用视网膜厚度分析仪测定正常眼及青光眼后极部视网膜厚度

目的　探讨视网膜厚度分析仪 (retinalthicknessanalyzer,RTA)对青光眼的诊断价值。方法　应用RTA测定 77例 ( 116只眼 )各年龄组正常人及 2 2例 ( 35只眼 )青光眼患者眼后极部视网膜厚度 ,并将图像经计算机处理后 ,得到该处视网膜的厚度值和厚度地形图 ,所得数据用SAS统计软件包进行分析。结果　正常人平均视网膜厚度为 ( 171 83± 18 5 0 ) μm ,各年龄组间差异无显著性 (F=2 6 8,P >0 0 5 ) ;性别间差异亦无显著性 ;黄斑与视乳头间视网膜最厚 ,黄斑鼻侧较颞侧厚 ;黄斑上下方基本对称。青光眼患者的视网膜呈弥漫性或局限性变薄 ,与正常人视网膜厚度比较 ,差异有非常显著性 (F =11 98,P =0 0 0 0 1) ,RTA检查对青光眼诊断的敏感性达 80 8% ,特异性达 78 5 %。结论正常人眼后极部视网膜厚度地形图呈马蹄形 ,与视神经节细胞及其视神经纤维的解剖位置相吻合。青光眼患者的视网膜呈弥漫性或局限性变薄改变 ,与相应的视野改变相吻合 ,视网膜厚度检测的敏感性较视野检测高。RTA检查操作简便、重复性强 ,无创伤性 ,是一种在活体上测定人视网膜厚度的理想方法     

Cirrus OCT扫描信号对正常人黄斑部视网膜厚度和容积测量的影响

目的 研究频域光学相干断层扫描（OCT）信号对黄斑部视网膜厚度、容积测量的影响。方法 回顾性队列研究。用Cirrus OCT对109例正常志愿者进行黄斑厚度扫描,测量黄斑部视网膜的厚度和容积。根据扫描信号将受检者分为A1组[双眼信号强度（SS）≥7]、A2组（双眼SS＜7）、B1组（双眼SS不同,均≥7）、B2组（双眼SS不同,均<7）和B3组（一眼SS≥7,另一眼SS＜7）,比较相同扫描信号两眼及不同扫描信号两眼眼底参数的差异。采用单因素方差分析和配对t检验进行分析。结果 A1组、A2组及B1组双眼黄斑部视网膜的厚度和容积差异无统计学意义。在B2组,信号较强眼的黄斑容积（CV）稍大于信号较弱眼,差异有统计学意义（t=-2.776,P＜0.05）;在B3组,信号较弱眼的黄斑容积（CV）及黄斑部平均厚度（CAT）稍大于信号较强眼,差异有统计学意义（t=2.871,P＜0.05;t=3.210,P＜0.05）。结论 扫描信号能够影响频域OCT对黄斑部厚度及容积的测量。     

正常青少年黄斑区活体测量及分析

目的:应用视网膜厚度分析仪(RTA)对青少年正常眼黄斑区视网膜厚度进行测定,以确定国人参考值范围及正常地形图的特点。方法:对100眼经眼科检查确认的正常眼按同一方法进行黄斑区RTA图像采集,使用随机软件对其厚度进行测量,并按照青少年黄斑地形图特点,人工测量不同黄斑分区距中心小凹的跨度,计算黄斑不同分区的范围及视网膜厚度的平均值。对结果应用多元回归方法探讨年龄、性别、眼别对视网膜厚度的影响。结果:黄斑区可分为中心小凹区、中心凹区、旁中心凹区,中心小凹直径为428±165μm,中心凹平均直径为1356±277μm,旁中心区平均直径为1450±226μm;黄斑部视网膜平均厚度168±14.3μm,黄斑各部位测量所得数值为:中心小凹区为128±22μm,中心凹区为138±17.6μm,旁中心凹区为169±15μm,不同分区视网膜厚度有明显差异(P <0.05),年龄对中心凹区和中心小凹区平均厚度影响最大(P <0.05);不同性别、眼别对视网膜厚度无影响(P >0.05)。我国青少年不同分区视网膜平均厚度低于RTA软件的正常参考值,差异有显著性(P <0.01)。结论:RTA能够对活体视网膜厚度进行精确的量化测定,青少年黄斑区厚度测定值可作为我国正常青少年人群黄斑视网膜厚度的正常值参考。     

