OCT测量黄斑区神经节细胞复合体厚度在高度近视眼中的应用进展

近视防控已经上升到我国国家战略层面,高度近视引起的视神经病变会损害视功能,但在临床上常常被忽视。OCT可以非侵入、高分辨率、快速以及可重复地定量视网膜各层厚度,是评估高度近视相关视神经病变的有力工具。由于高度近视常合并视盘和盘周的改变,视神经纤维层厚度的定量常出现误差。近年来,学者开始聚焦于黄斑区神经节细胞复合体(ganglion cell complex,GCC)厚度的研究,但其在高度近视眼中的变化规律尚不统一。该文针对近年来高度近视眼黄斑区GCC的测量规范、诊断价值、变化规律等进行综述,以期提高眼科医师对高度近视视神经病变的重视和研究水平。     

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....     

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.     

正常人黄斑区神经节细胞复合体厚度对称性分析

目的：研究正常人群黄斑区神经节细胞复合体(mGCC)厚度的对称性,确定双眼mGCC厚度差值的临界点。

方法：横断面研究。采用光学相干断层扫描技术(OCT)检测236例472眼自愿接受检查的健康志愿者双眼mGCC厚度,分析双眼mGCC厚度的差异及相关性,计算双眼mGCC厚度差值的临界点。

结果：本组研究对象右眼平均mGCC厚度为91.99±6.61μm,左眼为91.75±9.93μm; 右眼上方和下方mGCC厚度分别为92.32±6.66、91.27±8.87μm,左眼分别为92.05±6.55、91.51±6.76μm,双眼各区域mGCC厚度均相当。双眼平均mGCC厚度差值P_2.5、P_97.5分别为-4.82、4.36μm,上方mGCC厚度差值分别为-5.79、6.42μm,下方mGCC厚度差值分别为-7.21、6.28μm。双眼对应区域mGCC厚度均具有较强相关性。

结论：正常人双眼mGCC厚度对称,当双眼mGCC厚度差值超过正常范围时,可认为呈不对称状态,需要警惕青光眼的发生。     

高度近视眼黄斑区神经纤维层厚度分布特点及其与血流密度的关系

目的：研究高度近视眼黄斑区神经纤维层厚度和血流密度的分布特点并分析其相关因素。

方法：收集高度近视患者20例40眼,年龄为29.90±7.92岁,等效球镜屈光度为 -8.95±2.01 D。采用光学相干断层扫描血管成像技术(OCTA)测量黄斑区神经纤维层厚度,获取视网膜浅层毛细血管层、视网膜深层毛细血管层及脉络膜毛细血管层的血流分布图像并计算各层血流密度。直径6 mm的黄斑区分为9个亚区域：黄斑中心凹区,旁中心凹区和中心凹外区各自分为上方、下方、鼻侧和颞侧4个象限。比较黄斑不同亚区域的神经纤维层厚度的差别,分析其与屈光度、眼轴、各层血流密度的关系。

结果：旁中心凹区的4个象限中,上方神经纤维厚度最低,下方神经纤维厚度最高(均P<0.05)。中心凹外区4个象限中颞侧神经纤维厚度最低(均P<0.05)。中心凹外区上方神经纤维层厚度与屈光度存在负相关(r= -0.356,P=0.024)。视网膜浅层毛细血管层的血流密度与旁中心凹区鼻侧和下方象限,以及中心凹外区上方、鼻侧和下方象限的神经纤维层厚度呈正相关(r=0.314、0.408、0.467、0.655、0.737,均P<0.05); 脉络膜毛细血管层血流密度与中心凹外区的上方象限呈负相关(r=-0.356,P=0.024)。

结论：高度近视眼黄斑区神经纤维层具有各象限不均匀分布特点。随着屈光度的增加,局部神经纤维层变薄,并且存在区域特异性,部分区域神经纤维层厚度的变化与视网膜浅层毛细血管丛及脉络膜毛细血管层的血流密度相关。     

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。     

OCT测量黄斑区神经节细胞复合体厚度的可重复性分析

目的 分析光学相干断层扫描技术(ophcal coherence tomography,OCT)测量正常人和原发性开角型青光眼(primary open-angle glaucoma,POAG)患者黄斑区神经节细胞复合体(ganglion cell complex,GCC)厚度的可重复性.方法 随机选取正常人和POAG患者各15眼分为正常组和青光眼组,应用傅立叶域光学相干断层扫描(RTVue-100 FD-OCT),采用双盲法,检查者A和检查者B间隔4 h分别对2组受检者进行CCC程序的扫描,记录黄斑区平均、上方及下方GCC厚度,分别计算检查者A和检查者B测量黄斑区GCC厚度值的变异系数,统计分析检查者A和检查者B组内各组数据变异系数的差异以及两者之间各组数据变异系数的差异.结果 操作者A测量正常组黄斑区平均、上方、下方GCC厚度值的变异系数分别为2.17%±1.16%、2.24%±1.04%、2.10%±1.22%,青光眼组的变异系数分别为3.17%±1.34%、3.19%±1.67%、3.23%±1.59%;操作者B测量正常人黄斑区平均、上方、下方GCC厚度值的变异系数分别为2.26%±1.14%、2.39%±0.84%、2.43%±0.94%,青光眼组的变异系数分别为3.33%±1.34%、2.33%±1.61%、3.87%±2.02%.同一操作者内测量正常组、青光眼组黄斑区平均、上方、下方GCC厚度值的变异系数比较,差异均无统计学意义(均为P＞0.05);操作者之间测量数据的变异系数比较,差异也均无统计学意义(均为P＞0.05).结论 RTVue100 FD-OCT测量正常人、POAG患者黄斑区GCC厚度操作者内和操作者间均具有较好的可重复性.     

