基于学校的健康儿童青少年视网膜OCT数据

目的：探讨健康儿童青少年经光学相干断层成像（OCT）测得的黄斑区以及视盘区相关参数的正常 值范围,并分析个体因素对OCT主要参数的可能影响。方法：横断面研究。本研究为爱尔儿童青少年屈光发育队列研究的一部分内容,在2019年3─6月期间,使用 OCT对湖南醴陵市及湖北宜昌市 3所学校的913名中小学生（5～15岁）眼球黄斑区及视盘区进行扫描,以OCT自带软件导出视盘形态学指标、视盘及黄斑区视网膜厚度和神经纤维层厚度（RNFL）,分别以P2.5～P97.5及均值±1.96标 准差定义其正常值范围,并通过Spearman相关和多元线性回归模型分析年龄、性别、屈光度和眼轴长度对OCT主要参数的影响。结果：糖尿病早期治疗研究小组黄斑部格子分区（EDTRS）中,黄斑中心区视网膜厚度及RNFL的正常值范围分别为193.72～262.68 μm和0.67～8.18 μm。内环区视 网膜厚度依次为上方（288.07～340.29 μm）>鼻侧（283.89～340.53 μm）及下方（283.85～337.21 μm） >颞侧（275.32～326.32 μm）,RNFL依次为下方（24.40～33.01 μm）及上方（24.52～33.24 μm） >鼻侧（20.89～28.35 μm）>颞侧（20.54～24.45 μm）;外环区视网膜厚度依次为鼻侧（266.97～323.27 μm） >上方（254.81～305.03 μm）>下方（241.54～292.42 μm）>颞侧（238.45～286.59 μm）,RNFL依次为 鼻侧（42.38～63.03 μm）>下方（36.35～53.74 μm）及上方（36.19～53.64 μm）>颞侧（21.37～26.52 μm）。 视盘视网膜厚度依次为上方（286.13～378.29 μm）及下方（283.20～375.82 μm）>颞侧（256.90～325.30 μm） >鼻侧（235.40～309.79 μm）,RNFL依次为下方（122.07～193.79 μm）>上方（113.48～188.28 μm）>颞 侧（71.51～146.15 μm）>鼻侧（45.99～112.26 μm）。视盘面积（DA）、盘沿面积（RA）、视杯容积 （CV）、杯盘面积比（CDAR）、线性杯盘比（LCDR）、垂直杯盘比（VCDR）分别为1.37～3.16 mm2、 0.79～2.64 mm2、0.01～0.51mm3、0.03～0.64、0.17～0.80、0.15～0.78。多元线性回归分析显示等效球镜度与黄斑中心区、黄斑外环鼻侧、视盘鼻侧及视盘下方RNFL厚度和DA、CV、VCDR具有 相关性（r=-0.197、-0.317、4.458、1.633、0.069、0.020、0.040,均P<0.05）,年龄与黄斑中心区 RNFL及DA、CV、VCDR呈负相关（r=-0.099、-0.020、-0.005、-0.007,均P<0.05）,与黄斑外环鼻侧RNFL呈正相关（r=0.141,P=0.046）,眼轴与CV、VCDR、黄斑中心区及外环鼻侧RNFL呈正 相关（r=0.022、0.045、0.414,1.486,均P<0.05）,与视盘下方呈负相关（r=-2.192,P=0.012）,仅黄斑外环鼻侧RNFL与性别有相关性（r=-1.066,P=0.002）。结论：本研究提供了健康儿童青少年人群黄斑区以及视盘区相关参数正常范围,同时发现性别、年龄、屈光度以及眼轴均会对OCT的检查结果产生一定的影响,提示临床中应用OCT评估及诊治儿童青少年眼底病变时,应考虑这些因素的影响。     

不同程度近视患者视网膜神经纤维层厚度、黄斑外环区视网膜厚度观察

目的　观察不同程度近视患者视盘旁视网膜神经纤维层（ｒｅｔｉｎａｌｎｅｒｖｅｆｉｂｅｒｌａｙ-ｅｒ,ＲＮＦＬ）厚度、黄斑外环区视网膜厚度变化,并分析其特点。方法　参与检测的受检者共２０９例３９９眼分４组,分别为中低度近视组５２例（９８眼）、高度近视组４７例（９１眼）、高度近视青光眼组５７例（１０４眼）及５３人（１０６眼）健康志愿者为正常对照组。采用光学相干断层扫描仪测量视盘旁上方、颞侧、下方、鼻侧四个象限的ＲＮＦＬ厚度,视盘周围全周ＲＮ-ＦＬ厚度,黄斑外环区四个象限的视网膜厚度。采用Ｐｅａｒｓｏｎ相关分析法分析近视患者屈光度数与ＲＮＦＬ厚度及黄斑外环区视网膜厚度的相关性。结果　各组视盘旁ＲＮＦＬ厚度以上象限和下象限较厚,其次为颞侧象限,而鼻侧象限最薄。正常对照组与中低度近视组各象限ＲＮＦＬ厚度比较差异无统计学意义（Ｆ＝１．７３２,Ｐ＞０．０５）,其余各近视眼组患眼各象限ＲＮＦＬ厚度均有差异（Ｆ＝３６１．７１、４７８．９２、３９５．１６,均为Ｐ＜０．０５）。近视患者屈光度数与上、下、鼻侧ＲＮＦＬ厚度呈负相关（ｒ＝－０．２７９、－０．３１９、－０．２１３,均为Ｐ＜０．０５）,与颞侧象限ＲＮＦＬ厚度呈正相关（ｒ＝０．３２６,Ｐ＜０．０５）。高度近视青光眼组与高度近视眼组之间比较黄斑外环区颞侧、上方视网膜厚度减少,差异有统计学意义（Ｆ＝４７５．１２,Ｐ＜０．０５）。结论　光学相干断层扫描能够检测高度近视青光眼的ＲＮＦＬ厚度及黄斑外环区厚度的变化,为青光眼的早期诊断提供了一定的帮助。     

