｍ、（７４．６８±８．３３）μｍ、（７１．４５±９．１５）μｍ,对照组分别为（１４１．６７±１９．４５）μｍ、（１３７．６１±１８．４６）μｍ、（９４．５５±１１．６４）μｍ、（９０．４９±１０．４８）μｍ,差异均有统计学意义（均为Ｐ＜０．０５）;观察组上方、下方、颞侧、鼻侧四个象限的视野缺损值分别为（６．４９±０．８４）ｄＢ、（５．９１±０．６９）ｄＢ、（８．４２±０．９５）ｄＢ、（７．２９±０．９４）ｄＢ。相关性分析显示,观察组ＲＮＦＬ厚度与各相应视野内的视野缺损呈负相关,回归系数ｂ的差异均有统计学意义（均为Ｐ＜０．０５）。结论　ＰＯＡＧ患者存在ＲＮＦＬ损伤及视野缺损,且二者具有负相关性,能够准确判断病情。     

早期原发性开角型青光眼视盘血流密度的分析研究

目的:探讨早期原发性开角型青光眼(POAG)、高眼压症患者和健康者的视盘血流密度的差异。方法:横断面研究。收集2019-01/2021-04于福州东南眼科医院青光眼科门诊就诊患者,早期POAG组45例70眼,其中男32例49眼,女13例21眼,年龄48.50(26.75,64.50)岁,高眼压症组37例65眼,其中男17例29眼,女20例36眼,年龄37.00(27.00,47.00)岁,健康组51例94眼,其中男23例39眼,女28例55眼,年龄46.00(34.50,56.50)岁。分别对三组进行常规的眼科检查包括最佳矫正视力(BCVA)、眼压、视野、视网膜神经纤维层厚度(RNFL)、中央角膜厚度(CCT)等,通过光相干断层扫描血管成像检查(OCTA)采集并测量三组的视盘中心区、内层区、外层区和完整区的视盘血流密度。结果:三组眼压比较有差异(H=146.876,P<0.001),早期POAG组和高眼压症组与健康组的眼压值有差异(均P<0.01),早期POAG组和高眼压症组患者的眼压无差异(P=0.132)。早期POAG组和高眼压症组的BCVA、RNFL、MD值比较有差异(P=0.005、0.01、<0.01),早期POAG组和健康组两者的BCVA、RNFL、MD值比较有差异(P=0.013、<0.01、<0.01),高眼压症组和健康组两者的BCVA、RNFL、MD值比较无差异(P=1.000、0.660、1.000)。早期POAG组和健康组之间CCT无差异(P=0.074),早期POAG组和高眼压症组之间CCT比较有差异(P=0.006),高眼压症组和健康组之间CCT比较有差异(P<0.01)在中心区、内层区、完整区,早期POAG组和高眼压症组的血流密度比较有差异(均P<0.01),早期POAG组和健康组的血流密度比较有差异(均P<0.01),高眼压症组和健康组比较无差异(均P=1.000)。在外层区,早期POAG组和健康组的血流密度比较有差异(P=0.001),高眼压症组和早期POAG组及健康组比较有差异(P=0.067、0.877)。结论:早期POAG的视盘血流密度相比高眼压症和健康者是减少的,与视野MD、RNFL参数的变化是相一致的,早期POAG视盘不同区域血流密度均减少。     

OCT测量正常人与原发性开角型青光眼视网膜神经纤维层厚度的研究

目的：采用光学相干断层成像术(optical coherence tomography,OCT)测量正常人与原发性开角型青光眼(primary open angle glaucoma,POAG)视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度,为POAG的诊断提供理论依据。

方法：本组观察对象为2014-11/2017-11于我院就诊的POAG患者100例123眼,设为观察组,选择年龄、性别配对的正常体检人群50例100眼,设为对照组,根据视野平均缺损(mean defect,MD)将POAG患者分为早期组36例44眼、进展期组40例50眼与晚期组24例29眼; 采用OCT测量视盘全周、颞侧、鼻侧、下方、上方平均RNFL厚度,各象限MD采用全自动视野计测量,并进行相关性分析。

结果：观察组视盘全周、颞侧、鼻侧、下方、上方平均RNFL厚度均显著低于对照组,差异具有统计学意义(P<0.001); 观察组视盘全周、颞侧、鼻侧、下方、上方MD均显著高于对照组,差异具有统计学意义(P<0.001); 早期组、进展期组与晚期组平均RNFL厚度依次变薄,两两比较差异具有统计学意义(P<0.001),早期组、进展期组与晚期组MD依次变增加,两两比较差异具有统计学意义(P<0.001); 视盘全周、颞侧、鼻侧、下方、上方平均RNFL厚度与MD均呈负相关(r=-0.675、-0.667、-0.560、-0.711、-0.660,均P<0.001)。

