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。     

近视患者黄斑区微血流密度及神经节细胞复合体厚度的变化

目的　探讨近视患者黄斑区微血流密度及黄斑区神经节细胞复合体(mGCC)厚度的变化。方法　选取2018年12月至2020年12月就诊于遵义医科大学第二附属医院的近视患者25例(41眼)作为研究对象。按照患者屈光度分为:中度近视组（-3.00~-5.75 D）13例 (21眼)和高度近视组（-6.00~-9.25 D）12例(20眼) 。另选取11人(18眼)健康志愿者作为对照组,屈光度为0~-2.75 D。三组受试者年龄、性别构成差异均无统计学意义（均为P>0.05）。测量各组受试者等效球镜度数,使用IOL Master测量受试者眼轴长度。利用光学相干断层扫描血管成像（OCTA）进行检测,获取受试者黄斑区浅层视网膜毛细血管丛(SCP)血流密度和深层视网膜毛细血管丛(DCP)血流密度。通过ETDRS自动分割OCTA图像,以黄斑为中心进行3 mm×3 mm及6 mm×6 mm区域OCTA图像采集,记录受试者视网膜各象限mGCC厚度。结果　对照组受试者颞侧和上方SCP血流密度均较中度近视组患者高,差异均有统计学意义（均为P<0.05）;对照组受试者上方SCP血流密度较高度近视组患者高（P<0.05）。对照组受试者鼻上、鼻侧、颞下、鼻下RNFL厚度均较高度近视组患者厚（均为P<0.05）;中度近视组患者颞下RNFL厚度较高度近视组厚（P<0.05）。对照组受试者各象限mGCC厚度均较高度近视组患者厚（均为P<0.05）;中度近视组患者鼻侧及下方mGCC厚度均较高度近视组患者厚（均为P<0.05）。眼轴长度与RNFL厚度和mGCC厚度均呈负相关 (r=-0.607、r=-0.764,均为P<0.001) 。屈光度与RNFL厚度和mGCC厚度亦均呈负相关 (r=-0.729、r=-0.689,均为P<0.001) 。结论　随着近视程度的增加,患者黄斑区mGCC厚度逐渐变薄,RNFL亦呈现逐渐变薄趋势,黄斑区SCP、DCP血流密度有先降低后增高的趋势。     

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。     

Characteristics of the Optic Nerve Head in Myopic Eyes Using Swept-Source Optical Coherence Tomography

PurposeTo investigate the characteristics of the optic nerve head (ONH) in myopia using swept-source optical coherence tomography (SS-OCT).MethodsParticipants were divided into three groups according to the axial length (AL). The optic disc morphology, retinal nerve fiber layer (RNFL) thickness, and radial peripapillary capillary (RPC) vessel density (VD), optic disc tilt, rotation, Bruch''s membrane opening distance (BMOD), border length (BL), border tissue angle, focal lamina cribrosa (LC) defects, β- and γ-zone peripapillary atrophy (PPA), microvasculature dropout (MvD), choroidal thickness (CT), and the choroidal vascularity index (CVI) were compared. Linear regression analysis evaluated relationships between spherical equivalent, AL, and ONH parameters.ResultsOne hundred five, 98, and 118 eyes were included in groups 1, 2, and 3, respectively. With AL increasing, the mean, superior and temporal CT, central mean and temporal, pericentral mean, inferior and nasal RPC VD, and temporal CVI decreased, whereas the mean and temporal RNFL thickness, optic disc, RIM and β-PPA area, presence and area of γ-PPA, BMOD and BL increased. Compared to other groups, group 3 depicted a larger cup area, more focal LC defect and total and juxtapapillary MvD; a lower central superior, inferior and nasal, pericentral superior, and temporal RPC VD. Group 1 demonstrated more tilted disc, larger inferior and nasal CT, mean, superior, inferior, and nasal CVI.ConclusionsMyopia eyes have larger ONH changes, PPAs, regional RNFL, and MvD, but smaller regional CTs, RPC VD, and CVIs. SS-OCT may be useful in detecting ONH variations during myopia.     