Using ImageJ to Evaluate Optic Disc Pallor in Traumatic Optic Neuropathy

Purpose

To evaluate optic disc pallor using ImageJ in traumatic optic neuropathy (TON).

Methods

This study examined unilateral TON patients. The optic disc was divided into 4 quadrants (temporal, superior, nasal, and inferior), consistent with the quadrants on optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness maps. Optic disc photography was performed and disc pallor was quantified using gray scale photographic images imported into ImageJ software. The correlation between optic disc pallor and RNFL thickness was examined in each quadrant.

Results

A total of 35 patients (31 male, 4 female) were enrolled in the study. The mean participant age was 34.8 ± 15.0 years (range, 5 to 63 years). Overall RNFL thickness decreased in 6 patients, with thinning most often occurring in the inferior quadrant (28 of 35 eyes). There was a significant correlation between optic disc pallor and RNFL thickness (superior, rho = -0.358, p = 0.04; inferior, rho = -0.345, p = 0.04; nasal, rho = -0.417, p = 0.01; temporal, rho = -0.390, p = 0.02). The highest level of correspondence between disc pallor and RNFL thickness values outside of the normative 95th percentiles was 39.3% and occurred in the inferior quadrant.

Conclusions

Optic disc pallor in TON was quantified with ImageJ and was significantly correlated with RNFL thickness abnormalities. Thus, ImageJ evaluations of disc pallor may be useful for evaluating RNFL thinning, as verified by OCT RNFL analyses.     

剥脱性青光眼视盘视网膜神经纤维层厚度与视野缺损的相关性

探讨不同时期剥脱性青光眼（PXG）患者视盘视网膜神经纤维层（RNFL）厚度与视野缺损的相关性。方法：病例对照研究。连续性选取2013年1月至2018年1月在石家庄市第一医院青光眼科住院治疗的PXG患者97例（97眼），并将其分为早期PXG组28例，中期PXG组27例，晚期PXG组42例。另选择与PXG组匹配的正常志愿者32例（32眼）作为正常对照组。所有纳入对象均采用SD-OCT对视盘各区RNFL厚度进行扫描，采用单因素方差分析比较4组受检者视盘各区RNFL厚度差异，采用 Pearson相关分析对视盘RNFL厚度与视野平均缺损相关性进行分析。结果：正常对照组及早、中、晚期PXG组平均视盘RNFL厚度分别为（104±11）μm，（92±14）μm，（82±12）μm，（54±18）μm。4组受检者鼻侧、鼻上方、颞上方、颞侧、颞下方、鼻下方及平均RNFL厚度总体差异均具有统计学意义（F=24.38、36.40、47.84、8.70、95.46、54.75、82.28，均P<0.001）。进一步两两比较发现，正常对照组与早期PXG组颞上方、颞下方、鼻下方及平均视盘RNFL厚度差异有统计学意义（均P<0.05）；正常对照组与中期PXG组鼻侧、鼻上方、颞上方、颞下方、鼻下方及平均RNFL厚度差异有统计学意义（均P<0.05）；正常对照组与晚期PXG组各区RNFL厚度差异均有统计学意义（均P<0.001）。中、晚期 PXG组视盘平均RNFL厚度与视野平均缺损呈正相关（r=0.404，P=0.037；r=0.582，P<0.001）。结论：中、晚期PXG眼视盘平均RNFL厚度与视野缺损呈正相关，SD-OCT监测视盘RNFL厚度变化可以作为PXG诊断分期和随访的重要参考指标。     

Optical Coherence Tomography Measurement of Retinal Nerve Fibre Layer,Optic Nerve Head and Macula in Normal Subjects