结论：OCT检查显示POAG患者RNFL厚度较正常人群明显变薄,且随着病情进展RNFL厚度越薄,且与患眼MD有密切联系。     

Diurnal macular choroidal area fluctuation in normal and primary open angle glaucoma groups

AIM: To assess and compare the diurnal macular choroidal area fluctuation in normal and primary open angle glaucoma (POAG) groups using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: Twenty-eight normal and 27 POAG eyes were enrolled in this study. EDI-OCT was used to measure the macular choroidal area every 3h from 9:00 a.m. to 21:00 p.m. RESULTS: Significant diurnal fluctuations of macular choroidal area were observed in both normal (P=0.003) and POAG groups (P<0.001). But no significant macular choroidal area difference has been found between the two groups at all the five measurement time-points (512778±166242 vs 455079±207278 μm2, P=0.195 at 9:00 a.m.; 501526±168953 vs 447846±211147 μm2, P=0.245 at 12:00 a.m.; 501982±173158 vs 448024±206653 μm2, P=0.239 at 15:00 p.m.; 508912±174589 vs 457783±207081 μm2, P=0.252 at 18:00 p.m.; 503787±171241 vs 453230±205955 μm2, P=0.274 at 21:00 p.m.; respectively). Furthermore, neither the fluctuation manners nor the change in macular choroidal area between the two adjacent measurement time points showed significant difference between normal and POAG groups (all P>0.05). In the meantime, significant diurnal intraocular pressure fluctuations were also observed in normal and POAG groups (both P<0.001). CONCLUSION: In diurnal time, the macular choroidal area in both normal and POAG groups fluctuated significantly; moreover, neither the value of macular choroidal area, nor the fluctuation of macular choroidal area in POAG group is significantly different from that in normal group.     

MP-3 microperimeter in early primary open angle glaucoma with a new pattern

AIM: To investigate macular microperimetry in patients with early primary open angle glaucoma (POAG) using a new custom-made pattern, and analyze the characteristics of macular sensitivity. METHODS: This case-control study included 38 patients with POAG, who were divided into pre-perimetric glaucoma (18 eyes of 18 patients), early-stage (20 eyes of 20 patients), and control (20 eyes of 20 patients) groups. All subjects underwent standard 24-2 humphrey visual field test. An MP-3 microperimeter with a new custom-made pattern (28 testing points distributed in four quadrants, covering the central 10° of the retina) was used to evaluate macular sensitivity. Ganglion cell complex (GCC) thicknesses were examined using an RS-3000 Advance OCT system. The features of structure and function were analysed per quadrant. RESULTS: The pre-perimetric glaucoma group had significantly lower inferior hemifield macular sensitivity compared to controls (P<0.05). The early-stage POAG group had significantly lower average, inferior hemifield, inferonasal, and inferotemporal mean sensitivities compared to the pre-perimetric glaucoma group (P<0.05), and lower macular sensitivity in all sectors compared to controls (P<0.05). Regarding GCC thickness, all sectors in the early-stage POAG group became thinner compared to those in controls (P<0.05); whereas all sectors in the early-stage POAG group, except the superonasal quadrant, became thinner compared to those in the pre-perimetric glaucoma group (P<0.05). Macular sensitivity and GCC thickness were significantly associated in each sector. The inferotemporal quadrant had the highest correlation coefficients (0.840). The structure-function relationship for the inferonasal and inferotemporal sectors was stronger compared to the corresponding superior sectors. CONCLUSION: Microperimetry reveals variations in macular sensitivity in patients with early glaucoma earlier than conventional perimetry, particularly in pre-perimetric glaucoma cases in which it might be undetectable by conventional methods. The new custom-made pattern may improve the accuracy of microperimetry by enhancing point arrangement and reducing fatigue effects. Macular sensitivity measured by MP-3 with this pattern shows statistically significant structural and functional associations with the thicknesses of the GCC.     