频域OCT检测视野前青光眼黄斑区视网膜神经节细胞复合体厚度的初步研究

Objective To evaluate the diagnostic capabilities of ganglion cell complex (GCC) thickness in preperimetric glaucoma (PPG) with spectral domain optical coherence tomography (SD-OCT). Design Self control study and case control study. Participants Primary open-angle glaucoma (POAG) patients were 20 cases(40 eyes), of which 20 eyes without visual field defects as PPG, and healthy controls were 30 cases(30 eyes). Methods All subjects were underwent macular scanning and peripapillary retinal nerve fiber layer (RNFL) scanning using the RTvue SD-OCT. The area under the receiver operating characteristic curve (AUC) was used to assess the ability to discriminate PPG from normal control. Main Outcome Measures The thickness of GCC and RNFL, and their AUCs. Results Compared with normal eyes, the thickness of average GCC, superior GCC, inferior GCC, average RNFL, superior RNFL, and inferior RNFL in PPG eyes decreased (P<0.001). However, these parameters were thicker than POAG eyes (P≤0.002). The values of GCC-GLV and GCC-FLV increased compared with normal eyes (P<0.001, P=0.021), but decreased compared with POAG eyes (P<0.001). GCC-GLV had highest AUC for detecting PPG (0.983) from normal eyes, followed by average RNFL (0.930). However, the difference between the two parameters was not statistically significant (P>0.05). Conclusions In addition to RNFL, the GCC could be a structural parameter for detecting PPG. (Ophthalmol CHN, 2017, 26: 10-14)     

先天性高度近视弱视患者黄斑区神经节细胞厚度研究

目的:通过检测高度近视性弱视者弱视眼黄斑区视网膜神经节细胞厚度,探讨该类弱视的程度与视网膜神经节细胞厚度的关系。方法:选取先天性高度近视(10g/L阿托品眼膏散瞳后>-4.00DS)并伴有弱视患者12例20眼。年龄3.5～15岁。采用傅立叶域光学相干断层扫描仪(fourier-domain optica lcoherence tomography,FD-OCT)测量弱视眼的黄斑区神经节细胞厚度以及黄斑区视网膜厚度,并比较神经节细胞层厚度占视网膜层厚度的比例与患者弱视及近视程度的相关性。结果:我们发现高度近视患者近视程度与最佳矫正视力无明显相关性,近视程度高的患者其神经节细胞层相对厚度有变薄现象。结论:先天性近视性弱视的患者黄斑中心区神经节细胞层厚度占视网膜厚度的比例有下降。     

Distribution characteristics of retinal nerve fiber layer thickness in macular area and its relationship with vessel density in highly myopic eyes

AIM: To investigate the distribution characteristics of retinal nerve fiber layer thickness and vessel density in macular area of eyes with high myopia, using optical coherence tomography angiography (OCTA). METHODS: Forty eyes in 20 patients diagnosed with high myopia, age 29.90±7.92 years old, with a spherical equivalent of -8.95±2.01 D, were recruited. The retinal nerve fiber layer (RNFL) thickness and the vessel density of the superficial retinal capillary plexus, deep retinal capillary plexus, and choroidal capillary were measured by OCTA. Macular regions within a 6-mm diameter circle were divided into 9 subfields: the central subfield, and the pericentral and peripheral regions of superior, inferior, nasal, and temporal quadrants. The retinal nerve fiber layer thicknesses of different subfields were compared, and their relationships with spherical equivalent, axial length, and vessel density were analyzed. RESULTS: In the pericentral region, the retinal nerve fiber layer thickness of the superior quadrant was the lowest, whereas thickness was highest in the inferior quadrant (all P<0.05). In the peripheral region, the retinal nerve fiber layer thickness of the temporal quadrant was the lowest (all P<0.05). A negative correlation was found between the retinal nerve fiber layer thickness and spherical equivalent (r=-0.356, P=0.024) in the peripheral superior subfield. The vessel density of superficial retinal capillary plexus was positively correlated with retinal nerve fiber layer thickness in the nasal and inferior quadrants of the pericentral region and in the superior, nasal, and inferior quadrants of the peripheral region (r=0.314, 0.408, 0.467, 0.655, and 0.737 respectively; and all P<0.05), whereas the vessel density of choroidal capillary was negatively correlated with retinal nerve fiber layer thickness in the peripheral superior subfield (r= -0.356, P=0.024). CONCLUSION: The RNFL of macular areas is not uniformly distributed in high myopia (HM). As the spherical equivalent (SE) increases, the RNFL thickness decreases in certain areas, which correlates with the vessel density(VD) of superficial retinal capillary plexus (SCP) and choroidal capillary (CC) layers.     