The aim of the study was to evaluate the variation in retinal nerve fibre layer (RNFL), optic nerve head (ONH) and macular measurements in healthy Turkish subjects using Stratus optical coherence tomography (OCT). The design is a cross-sectional study of 398 eyes in 199 normal subjects aged between 5 and 70 years. The participants underwent a detailed ophthalmologic examination including imaging with Stratus OCT. RNFL, optic disc and macula fast scan methods were used to obtain the peripapillary RNFL thickness, ONH and macular parameters. The effects on the findings of age, gender and laterality of the eye tested were assessed. The average RNFL thickness and the thickness measured in the superior and temporal quadrants were statistically significantly negatively correlated with age. Similar results were found for mean macular thickness, macular RNFL thickness and for total macular volume. There was no effect of age on ONH measurements. The RNFL thickness in the temporal quadrant was significantly greater in females than in males (p<0.05). The mean macular thickness in 1–3?mm was greater in males than in females (p<0.05). The nasal RNFL thickness was significantly thicker in the right eyes than in the left eyes (p<0.05). We conclude that, in healthy subjects, as age increases there is a significant reduction in peripapillary and macular RNFL thickness and in macular thickness and volume. The hypothesis that RNFL and macular measurements are not symmetrical between the two eyes merits further study.     

OCT测量视网膜神经纤维层和黄斑厚度在青光眼早期诊断中的意义

目的应用光学相干断层成像术（optical coherence tomography，OCT）测量青光眼患者的视网膜神经纤维层（retinal nerve fiber layer，RNFL）厚度和黄斑厚度，比较两者在青光眼早期诊断中的作用。方法应用Stratus OCT测量62例（101眼）正常人和41例（64眼）青光眼患者的RNFL厚度和黄斑厚度，比较正常人和青光眼患者之间．正常人和早期青光眼患者之间上、下、鼻、颞四个象限与平均RNFL厚度、黄斑区内外环各象限厚度和总黄斑体积等参数有无统计学差异：用受试者工作特征曲线下面积（area under the receive operating characteristi ccurve，AROC）评价各个参数在青光眼早期诊断中的作用。结果青光眼患者各象限、平均RNFL厚度和各分区黄斑厚度、总黄斑体积均比正常人减少．差异有显著性（P=0．014—0．000），视乳头旁平均RNFL的AROC最大（0．961），其次为下方RNFL（0．928）和上方RNFL（0．924）。黄斑下方外环区AROC最大（0．876）。早期青光眼患者各象限、平均RNFL厚度和黄斑外环各分区、总黄斑体积较正常人减少，差异有显著性（P=0．021～0．000），而黄斑内环各区与正常人差异无显著性。视乳头旁平均RNFL的AROC最大（0．877），其次为上方RNFL（0．783）和下方RNFL（0．767）。黄斑下方外环区AROC最大（0．728）。结论测量RNFL厚度较测量黄斑厚度具有更强的青光眼早期诊断价值。黄斑厚度测量为青光眼的早期诊断提供了一种新的手段。     

Quantification of the retinal nerve fibre layer thickness in normal Indian eyes with optical coherence tomography

PURPOSE: To quantitatively assess the normative values for peripapillary retinal nerve fibre layer (RNFL) thickness with Optical Coherence Tomography (OCT 3) in Indian subjects. METHODS: The peripapillary retinal nerve fibre layer of 146 normal subjects was imaged on OCT 3 in this cross-sectional study. Thickness of the RNFL around the disc was determined with three 3.4 mm diameter circle OCT scan. The RNFL thickness was measured in four quadrants; superior, nasal, inferior and temporal. The data was analysed using SAS commercial statistical software. Influence of age and gender was evaluated on various measured parameters using unpaired t test, one-way analysis variance (ANOVA) and Pearson's correlation coefficient. RESULTS: One hundred and forty six eyes of 146 patients, 84 males and 62 females were studied. The average RNFL thickness in the sample population under study was 104.27 +/- 8.51 (95% CI 87.25-121). The RNFL was thickest in the inferior quadrant, followed by the superior quadrant, and progressively less in nasal and temporal quadrant. The difference between inferior and superior quadrants was not statistically significant. Age had a significant negative correlation with average RNFL thickness (r = -0.321, P = 0.000) and with average superior (r = -0.233, P = 0.005) and average inferior RNFL thickness (r = -0.234, P = 0.004). There was no effect of gender on various RNFL thickness parameters. CONCLUSIONS: RNFL thickness is significantly correlated with age, but not with gender. This normative database of RNFL thickness with OCT in Indian eyes is similar to previously reported values in normal Asian eyes.     