近视眼视网膜神经纤维层厚度光学相干断层扫描特点

目的:探讨人视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度随近视眼屈光度及眼轴变化而变化的特点。方法:将近视眼60例108眼分为低、中、高度近视组和正常对照组25例32眼,应用光学相干断层扫描仪(OCT)进行以视盘为中心,直径3.46mm圆周的RNFL厚度测量,研究近视眼平均RNFL厚度与屈光度及眼轴长度的相关性,并计算各组平均RNFL厚度及上、下、鼻、颞4个象限的RNFL厚度,分别比较各近视组与正常组RNFL的差别。结果:近视眼平均RNFL厚度与屈光度呈负相关(r=-0.535,P<0.05),与眼轴成负相关(r=-0.693,P<0.01)。分区分析低度近视组、中度近视组、高度近视组平均RNFL厚度变薄与正常对照组相比有显著统计学差异(P<0.01),近视眼各象限RNFL厚度最早变薄的是鼻侧象限,低度近视组即与正常人有统计学差异(P<0.05),高度近视组上、下、鼻象限RNFL厚度均明显变薄(P<0.01)与正常人相比有显著统计学差异,颞侧象限RNFL反而增厚,但与正常人无统计学差异(P>0.05)。结论:近视眼视网膜神经纤维层厚度随眼轴长度及眼屈光度的增加而减少,分区分析上、下、鼻象限变化与平均相一致,而颞侧增厚,这可能是近视眼RNFL的特点,这些特点对临床疾病的诊断具有指导意义,特别是出现异常数值时,要考虑屈光度及眼轴的影响,综合评价临床意义。     

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.     

青年近视患者神经纤维层厚度的临床研究

目的 探讨青年近视患者的神经纤维层(RNFL)厚度分布特性及其影响因素.方法 横断面研究.选取准分子激光角膜屈光手术前的青年近视患者162例(162眼),平均年龄(27.0±4.6)岁,等效球镜度-0.75～-11.00 D,平均(-4.98±2.64)D.其中,低度近视组54例,平均等效球镜度为(-2.27±0.64)D;中度近视组55例,平均等效球镜度为(-4.54±0.79)D;高度组53例,平均等效球镜度为(-8.19±1.51)D.采用光学相干断层扫描(OCT)仪检查视盘周围神经纤维层厚度,用偏相关分析RNFL厚度与患者年龄、性别、等效球镜度、眼轴、角膜中央厚度及角膜曲率的相关性.结果 本组入选患者视盘周围平均RNFL厚度:全周为(103.6±9.5)μm,上方为(128.7±16.8)μm,鼻侧为(67.8± 16.5)μm,下方为(125.9± 17.2)μm,颞侧为(91.9±16.9)μm.各RNFL厚度参数与年龄、性别、角膜曲率、中央角膜厚度无相关性,全周、上方、鼻侧、下方的平均RNFL厚度与眼轴呈负相关(r=-0.379、-0.297、-0.180 、-0.291,P＜0.05),颞侧的平均RNFL厚度则与眼轴无相关性,鼻侧、下方的平均RNFL厚度与等效球镜度呈负相关(r=-0.233、-0.163,P＜0.05),颞侧平均RNFL厚度与等效球镜度则呈正相关(r=0.159,P＜0.05).结论 青年近视患者视盘周围平均RNFL厚度上方＞下方＞颞侧＞鼻侧,全周、鼻侧、上方、下方平均RNFL厚度随眼轴的增长而变薄,下方和鼻侧RNFL厚度随等效球镜度增加而变薄,颞侧平均RNFL厚度随着等效球镜度增加而增厚.     

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.     

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.     

Increasing sampling density improves reproducibility of optical coherence tomography measurements.

PURPOSE: Published series of peripapillary retinal nerve fiber layer (RNFL) measurements using optical coherence tomography (OCT) have sampled 100 evenly distributed points on a 360 degrees peripapillary circular scan. The goal of this study was to determine whether a four-fold increase in sampling density improves the reproducibility of OCT measurements. METHODS: Complete ophthalmic examinations, achromatic automated perimetry, and OCT imaging were performed in all patients. The OCT scanning consisted of three superior and inferior quadrantic scans (100 sampling points/quadrant) and three circular scans (25 points/quadrant). The RNFL thickness measurements and coefficient of variation (CV) were calculated for the superior and inferior quadrants for each sampling density technique. RESULTS: The study included 22 eyes of 22 patients (3 control subjects; 2 patients with ocular hypertension; and 17 patients with glaucoma). Quadrants with associated glaucomatous visual field loss on automated achromatic perimetry had thinner RNFLs than quadrants without functional defects for both the 25- and 100-points/quadrant scans. For quadrants associated with normal visual hemifields (n = 22), there was no difference between the 25- and 100-points/quadrant scans in mean RNFL thickness and CV. Among quadrants with visual field defects (n = 22), RNFL thickness measurements were thinner in the 25-points/quadrant scans than in the 100-points/quadrant scans. The CV for the 25-points/quadrant scans (25.9%) was significantly higher than that for the 100-points/quadrant scans (11.9%). CONCLUSION: Increasing the sampling density of OCT scans provides less variable representation of RNFL thickness. The optimal sampling density to achieve maximal reliability of OCT scans remains to be determined.     