Comparison between Glaucomatous and Non-glaucomatous Eyes with Unilateral Retinal Vein Occlusion in the Fellow Eye

Purpose

To evaluate and compare the clinical and angiographic characteristics of retinal vein occlusion (RVO) in glaucomatous and non-glaucomatous eyes with unilateral RVO in the fellow eye.

Methods

Twenty-one glaucomatous eyes (GL group) and 25 age-matched non-glaucomatous eyes (non-GL group) with unilateral RVO in the fellow eye were included in this study. Fluorescein angiographic images were assessed in both groups by 3 retina specialists in order to determine the RVO occlusion site. The occlusion site was divided into 2 types: arteriovenous (AV)-crossing and non-AV-crossing (optic cup or optic nerve sited). The clinical characteristics and prevalence of AV-crossing and non-AV-crossing RVO were compared between the 2 groups.

Results

The mean baseline intraocular pressures of the RVO eye and the fellow eye did not differ between the 2 groups (RVO eye: 14.3 ± 2.5 mmHg [non-GL group], 15.5 ± 3.9 mmHg [GL group], p = 0.217; fellow eye: 14.4 ± 2.5 mmHg [non-GL group], 15.7 ± 3.7 mmHg [GL group], p = 0.148). The prevalence of systemic disease did not differ between the 2 groups (e.g., diabetes mellitus and hypertension, p = 0.802 and 0.873, respectively). AV-crossing RVO was significantly more frequent in the non-GL group (19 eyes; 76%) than in the GL group (4 eyes, 19%, p < 0.001).

Conclusions

Non-AV-crossing RVO, i.e., optic cup- or optic nerve-sited RVO, is more frequently associated with glaucomatous changes in the fellow eye. Therefore, this type of RVO should be monitored more carefully for indications of glaucoma in the fellow eye.     

Correlation of Peripapillary Choroidal Thickness and Retinal Nerve Fiber Layer Thickness in Normal Subjects and in Patients with Glaucoma

Purpose: This study was designed to compare the normal and glaucomatous eyes regarding retinal nerve fiber layer (RNFL) thickness and peripapillary choroidal thickness (PCT), and to investigate the correlation of RNFL thickness and PCT. Subjects and Methods: Subjects were selected as a convenience sample of those from a tertiary referral practice of glaucoma. Thirty-two glaucomatous eyes were accepted as group 1; 30 normal eyes were accepted as group 2. Groups were compared for RNFL thickness and PCT. Correlations of RNFL thickness and PCT were assessed for each peripapillary location. Results: Mean inferior and superior RNFL thickness in group 1 were significantly lower than the control group; mean thicknesses of temporal and nasal quadrants were not different in the two groups. Mean PCT at 500 µm distance in the inferior, at 1500 µm distance in the superior, at 500, 1000, and 1500 µm distance in the temporal, and at 1000 and 1500 µm distance in nasal quadrants were found to be significantly thinner in the glaucoma group compared with the control group. Retinal nerve fiber thickness was strongly correlated with PCT at all points of inferior quadrants at 500 µm distance in the superior. There was no correlation between RNFL thickness and PCT at any point in the control group. Conclusion: Peripapillary choroidal thickness was thinner in glaucomatous eyes compared with normal eyes. Correlation of PCT and RNFL thickness found in patients with glaucoma did not exist in normal subjects.     

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.     