频域光学相干断层扫描（OCT）测量视盘参数及视网膜厚度在早期青光眼诊断中的作用

目的　探讨频域光学相干断层扫描（optical coherence tomography,OCT）测量视盘参数及视网膜厚度在早期青光眼诊断中的作用。方法　采用频域OCT测量40例（40眼）健康志愿者（对照组）和85例（85眼）原发性开角型青光眼（primary open angle glaucoma,POAG）患者［早期青光眼亚组（n=36）和进展期青光眼亚组（n=49）］视盘参数及视网膜神经纤维层（retinal nerve fiber layer,RNFL）厚度,比较各组RNFL厚度、视盘参数并与视野平均缺损（mean deviation,MD）值进行相关性分析,采用ROC曲线下面积评估视盘周围区RNFL厚度及视盘参数在青光眼中的诊断效果。结果　POAG组患者颞侧、上方、鼻侧及下方象限RNFL厚度和全周RNFL厚度均显著低于对照组（均为P<0.05）,且与早期青光眼组比较,进展期青光眼组患者颞侧、上方、鼻侧及下方象限RNFL厚度和全周RNFL厚度均显著降低（均为P<0.05）。各组除视盘面积外,其他视盘参数比较差异均具有统计学意义（均为P<0.05）。Pearson相关性分析显示,POAG组患者视盘颞侧、上方、下方象限RNFL厚度及全周RNFL厚度与MD均呈负相关（均为P<0.05）,而视盘参数中视杯容积和视杯/视盘面积比与MD均呈正相关（均为 P<0.05）,盘缘面积、盘缘容积和视盘容积与MD均呈负相关（均为P<0.05）。经ROC曲线分析显示,视盘周围区下方象限RNFL厚度的曲线下面积最大为0.886,其特异度和敏感度分别为0.775和0.924;视盘参数中视杯/视盘面积比曲线下面积最大,其特异度和敏感度分别为0.741和0.815。结论　OCT检测视盘结构和RNFL厚度能够用于青光眼早期诊断,且具有较高敏感度和特异度。     

频域OCT对LHON患者神经纤维层厚度的观察

目的 利用频域光学相干断层成像技术(OCT)测量Leber's遗传性视神经病变(LHON)患者视网膜神经纤维层(RNFL)厚度,描述LHON患者RNFL厚度变化的影像学特征.方法 回顾性病例对照研究.利用海德堡频域OCT分别对临床拟诊的LHON患者(33例66眼)、正常志愿者(67例67眼)进行环视盘和环黄斑RNFL厚度的测量;同时采集患者静脉血样,进行3个原发性mtDNA突变位点(G11778A,G3460A和T14484C)的检测.根据基因检测结果将临床拟诊的LHON病患者分为LHON组和疑似LHON组,应用单因素方差分析比较LHON组、疑似LHON组与正常对照组之间及两患病组之间视盘和黄斑颞侧、颞上、颞下、鼻侧、鼻上、鼻下及360°平均RNFL厚度的区别.结果 33例临床拟诊的LHON患者中确诊为LHON的患者18例,疑似LHON患者15例.LHON组、疑似LHON组、正常对照组三组之间,环视盘颞侧,颞上,颞下和鼻上的RNFL厚度差异有统计学意义(F值分别为145.14、11.25、57.10、4.48;P＜0.05),环黄斑颞侧、颞上、颞下、鼻侧、鼻上、鼻下的RNFL厚度差异均有统计学意义(F值分别为:24.07、67.01、85.99、130.21、121.90、128.66;P＜0.05);两两比较示,LHON组较正常对照组环视盘除鼻侧、鼻下象限外的RNFL厚度均萎缩变薄(P＜0.05);疑似LHON组较正常对照组环视盘颞侧、颞上、颞下的RNFL厚度萎缩变薄(P＜0.05);LHON组与疑似LHON组比较,无论是环视盘还是环黄斑,各象限RNFL厚度间差异均无统计学意义(P＞0.05).结论 LHON不仅表现为乳斑束神经纤维层的萎缩,视盘颞上及颞下的弓形纤维也显著萎缩变薄,鼻侧神经纤维可相对保留.     

正常人黄斑厚度及视盘旁神经纤维频域OCT分析

目的 应用频域OCT(spectral domain Optical Coherence Tomography,SD-OCT)分析正常人眼黄斑厚度、体积及视盘旁神经纤维的分布情况.方法 应用频域OCT对62名124只眼正常人(21～58岁)黄斑及视盘旁进行快速扫描,测量正常眼中心/小凹厚度(Central point thickness,CPT),黄斑部直径为3mm圆形区域内9个分区内平均厚度(Th)及体积(V);同时测量视盘旁直径为3.4mm圆形区域神经纤维分布情况.入组标准:矫正视力20/20,眼压正常,没有已知眼病.结果 124只正常眼中心小凹平均厚度为(215.11±15.475)μm,中心区为(255.56±16.709)μm),黄斑区厚度图呈开口向颞侧的马蹄形,在所有ETDRS区域中,鼻外象限厚度最大(352.87±15.886)μm;中心凹鼻侧厚度及体积大于颞侧(P<0.05);在内环区域,上下方视网膜厚度及体积无明显差异;在外环区域,上下方视网膜厚度及体积差异有统计学意义(P<0.05);视盘旁神经纤维的分布,颞下方神经纤维分布最多,鼻侧神经纤维最少差异有统计学意义.结论 应用频域OCT测量,正常人眼黄斑部中心小凹厚度为(215.11±15.475)μm,中央区为(255.56±16.709)μm,神经纤维层厚度与以往时域OCT测量结果基本一致.频域OCT成像清晰,能够精确测量黄斑视网膜厚度及视盘旁神经纤维分布情况,可为临床诊治黄斑及视神经病变提供客观、定量的指标.