原发性闭角型青光眼患者虹膜生物学结构特点

目的　观察原发性闭角型青光眼（ｐｒｉｍａｒｙａｎｇｌｅｃｌｏｓｕｒｅｇｌａｕｃｏｍａ,ＰＡＣＧ）患者虹膜生物学结构特点。方法　采用眼前段光学相干断层扫描仪（ａｎｔｅｒｉｏｒｓｅｇｍｅｎｔｏｐｔｉｃａｌｃｏ-ｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＡＳ-ＯＣＴ）,获取ＰＡＣＧ组与对照组眼前段图像,采用中山房角分析软件（Ｚｈｏｎｇｓｈａｎａｎｇｌｅａｎａｌｙｚｅｐｒｏｇｒａｍ,ＺＡＡＰ）对图片进行分析,对比ＰＡＣＧ组与对照组虹膜结构参数的差异。结果　ＰＡＣＧ组患者前房浅、眼轴短、晶状体厚、房角窄及前房宽度小,与对照组相比差异均有显著统计学意义（均为Ｐ＜０．００１）。ＰＡＣＧ组虹膜厚度ＩＴ７５０为（０．４８±０．１５）ｍｍ,对照组为（０．４３±０．１８）ｍｍ,ＰＡＣＧ大于对照组;ＰＡＣＧ组虹膜厚度ＩＴ２０００为（０．５２±０．１４）ｍｍ,对照组为（０．４７±０．１６）ｍｍ;ＰＡＣＧ组虹膜面积为（１．５６±０.２８）ｍｍ２,对照组为（１．５０±０．２８）ｍｍ２;ＰＡＣＧ组虹膜弯曲距离为（０．３１±０．１７）ｍｍ,对照组为（０.２５±０．１２）ｍｍ;ＰＡＣＧ组瞳孔直径（４．０９±１．７１）ｍｍ,对照组为（４．４８±１．７１）ｍｍ;两组间虹膜厚度、虹膜面积、虹膜弯曲距离、瞳孔直径差异均有显著统计学意义（均为Ｐ＜０．００１）。结论　与对照组相比,ＰＡＣＧ患者虹膜厚、面积大、虹膜弯曲距离大,虹膜结构参数可能参与ＰＡＣＧ发病。     

OCT血管成像在原发性开角型青光眼早期诊断中的应用

目的：探讨光学相干断层扫描( optical coherence tomography,OCT)血管成像技术对原发性开角型青光眼( primary open angle glaucoma,POAG)早期诊断的价值。方法：观察31例31眼早期POAG患者视盘血流情况。以分光谱振幅去相关 OCT血管成像技术测量视盘周围毛细血管密度及视盘大血管直径,分析与患者视网膜神经纤维层厚度及视野平均缺损度的相关性。结果：视盘上方毛细血管平均密度为7.34±1.40根/mm,与上方视网膜神经纤维层平均厚度呈正相关(P<0.05);视盘下方毛细血管平均密度为7.76±1.34根/mm与下方视网膜神经纤维层平均厚度呈正相关(P<0.05)。视盘大血管平均直径为94.71±11.20μm,与视野平均缺损度呈正相关(P<0.05)。结论：OCT血管成像可以方便无创观察青光眼患者视盘血流情况,可以作为原发性开角型青光眼早期诊断的参考指标。     

光学相干断层扫描血管成像（OCTA）对早期原发性开角型青光眼的诊断能力

目的　探讨光学相干断层扫描血管成像（optical coherence tomography angiography,OCTA）诊断早期原发性开角型青光眼（primary open angle glaucoma,POAG）的能力。方法　选取200例200眼作为研究对象,其中包括正常组73例73眼、视野前POAG组46例46眼、早期POAG组81例81眼。观察OCTA所得视神经纤维层内放射状盘周毛细血管（radial peripapillary capillaries,RPC）的分布情况,采用分形维数的方法对不同受试者的RPC层各血管参数进行分析,并对结果进行比较。结果　正常组、视野前POAG组、早期POAG组间OCTA各血管参数:大血管占比［（39.29±6.40）%、（34.94±7.56）%、（29.00±6.56）%］、毛细血管占比［（39.24±7.47）%、（31.29±4.57）%、（25.53±4.18）%］、毛细血管间隙占比［（15.58±5.40）%、（26.25±8.04）%、（33.42±8.46）%］和无血管区占比［（5.89±3.47）%、（7.53±3.97）%、（12.16±5.35）%］差异均有统计学意义（均为P＜0.01）。视野前POAG组与正常组相比,毛细血管占比的曲线下面积（area under the curve,AUC）为0.885。早期POAG组与正常组相比,大血管占比的AUC为0.897,毛细血管占比的AUC为0.944。结论　OCTA作为一种方便无创的可测量视盘血流的血管造影技术或可为POAG的早期诊断提供新的思路。     

OCT测量视网膜神经纤维层厚度在青光眼诊断中的研究进展

青光眼是一种进展性视神经疾病,它能引起视神经结构改变,最终导致不可逆视功能损害。青光眼的早期诊断对保护视功能有重要的意义。光学相关断层扫描仪可以定量检测视网膜神经纤维层厚度,为早期诊断青光眼,监测视神经损害及指导青光眼的治疗提供了新的思路。本文主要反映该技术在青光眼诊断中的研究进展。许多研究都发现光学相关断层扫描仪检测的视网膜神经纤维层厚度在有视野改变的青光眼中有明显改变,且与视野损害在位置和严重程度上有很好的相关性,但仍缺乏有力的纵向研究来评价其在无视野改变青光眼中的诊断价值。     

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.