Matrix metalloproteinases and their inhibitors in the chamber angle of normal eyes and patients with primary open-angle glaucoma and exfoliation glaucoma

Background In glaucoma, extensive pathological changes occur in the trabecular meshwork (TM) and juxtacanalicular tissue of the chamber angle. Aqueous humor drainage is disturbed due to the accumulation of extracellular matrix (ECM) material in the outflow system. Matrix metalloproteinases (MMPs) remodel ECM material and, thus, they may have a role in regulating outflow facility and intraocular pressure (IOP). This study examined the expression of MMPs and tissue inhibitors of MMPs (TIMPs) in the chamber angle of normal eyes and in primary open-angle glaucoma (POAG) and in exfoliation glaucoma (ExG). Methods TM tissues were isolated from healthy donor eyes for corneal transplantation. Specimens of the inner wall of Schlemm’s canal and the juxtacanalicular tissue were collected from patients with POAG or ExG during deep sclerectomy operation. Monoclonal antibodies against MMPs (MMP-1, -2, -3, and -9) and antibodies against TIMPs (TIMP-1, -2, and -3) were used for immunohistochemical staining Results Immunoreactivity for MMP-2, TIMP-2, or TIMP-3 was observed in human normal TM and in the inner wall of Schlemm’s canal. In general, immunoreactions for all of the tested MMPs were more intense in POAG samples than in ExG samples or in the control group. The only exception was the MMP-2 level, which was the highest in the control group. The staining intensity of MMP-1 or MMP-3 was significantly higher in POAG when compared to ExG. TIMP-1 was significantly increased in POAG compared with ExG and there were no marked differences in the levels of TIMP-2 or TIMP-3 between POAG and ExG. The ratios of MMP-1/TIMP-1 and MMP_1+2+3+9 and TIMP₁₊₂₊₃ were significantly higher in samples from POAG compared to those of ExG. Conclusions Our results reveal an expression imbalance between MMPs and their endogenous tissue inhibitors in tissue samples from patients with POAG and ExG. Differences in immunohistochemical reactions reflect discrete local pathogenic mechanisms involved in POAG and ExG. With respect to the proposed role of MMPs in the remodeling of ECM material, this may point to a weaker reactivity to the accumulation of ECM material in TM in ExG than POAG eyes.     

特发性黄斑裂孔手术成功愈合后的光相干断层扫描图像分析

目的 研究玻璃体切除治疗特发性黄斑裂孔(IMH)手术成功愈合后的光相干断层扫描(OCT)图像特征及其与视功能恢复的关系。 方法 IMH患者24例25只眼，通过玻璃体切除、内界膜剥除、自体血清注入等手术，黄斑裂孔均已成功闭合。回顾分析IMH患者OCT图像特征，IMH II级9只眼,III级13只眼，IV级3只眼。手术后3~24个月进行视力、最佳矫正视力、裂隙灯、视网膜镜、间接检眼镜、荧光素眼底血管造影（FFA）及OCT检查 。 结果 IMH手术使黄斑裂孔成功闭合后，其OCT图像大致可分成3组。U型5只眼：相对正常的中心凹形状；V型7只眼：黄斑中心凹较陡；W型13只眼：黄斑中心凹处神经上皮缺损，但裂孔缘未翘起，无囊腔形成。手术后患者视力均有提高，以U型视力预后最好。 结 论 IMH的OCT图像特征与手术后视力相关。 （中华眼底病杂志，2004，20：90-93）     