Abstract：

Objective To determine normal values for macular thickness, volume and peripapillary retinal nerve fiber layer thickness(RNFL)measured by spectral domain Optical Coherence Tomography (SD-OCT)in subjects with no known retinal disease and to examine the relationship of RNFL with macular thickness. Methods Sixty-two healthy adults(124 eyes, 21-58 years old)with no known eye disease,best-corrected visual acuity 20/20, and normal intraocular pressure were enrolled. All subjects underwent a complete ophthalmologic examination to rule out any retinal diseases or glaucoma. All the OCT scans were performed by a single operator, Central point thickness(CPT)and retinal thickness(Th)in 9 Early Treatment Diabetic Retinopathy Study(ETDRS)subfields, including central subfield(CSF), were analyzed. Statistical analyses were carried out using the analysis of variance. RNFL thickness was measured around the optic nerve head using 16 automatically averaged, consecutive circular B-scans with 3.4 mm diameter. The automatically segmented RNFL thickness was divided into 7 segments. Results Overall, the mean CPT was(215.11±15.475)μ m, and mean CSF was(255.56± 16.709)μ m. The macular thickness mapping in normal persons was "horse shoe" shaped open to the temporal side. Among the ETDRS subfields, the outer nasal quadrant had the maximum thickness(352.87± 15.886)μ m. The nasal quadrant had a larger thickness and volume than temporal side(P 0.05); in the inner circle area, there was no difference between the superior and inferior retinal average thickness; on the contrary, there was a significant difference between the superior and inferior retinal average thickness and volume in outer circle area. While the distribution of peripapillary retinal nerve fiber also had marked difference. The inferior-temporally side had the most, while the nasal side had the least. Conclusions Normative values for macular thickness in otherwise healthy eyes ware measured to be(215.11 ±15.475)μ m(CPT)and(255.56± 16.709)μ m(CSF)using commercially available Spectralis SD-OCT. Normal RNFL results with SD-OCT are comparable to those reported with time-domain OCT. Due to the legible imaging characters, the SD-OCT can measure normal macular thickness and the distribution of peripapillary retinal nerve fiber accurately, which can provide objective and quantitative indexs for diagnosis and therapy of macular disease and optical neuropathy.     

Retinal nerve fiber layer thickness in human eyes

· Background: A study was carried out to measure the thickness of the retinal nerve fiber layer (RNFL) at the optic disc border. · Methods: RNFL thickness at the optic disc border was histomorphometrically measured on histological sections of 22 human eyes with normal optic nerves and 21 human eyes with absolute secondary angle-closure glaucoma. For three eyes with normal optic nerves, serial sections through the whole optic disc area were available. · Results: In the eyes with normal optic nerves, the RNFL at the optic disc border showed a double hump configuration with the highest mean thickness in the inferior quadrant (mean ± S.D: 266±64 μm), followed by the superior quadrant (240±57 μm), the nasal quadrant (220±70 μm), and finally the temporal quadrant (170±58 μm). In the three globes with serial sections, RNFL was thickest at the inferior disc pole (397±58 μm), followed by the superior disc pole (313±38 μm), the nasal disc pole (165±19 μm), and finally the temporal disc pole (131±15 μm). In the eyes with absolute glaucoma, mean thickness of the remainder of the RNFL was 40±18 μm with no marked differences between the disc regions. · Conclusions: In normal eyes, the RNFL shows a double hump configuration with its thinnest part at the temporal disc pole, followed by the nasal disc pole and the superior disc pole. RNFL is thickest at the inferior disc pole. In glaucomatous optic neuropathy, the inner limiting membrane moves backward about 60–100 μm at the temporal disc border, and more than 200 μm at the inferior and superior disc poles. Received: 24 July 1998 Revised version received: 29 September 1998 Accepted: 22 October 1998     