Retinal nerve fiber layer and ganglion cell complex thickness in patients with type 2 diabetes mellitus

Aim:

The aim of the following study is to evaluate the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness in patients with type 2 diabetes mellitus (DM).

Materials and Methods:

Average, inferior, and superior values of RNFL and GCC thickness were measured in 123 patients using spectral domain optical coherence tomography. The values of participants with DM were compared to controls. Diabetic patients were collected in Groups 1, 2 and 3. Group 1 = 33 participants who had no diabetic retinopathy (DR); Group 2 = 30 participants who had mild nonproliferative DR and Group 3 = 30 participants who had moderate non-proliferative DR. The 30 healthy participants collected in Group 4. Analysis of variance test and a multiple linear regression analysis were used for statistical analysis.

Results:

The values of RNFL and GCC in the type 2 diabetes were thinner than controls, but this difference was not statistically significant.

Conclusions:

This study showed that there is a nonsignificant loss of RNFL and GCC in patients with type 2 diabetes.     

频域OCT检测mGCC厚度在原发性青光眼诊断中的应用进展

青光眼是一种具有特征性视神经损害和视野缺损的不可逆致盲眼病,其早期诊断、早期治疗是决定预后的关键。黄斑区视网膜神经节细胞复合体( macular ganglion cell complex,mGCC)由黄斑区视网膜的内三层结构组成,包括视网膜神经纤维层( nerve fiber layer,RFL)、神经节细胞层( gangalion cell layer, GCL )和内丛状层( inner plexiform layer,IPL),它是青光眼结构损害的靶组织,有助于青光眼的早期诊断。光学相干光断层扫描( optical coherence tomography,OCT)具有非接触性、可重复性好、获取眼部图像快等优点,已在眼科领域广泛应用。频域OCT能提供更高的图像分辨率,可对黄斑区视网膜神经节细胞复合体( mGCC )的厚度进行精确测量,为青光眼的早期诊断提供了新参数。     

睡眠呼吸障碍患者黄斑区神经节细胞复合体厚度研究

目的:比较不同程度睡眠呼吸障碍患者黄斑区神经节细胞复合体(GCC)的厚度变化。方法:采用横断面研究,收集2015-06/2018-06间于我校附属医院诊断为阻塞性睡眠呼吸障碍综合征的患者和健康体检者,将呼吸暂停低通气指数(AHI)≥5的58例患者纳入睡眠呼吸障碍组,根据AHI值将其分为轻、中、重度三个亚组,将AHI<5的50例健康体检者纳入对照组。采用RTVUE 100-2型相干光断层扫描检查仪对黄斑区视网膜进行扫描,测量黄斑区GCC总体平均厚度(GCC-Avg)、上方平均厚度(GCC-Sup)、下方平均厚度(GCC-Inf)、局部丢失容积(FLV)与整体丢失容积(GLV)。分析比较各组间GCC厚度的差异。结果:不同程度睡眠呼吸障碍组各区GCC厚度均较对照组变薄(P<0.05),但FLV和GLV均较对照组增加(P<0.05),不同程度睡眠呼吸障碍组组间FLV比较无差异(P>0.05),不同程度睡眠呼吸障碍组组间GLV比较有差异(P<0.05)。结论:随着睡眠呼吸障碍程度的加重黄斑区GCC厚度变薄。     

Retinal nerve fiber layer and ganglion cell complex thickness analysis in patients having relative afferent pupillary defect

Purpose:To determine the retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) thickness in patients having relative afferent pupillary defect (RAPD) measured by optical coherence tomography (OCT).Methods:This cross-sectional study was conducted on 30 patients with posterior segment disease and glaucoma presenting with RAPD. The control group comprised 30 patients with the aforementioned diseases without RAPD. RAPD was graded using neutral density filters placed over the unaffected eye. Peripapillary RNFL thickness and macular GCC were measured using the Cirrus HD-OCT machine.Results:There were 45 males and 15 females. There was a statistically significant (P < 0.05) difference in the mean of average RNFL thickness in patients having RAPD (64.73 ± 15.16 mm in the affected eyes) as compared to sick control (82.73 ± 11.33 mm in the affected eyes). It was further observed that there was a decrease in RNFL thickness with advancing grades of RAPD. There was a statistically significant (P < 0.05) difference in the mean of average GCC thickness in patients having RAPD (51.57 ± 14.96 mm in the affected eyes) as compared to sick control (76.36 ± 8.06 mm in the affected eyes).Conclusion:Our study suggests that there is a significant reduction in RNFL thickness and GCC thickness in RAPD patients as compared to the sick control group.