青光眼视网膜血氧饱和度与结构功能损害程度的相关分析

目的比较青光眼与正常人视网膜血氧饱和度的差异,分析青光眼患者中视网膜血氧饱和度与结构功能损害程度的相关性。方法病例对照研究。选取原发性开角型青光眼患者28例（35眼）为青光眼组,记录患者年龄、性别、眼压、血压、杯盘比,并进行中心30°阈值视野检测和光学相干断层扫描（OCT）检测视乳头旁视网膜神经纤维层（RNFL）厚度,并纳入27例（41眼）正常人作为对照组,采用视网膜血氧饱和度分析仪测量青光眼患者和正常人视网膜血管血氧饱和度。2组动静脉血氧饱和度差异比较采用独立样本t检验。采用Pearson或Spearman秩相关分析对青光眼组视网膜血氧饱和度与年龄、眼压、血压、杯盘比、视野平均缺损（MD）、视野指数（VFI）、视乳头旁RNFL厚度进行相关分析。结果青光眼组与正常对照组的视网膜动脉血氧饱和度差异无统计学意义,青光眼组静脉血氧饱和度较对照组高（t=4.017,P＜0.001）,动静脉血氧饱和度差值较小（t=-4.431,P＜0.001）。青光眼组视网膜动脉血氧饱和度、静脉血氧饱和度、动静脉血氧饱和度差值与年龄、眼压、血压均无线性相关性。视网膜动脉血氧饱和度与杯盘比、视野MD、VFI、视乳头旁RNFL厚度等均无线性相关。视网膜静脉血氧饱和度与杯盘比、视野MD值呈正相关（杯盘比：r=0.418,P=0.012;视野MD：r=0.504,P=0.002）,与RNFL厚度、VFI呈负相关（RNFL：r=-0.514,P=0.002;VFI：r=-0.470,P=0.004）。视网膜动静脉血氧饱和度差值与杯盘比、视野MD均呈负相关（杯盘比：r=-0.390,P=0.021;视野MD：r=-0.478,P=0.004）,与VFI、视乳头旁RNFL厚度呈正相关（VFI：r=0.449,P=0.007;RNFL：r=0.385,P=0.022）。结论随着青光眼加重,静脉血氧饱和度增加,动静脉血氧饱和度差值降低。青光眼患者视网膜耗氧量降低可能与视网膜神经组织萎缩有关。     

Quantitative assessment of macular thickness in normal subjects and patients with diabetic retinopathy by scanning retinal thickness analyser

AIMS: To evaluate the scanning retinal thickness analyser (RTA), a novel non-invasive imaging instrument, in diagnosing and quantitatively characterising diabetic macular oedema, and to investigate the relation between central macula thickness measured by RTA and other clinical examinations. METHODS: Central macular thickness was measured using the RTA in 40 normal subjects and 60 patients with diabetic retinopathy. The reproducibility of the retinal thickness measurements was evaluated by calculating the mean of the inter- and intrasession variations. Central macular thickness was correlated with the results of visual acuity measurements, biomicroscopy, and fluorescein angiography. RESULTS: Intra- and intersession reproducibility of the RTA in normal subjects was plus or minus 5.2% (16 microns) and plus or minus 6.1% (19 microns), respectively. The mean central macular thickness was 182 (SD 16) microns in normal subjects, 283 (116) microns in diabetic eyes without clinically significant macular oedema (CSMO), and 564 (168) microns in diabetic eyes with CSMO. Central macular thickness was significantly greater (p < 0.001) in eyes with diabetic retinopathy than in normal subjects, even when macular thickening did not meet the standard for CSMO (p = 0.019) measured by biomicroscopy. Although greater fluorescein leakage at the macula results in greater central macular thickness, only eyes with diffuse leakage had statistically significant macular thickening compared with normal subjects (p = 0.022). Central macular thickness measured with the RTA was significantly correlated with the logarithmic converted visual acuity (r2 = 0.76) in diabetic eyes. CONCLUSION: Scanning RTA, which has good reproducibility, might be useful to quantitatively detect and monitor macular thickening in diabetic retinopathy. Central macular thickness was highly correlated with logarithmic converted visual acuity in diabetic macular oedema.     