光学相干断层扫描在社区糖尿病视网膜病变筛查中的应用

目的：探讨应用光学相干断层扫描仪( optical coherence tomography, OCT )在社区筛查糖尿病视网膜病变( diabetic retinopathy,DR)的可行性及意义。方法：回顾性分析。选取在抚顺市将军社区医院就诊的2型糖尿病患者378例400眼,男184例193眼,女194例207眼,年龄43~76(平均59.0±9.7)岁。根据DR分期标准,将伴有眼底改变的DR患者278例300眼分为DR1、DR2和DR3三组,无眼底改变的糖尿病患者100例100眼做对照组,共4组。应用频域OCT快速扫描模式扫描4组患者视盘周围3.4mm直径范围,按照不同区域记录视神经纤维层( retinal nerve fiber layer thickness, RNFL)厚度。采用应用独立样本t检验和单因素方差分析比较各组RNFL厚度是否存在差异。
　　结果：对照组、DR1、DR2及DR3组的平均RNFL厚度分别为109.52±7.13、108.51±7.09、99.37±8.92、98.48±8.57μm;与对照组比较,DR各分期组的RNFL厚度差异有统计学意义( P<0.05)。不同区域RNFL厚度的比较发现：对照组和DR组(1~3期)的RNFL厚度分布具有相似性,即鼻侧和颞侧 RNFL 最薄,颞上和颞下象限RNFL最厚。最薄与最厚处比较,差异有统计学意义( P<0.05)。与对照组相比,DR1期患者视盘鼻侧、颞上、鼻下象限的RNFL厚度差异有统计学意义( P<0.05);DR2期的鼻侧、颞上、鼻下象限的RNFL厚度差异有统计学意义( P<0.05);DR3期各个象限RNFL厚度差异均有统计学意义( P<0.05)。 DR1期与DR2期相比,各个象限差异均无统计学意义( P>0.05);DR1期与DR3期相比,除颞侧象限外均有统计学意义( P<0.05);DR2期与DR3期相比,除颞侧象限外均有统计学意义(P<0.05)。结论：视盘旁RNFL厚度是早期诊断DR的敏感指标之一,将OCT应用于社区DR的筛查有助于疾病的早期预测及病情进展评估。     

增强深度成像OCT对急性期视神经炎患者早期视网膜和脉络膜变化的定量评估

背景 视神经炎是常见的神经眼科疾病之一.频域OCT(SD-OCT)是客观评价视网膜厚度变化的有用工具,而增强深度成像(EDI)OCT则可进一步对视网膜和脉络膜的形态进行定量评估.目前关于视神经炎的早期视网膜和脉络膜形态变化尚未阐明. 目的 采用SD-OCT和EDI OCT对视神经炎早期的视网膜和脉络膜形态进行定量检测,了解视神经炎早期的视网膜和脉络膜变化特征. 方法 采用前瞻性队列研究方法,于2015年7月至2016年5月纳入天津市眼科医院确诊的急性发作期视神经炎患者20例20眼,同期纳入性别和年龄匹配的健康体检者22人22眼.采用SD-OCT及EDI OCT测量受检者视盘周围3.4mm区域上、下、鼻、颞侧4个象限的视网膜神经纤维层(RNFL)平均厚度及上、下、鼻、颞侧4个象限的脉络膜厚度以及黄斑区RNFL、神经节细胞层(GCL)、内丛状层(IPL)、内核层(INL)、外丛状层(OPL)、外核层(ONL)、光感受器层的平均厚度.所有受检者均行图形视觉诱发电位(P-VEP)及视野检查,评价视野平均缺损(MD)与视盘周围RNFL平均厚度、脉络膜厚度、黄斑区RNFL、GCL、IPL、INL、OPL、ONL、光感受器层厚度的相关性. 结果 视神经炎患者视盘周围3.4 mim区域上方、下方及鼻侧3个象限的RNFL厚度分别为(424.00±160.30)、(428.40±169.83)和(108.15±50.66) μm,较正常对照组的(265.68±26.25)、(283.27±52.81)和(72.68±12.01) μm均明显增加,差异均有统计学意义(t=4.571、3.814、3.190,均P＜0.01),2个组间颞侧象限的RNFL厚度差异无统计学意义(t=0.849,P=0.401);2个组间上方、下方、鼻侧、颞侧4个象限的脉络膜厚度的差异均无统计学意义(均P＞0.05).视神经炎组患者黄斑1 mm区域RNFL、GCL、IPL平均厚度较正常对照组受检者明显变薄,视神经炎组患者黄斑3 mm区域GCL、IPL、INL平均厚度较正常对照组受检者明显变薄,差异均有统计学意义(均P＜0.05).视神经炎组患者P-VEP P100波潜伏期为(133.15±11.11)s,较正常对照组的(94.59±4.38)s明显延长,差异有统计学意义(t=15.058,P＜0.05).MD与视盘周围上方、下方、鼻侧3个象限的RNFL平均厚度呈中等线性正相关(r=O.649、0.649、0.635,均P＜0.05),而各象限脉络膜厚度与MD均无明显线性相关(r=-0.120、-0.102、-0.415、0.120,均P＞0.05);黄斑区RNFL、GCL、IPL、INL、OPL、ONL、光感受器层厚度与MD均无明显线性相关. 结论 EDI OCT检测发现视神经炎早期患者视盘周围RNFL发生水肿,厚度增加,黄斑区各层视网膜厚度均不同程度地变薄,但患者的脉络膜厚度无明显改变.EDI OCT是客观和定量评价视神经炎早期视网膜和脉络膜形态学的有用工具.     