累及黄斑的孔源性视网膜脱离手术后黄斑下积液眼黄斑形态变化与视力预后的关系及其影响因素分析

目的 观察累及黄斑的孔源性视网膜脱离手术后黄斑下积液眼黄斑形态变化与视力预后的关系,探讨长期黄斑下积液的影响因素.方法 回顾性研究.分析63例一次性手术成功的累积黄斑的视网膜脱离患者的资料,共63只眼.根据手术后黄斑下积液时间分为无积液组,小于3个月的短期积液组,大于等于3个月的长期积液组.随访6～12个月.应用频域光相干断层扫描(SD-OCT)观察黄斑形态变化,测量手术后1个月中心凹黄斑下积液高度及中心凹外核层(ONL)厚度,评估黄斑形态变化与手术后最小分辨角对数(logMAR)视力的关系,探讨手术后长期黄斑下积液的影响因素.结果 手术后存在黄斑形态异常45只眼,占71.42％.黄斑下积液32只眼,占50.79％.其中,长期积液21只眼.光感受器外节(OS)不规则23只眼.内外节连接(IS/OS)缺损21只眼,其中,IS/OS和外界膜(ELM)同时缺损14只眼.OS不规则在长期积液组明显高于短期积液组(x2=5.788,P=0.035),IS/OS缺损及IS/OS和ELM同时缺损发生的比例在长期积液组也高于短期积液组,但差异无统计学意义(x2=0.744、0.375,P=0.472、0.403).单因素相关统计结果显示,手术前视力、视网膜脱离时间与手术后视力显著相关(r=0.611、-0.374,P=0.007、0.037).长期积液组、短期积液组和无黄斑下积液组患眼的手术后logMAR视力分别为0.53±0.41、0.42±0.31、0.27±0.26,3组间比较,差异有统计学意义(U=28.640,P=0.049).OS不规则,IS/OS缺损均与手术后视力不相关(r=0.331、0.320,P=0.073、0.102),但OS不规则与IS/OS缺损之间关系密切(r=0.388,P=0.027).IS/OS缺损合并ELM缺损眼手术后视力明显低于其他患眼(U=29.920,P=0.036).手术方式与是否有手术后黄斑下积液残留显著相关(r=0.477,P＜0.001).手术前视网膜脱离时间及手术后1个月黄斑下积液高度是影响黄斑下积液吸收的因素(r=0.354、0.375,P=0.047、0.039).结论 手术后光感受器受损几率随黄斑下积液时间延长而明显升高,IS/OS合并ELM的损害预示着更差的视力预后.病程、手术方式、手术后1个月黄斑下积液高度是影响手术后黄斑下积液时间的重要因素.     

单眼发病的原发性开角型青光眼黄斑脉络膜厚度及影响因素初探

目的:初步探讨原发性开角型青光眼（POAG）单眼发病患者黄斑中心凹下脉络膜厚度（SFCT）与其对侧眼和健康人的差异及其影响因素。方法:横断面研究。收集2018年9月至2019年9月就诊于首都医科大学附属北京同仁医院青光眼门诊确诊为POAG的单眼发病、对侧眼正常的患者（POAG组）以及健康志愿者（健康对照组）。对所有参与...     

Retinal nerve fiber layer and macular inner retina measurements by spectral domain optical coherence tomograph in Indian eyes with early glaucoma

Purpose

To compare the diagnostic abilities of peripapillary retinal nerve fiber layer (RNFL) and macular inner retina (MIR) measurements by spectral domain optical coherence tomography (SD–OCT) in Indian eyes early glaucoma.

Methods

In an observational, cross-sectional study, 125 eyes of 64 normal subjects and 91 eyes of 59 early glaucoma patients underwent RNFL and MIR imaging with SD–OCT. Glaucomatous eyes had characteristic optic nerve and RNFL abnormalities and correlating visual field defects and a mean deviation of better than or equal to -6 dB on standard automated perimetry. Areas under the receiver operating characteristic curves (AUC), sensitivities at a fixed specificity and likelihood ratios (LRs) were estimated for all RNFL and MIR parameters.