单眼屈光参差性弱视眼视网膜神经纤维层厚度分析

目的:比较单眼屈光参差性弱视患者弱视眼和非弱视眼视盘周围视网膜神经纤维层(retinal nerve fiber layer,RNFL)的厚度。方法:选择38例不伴有斜视的单眼屈光差性弱视患者,应用光学相干断层成像技术(OCT)测量其弱视眼和非弱视眼的视盘周围RNFL平均厚度。结果:弱视患者38例的平均年龄为10.73岁,弱视眼RNFL平均厚度为106.38±12.05μm,下方象限RNFL(I):133.67±19.44μm最厚,其次为上方象限(S):123.31±13.95μm,鼻侧象限(N):89.96±17.71μm,颞侧象限(T):70.06±10.18μm最薄;单眼屈光参差性弱视中,弱视眼的RNFL平均厚度和鼻侧象限RNFL厚度较对侧非弱视眼厚,差异具有统计学意义(P=0.016;P=0.01)。结论:单眼屈光参差性弱视患者弱视眼的RNFL厚度较非弱视眼厚,以鼻侧象限RNFL厚度和RNFL平均厚度的差异最为显著。     

Normative database of retinal nerve fiber layer and macular retinal thickness in a Thai population

Purpose  To investigate the distribution of retinal nerve fiber layer (RNFL) and macular retinal thickness measured by optical coherence tomography (OCT) in a Thai population. Methods  We studied one eye each of 250 healthy subjects [age ≥ 18 years; spherical refractive error within ±6 diopters (D); astigmatism ≤3 D; no ocular pathology]. A complete eye examination, standard automated perimetry, and fast RNFL and macular thickness measurement by OCT were performed, and a disc photograph was taken. The distributions of both thicknesses, including their relationship with demographic data, were analyzed. Results  The mean ± SD age of the study population was 44.7 ± 12.2 years. The mean ± SD RNFL thickness was 109.3 ± 10.5 m, which was 10% thicker than that in the OCT normative database. RNFL decreased 2.3 m per decade (P < 0.001). Sex and spherical equivalent were not associated with RNFL thinning. The mean ± SD central foveal thickness was 183.2 ± 1.3 m. The macular thickness in the outer area was significantly thinner than that in the inner area (P < 0.001). The temporal regions were the thinnest among the four quadrants (P < 0.001). Thinning of all macular areas, except the center, was found to be associated with advancing age (P < 0.05). Conclusions  RNFL thickness in the measured Thai population was about 10% thicker than that in the original normative database. Macular thickness and RNFL thickness in the superior and inferior quadrants decreased with advancing age. Presented at the 6^th International Glaucoma Society Meeting, 28–31 March 2007, Athens, Greece     

近视儿童青少年盘周神经纤维层厚度的研究

目的：通过测量6～18 岁正视和近视儿童青少年盘周神经纤维层（RNFL）厚度,分析盘周平均RNFL厚度及相关的影响因素,研究不同屈光状态下盘周RNFL厚度分布地形图特点。方法：横断面研究。采用频域光学相干断层扫描仪测量6～18岁正视和近视儿童青少年盘周RNFL厚度,测量眼部及全身生物学指标（包括身高、体质量、体质量指数、头围、胸围、腰围、血压等）。根据等效球镜度（SE）分为不同的屈光组（包括正视组、低度近视组、中度近视组和高度近视组）,分析不同屈光状态下盘周不同区域RNFL厚度和地形图及厚度变化的影响因素。盘周RNFL厚度与各测量指标之间的相关性采用一元和多元逐步回归,各个组之间的差异采用单因素方差分析。结果：1 056 名正视和近视儿童青少年盘周各区域平均RNFL厚度为（104 ± 10）μm,正视组为（107 ± 9）μm,低度近视组为（105 ± 9）μm,中度近视组为（101 ±10）μm,高度近视组为（95 ± 8）μm。不同屈光组之间RNFL厚度差异均具有统计学意义（P < 0.01）。多元逐步回归显示RNFL平均厚度与SE（r=0.25,P < 0.001）、眼轴长度（AL）（ r=-0.18,P < 0.001）和晶状体厚度（LT）（ r=0.10,P =0.033）有相关性,与SE和LT呈正相关,与AL呈负相关;与性别、年龄等其他因素无相关性。不同屈光组,盘周RNFL厚度分布地形图不同。所有参与者的颞下象限最厚,为（162 ± 23）μm,鼻侧象限最薄,为（61 ± 10）μm。正视组和不同程度近视组中RNFL厚度均为颞下象限最厚,鼻侧象限最薄,其他区域的厚度地形图在不同的屈光组是不同的。颞侧盘周RNFL厚度随近视程度增加而增加,低度近视组为（87 ± 14）μm,高度近视组为（98 ± 21）μm;而其他区域的RNFL厚度则随着近视度数的增加而降低,尤其是鼻下象限。结论：盘周RNFL平均厚度与SE和LT呈正相关,与AL呈负相关;近视程度不同,盘周各区域RNFL厚度分布不同;颞侧RNFL随近视程度增加而逐渐变厚,其余象限则变薄。     