Results

The AUCs for the RNFL parameters ranged from 0.537 for the temporal quadrant thickness to 0.821 for the inferior quadrant RNFL thickness. AUCs for the MIR parameters ranged from 0.603 for the superior minus inferior MIR thickness average to 0.908 for ganglion cell complex focal loss volume (GCC–FLV). AUC for the best MIR parameter (GCC–FLV) was significantly better (P<0.001) than that of the best RNFL parameter (inferior quadrant thickness). The sensitivities of these parameters at high specificity of 95%, however, were comparable (52.7% vs58.2%). Evaluation of the LRs showed that outside normal limits results of most of the RNFL and MIR parameters were associated with large effects on the post-test probability of disease.

Conclusion

MIR parameters with RTVue SD–OCT were as good as the RNFL parameters to detect early glaucoma.     

特发性黄斑裂孔的黄斑裂孔直径、被破坏的光感受器细胞内外节直径及其与视力的相关性研究

目的 观察特发性黄斑裂孔（IMH）的频域光相干断层扫描（OCT）特征以及与视力的相互关系。方法 回顾性分析IMH患者37例39只眼的临床资料;其中11只眼接受了玻璃体切割手术治疗。所有患者均接受Snellen视力表检查、眼压、裂隙灯、间接检眼镜及OCT检查,OCT扫描速度为27 000A扫描/s,扫描区域6.0 mm×6.0 mm,扫描模式为512×128;测量黄斑裂孔直径及被破坏的光感受器细胞内外节(IS/OS)直径。采用SPSS 14.0统计软件进行统计学处理,分析黄班裂孔直径、IS/OS直径与视力的相关性。结果 最小可分辨视角的对数值（logMAR）为0.15～2.00,平均对数值0.99±0.44;黄斑裂孔直径171～1491 μm, 平均直径(942.0±348.4) μm;被破坏的IS/OS直径463～3176 μm,平均直径(1870.3±673.2) μm。logMAR、裂孔直径、被破坏的IS/OS直径三者间均具有相关性（P=0.038,0.002,P=0.000）。接受手术治疗前后裂孔闭合的9只眼中,logMAR和被破坏的IS/OS直径差异均有统计学意义（P=0.022,0.020）。结论 IMH光感受器层的破坏大于裂孔直径,视力情况与裂孔直径、被破坏的IS/OS直径相关。经手术治疗后,视力提高且裂孔闭合,被破坏的IS/OS直径也相应缩小,但在裂孔闭合的情况下仍持续存在。     

Repeatability in and interchangeability between the macular and the fast macular thickness map protocols: a study on normal eyes with Stratus optical coherence tomography

Purpose: To collect a normal material and to compare the macular and the fast macular thickness map protocols regarding normal values and repeatability. Methods: Sixty‐seven individuals underwent three repeated scans with the macular thickness protocol; 45 of them also had three scans with the fast thickness protocol in Stratus optical coherence tomography (OCT). The maps were divided into nine ETDRS fields, where thickness values were presented. The repeatability was calculated as intraclass correlation coefficient (ICC), coefficient of variance (CV) and coefficient of repeatability (CR). For comparison between the two protocols, limits of agreement were determined according to Bland–Altman. Results: Normal values for the two protocols were very close. Repeatability was high. ICC for all areas was 0.92–0.98. CV was less than 1% and CR was 6–8 μm for both protocols, with the exception of the fovea in the fast protocol (where CV was 1.44% and CR 12.4 μm). Limits of agreement between the two protocols were less than 10 μm as a rule. Conclusion: Normal values for the protocols are equal and they both have excellent repeatability. The fast macular map is a good alternative with the possible exception of the fovea, where variation is twice that of the macular thickness map.     