虹膜颜色与视网膜神经纤维层和黄斑及脉络膜厚度关系的研究

目的:明确眼虹膜颜色与眼轴长度、眼压、视网膜神经纤维层厚度(RNFL)、黄斑厚度、脉络膜厚度是否相关.方法:前瞻性横断面研究.92例(92眼)正常个体根据虹膜颜色分为深色组(DCE)和浅色组(LCE).用标准光学相干断层扫描(OCT)分析RNFL和黄斑厚度,EDI(Electronic data interchange)分析脉络膜厚度.脉络膜厚度在中央凹及水平位置距离中央凹1500μm的鼻侧、颞侧进行测量.结果:92眼中,深色组62眼(67.4%)平均年龄29.22±5.86y, 浅色组30眼(32.6%)平均年龄28.86±6.50y.各组间平均年龄、眼轴长度、黄斑厚度、脉络膜厚度及眼压无显著性差异 (P>0.05).视网膜神经纤维层厚度的变化取决于测量象限,而LCE个体在全眼球,鼻侧和颞侧象限较低 (P≤0.022).结论:深色组和浅色组个体间眼内压(IOP),黄斑厚度和脉络膜厚度无显著差异,且视网膜神经纤维层厚度较低.     

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。     

不同程度近视患者视盘区视网膜微循环变化特点分析

目的:基于光学相干断层扫描血管成像(OCTA)分析不同程度近视患者视盘区微血管密度(MVD)和视网膜神经纤维层(RNFL)厚度与眼轴长度(AL)的关系。方法:前瞻性病例对照研究。本研究于2020-05/2021-01在安徽理工大学第一附属医院(淮南市第一人民医院)共招募51名健康受试者,符合标准共94眼依据AL划分为三组,23mm≤AL<24mm且等效球镜度数(SE)+0.50~-0.50D为正视组31眼,24mm≤AL<26mm且-0.75≤SE<-6.00D为低中度近视组32眼,AL≥26mm且SE≥-6.00D为高度近视组31眼。利用OCTA对受试者视盘为中心的4.5mm×4.5mm扫描区成像并自动定量测出视盘不同分区的MVD和RNFL厚度,并进行相关分析。结果:ISNT四分区中,颞侧RNFL厚度与AL呈正相关(r=0.343,P<0.05)。上侧、下侧及鼻侧象限RNFL厚度与AL呈负相关(r=-0.341、-0.289、-0.269,均P<0.05)。在Garway Heath分区法中,颞上象限RNFL厚度与AL呈正相关(r=0.382,P<0.05),鼻上、鼻下及下鼻象限RNFL厚度、MVD与AL呈负相关(r=-0.226、-0.211、-0.369、-0.316、-0.304、-0.241,均P<0.05)。盘内整体MVD随AL增加而密集(r=0.376,P<0.05),而盘周MVD却与AL呈负相关(r=-0.361,P<0.05)。结论:视盘区MVD变化、RNFL厚度与AL紧密相关。随AL增加,鼻上、鼻下和下鼻象限RNFL厚度和MVD均减少,盘周整体MVD降低,颞上象限RNFL厚度及盘内MVD增加,尤以高度近视患者变化显著。     

视盘周围血管密度和视网膜神经纤维层厚度与眼轴长度和屈光度的相关性分析

目的　应用光学相干断层扫描血管成像（optical coherence tomography angiography,OCTA）观察视盘周围血管密度和视网膜神经纤维层（retinal nerve fibre layer,RNFL）厚度与眼轴长度和屈光度之间的关系。方法　纳入受试者40名40眼,测量屈光度和眼轴长度,通过OCTA检查各上方、下方、鼻侧、颞侧四个象限及整体视盘周围血管密度,测量相应区域的视盘周围RNFL厚度,分析两者之间及两者分别与眼轴长度和屈光度之间的相关性。结果　视盘周围整体RNFL厚度与眼轴长度呈显著负相关（r=-0.760,P<0.001）,与屈光度呈显著正相关（r=0.625,P<0.001）。且上方、下方和鼻侧象限的视盘周围RNFL厚度均与眼轴长度呈显著负相关（r=-0.506、-0.667、-0.700,均为P<0.01）,与屈光度呈显著正相关（r=0.409、0.506、0.556,均为P<0.01）。视盘周围整体及颞侧象限的血管密度与眼轴长度均呈显著负相关（均为P<0.05）,与屈光度均呈显著正相关（均为P<0.05）。视盘周围血管密度与RNFL厚度整体上呈显著正相关（r=0.500,P=0.001）,而仅在鼻侧象限发现视盘周围血管密度与RNFL厚度存在显著正相关（r=0.550,P<0.001）。结论　视盘周围血管密度和RNFL厚度与屈光度及眼轴长度相关,且视盘周围血管密度和RNFL厚度具有相关性。