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。     

原发性开角型青光眼视乳头旁脉络膜萎缩区的双眼对照研究

目的研究单眼视野缺损的原发性开角型青光眼患者双眼间视乳头旁脉络膜萎缩区（PPA）的出现频率和面积大小差异。方法利用计算机图像分析系统对视乳头立体照相进行测量,比较40例单眼视野缺损的原发性开角型青光眼患者双眼间PPA的发生率及大小差异。所有入选患者的屈光度（等效球镜）均在-3．00-＋3．00D之间。结果视野缺损眼的视杯面积、杯盘面积比均大于视野正常眼,差异有统计学意义（视杯面积：t=5．332,P〈0．01;杯盘面积比：t=5．126,P〈0．01）。视野缺损眼的α区面积略大于视野正常眼,差异有统计学意义（t=3．02,P=0．0045）;双眼间β区面积差异无统计学意义（S：13．5,P=0．426）;双眼α区与β区的发生率均存在一致性（α区：Х^2=0．00,P=1．000;β区：Х^2=1．2857,P=0．2568）。结论在排除了-3．00D以上的中高度近视眼人群后,单眼视野缺损的原发性开角型青光眼α区、β区的有无和13区的大小均不能很好地反映双眼间视野缺损的差异。     

明视负波反应与视网膜厚度分析在开角型青光眼早期诊断应用分析

目的 探讨明视负波反应(PhNR)与视网膜厚度分析(RTA)是否能够诊断早期原发性开角型青光眼(POAG)及其各自特性.方法 采用回顾性病例系列对照研究,通过对早期POAG组30例(52只眼).正常对照组40例(80只眼)进行PhNR与RTA检查,比较两种检查的各项指标在早期POAG检测中敏感性、特异性、ROC曲线下面积.结果 对照组和早期POAG组的PhNR振幅比较差异有统计学意义(P<0.01);对照组和早期POAG组的RTA各项检查指标比较差异有统计学意义(P<0.01);PhNR的敏感性和特异性分别为87.5%和76.9%;视盘三维形态参数的敏感性分别为75.0%、71.3%、76.3%、82.5%,特异性分别为62.8%、58.7%、65.3%、69.4%;盘周和黄斑区视网膜厚度的敏感性分别为80.0%、83.8%,特异性分别为68.6%、66.1%;PhNR的ROC曲线下面积为0.880,RTA检查各项参数的ROC曲线下面积分别为0.756、0.715、0.767、0.813、0.808、0.831.结论 PhNR与RTA检查均可以诊断早期POAG;PhNR比RTA更敏感,更特异,说明PhNR可以早期发现POAG损害,联合检查将更有助于POAG的早期诊断.     

Evaluation of Macular and Retinal Nerve Fiber Layer Thickness in Children with Type 1 Diabetes Mellitus without Retinopathy

PurposeThere are limited data from Asian countries regarding retinal thickness in children with type 1 diabetes mellitus (T1DM). This study aimed to compare the macular and retinal nerve fiber layer (RNFL) parameters between diabetic children without retinopathy and non-diabetic healthy children. We also evaluated the factors associated with RNFL thickness in children with T1DM.MethodsA comparative cross-sectional study was conducted among children with T1DM and healthy children aged 7 to 17 years old in Hospital Universiti Sains Malaysia from 2017 to 2019. Children with retinal disease or glaucoma were excluded. Macular and RNFL thicknesses were measured using spectral-domain optical coherence tomography. Demographic information, duration of diabetes, blood pressure, body mass index, visual acuity, and retinal examination findings were documented. Glycosylated hemoglobin levels, renal function, and blood lipid levels were also collected.ResultsForty-one children with T1DM and 80 age- and sex-matched children were enrolled. Both sexes were affected. Mean duration of diabetes mellitus was 3.66 years. The mean glycated hemoglobin levels in the T1DM group was 9.99%. The mean macular and RNFL thicknesses in children with T1DM were 277.56 (15.82) μm and 98.85 (12.05) μm, respectively. Children with T1DM had a significantly thinner average macula, superior outer macula, nasal outer macula, mean RNFL, and inferior RNFL thickness compared to controls (p < 0.05). There was a significant association between nephropathy and the mean RNFL thickness.ConclusionsChildren with T1DM had significantly decreased mean macular and RNFL thicknesses. Nephropathy is associated with an increased RNFL thickness.