Study of retinal nerve fibre layer thickness in eyes with high tension glaucoma and hemifield defect

AIM: To quantitatively evaluate retinal nerve fibre layer (RNFL) difference in areas of apparently normal appearing visual field in eyes with high tension glaucoma (HTG) and hemifield defects using scanning laser polarimetry. METHODS: 40 eyes from 40 patients with HTG with superior or inferior hemifield defects based on the Humphrey field analyser (HFA) underwent RNFL thickness measurements. 20 normal eyes from 20 subjects matched in age and refractive error were selected as a control group. The RNFL thickness was measured with a scanning laser polarimeter. Mean RNFL thickness was evaluated in four quadrants (superior, inferior, nasal, and temporal). A superior or inferior quadrant in the defined ring of scanning laser polarimetry corresponds to inferior or superior hemifield in HFA. RESULTS: The mean RNFL thickness in the unaffected quadrant (the quadrant corresponding to the hemifield with apparently normal visual field based on HFA) of the HTG group was significantly thinner than the average RNFL thickness of the corresponding quadrant of the control eyes. The RNFL thickness of the unaffected quadrant in the eyes with HTG was reduced and statistically similar to that of the affected quadrant. Symmetry, calculated as the ratio of superior to inferior RNFL thickness, showed no statistical difference between the study and control group. CONCLUSION: Changes in RNFL are present in the apparently normal hemifield in the eyes with HTG. The thickness of the RNFL is reduced symmetrically in both superior and inferior quadrants based on the GDx parameters.     

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。     

急性闭角型青光眼大发作后视网膜神经纤维层厚度的变化

目的观察急性闭角型青光眼大发作后视网膜神经纤维层厚度的改变。方法应用相关光断层扫描（OCT）测量急性闭角型青光眼大发作患者发病及治疗后的视网膜神经纤维层厚度的改变，在同期测量36只眼正常成人的视网膜神经纤维层厚度作为对比。病例入选标准为急性闭角型青光眼单眼大发作患者，能够配合进行OCT检测。测量时间为人院后当天、经治疗眼压下降至正常范围后1、3、6个月。结果符合人选标准并完成随访的病例共36例。在入院当天视网膜神经纤维层厚度较正常对照组增加（P〈0．05）。眼压正常后1、3、6个月，平均视网膜神经纤维层厚度较正常对照均明显下降（P〈0．05），并随时间推移呈逐渐下降趋势。在眼压下降到正常范围后的1—3个月内视力逐渐上升，而在3～6个月内视力基本稳定。眼压下降到正常后，在整个随访期内均处于正常范围，但是随着时间的推移有逐渐上升的趋势。结论眼压的急性升高在早期可造成视网膜神经纤维层平均厚度增加，以上、下方为主。在经过治疗眼压降至正常范围内后，视网膜神经纤维层厚度逐渐下降、变薄。     

Evaluation of the effect of aging on retinal nerve fiber layer thickness measured by optical coherence tomography

PURPOSE: To evaluate the relationship between age and retinal nerve fiber layer (RNFL) thickness in normal subjects, as measured by optical coherence tomography (OCT). METHODS: One hundred and forty-four normal subjects (144 eyes), ranging from 16 to 84 years of age, were enrolled in this cross-sectional study. The RNFL thickness was determined using OCT with three circle scans 3.4 mm in diameter. RESULTS: The average RNFL thickness was inversely correlated with age (r = -0.348, p < 0.001). Analyzing the quadrants as a parameter, RNFL thickness in the superior, temporal and inferior quadrants also decreased with age. Using 30-degree segments, there were significant correlations between age and the RNFL thickness of temporal segments (7-11 o'clock). The average RNFL thickness had the highest correlation among all parameters (r = -0.348, p < 0.001). Regarding nasal quadrant thickness, RNFL ratios (average, superior, temporal and inferior RNFL thickness relative to the nasal quadrant thickness) were not significantly correlated with age. The refractive error did not affect RNFL thickness (r = 0.091, p = 0.276). CONCLUSION: Our study revealed that RNFL thickness, in particular in the temporal quadrant, measured by OCT significantly decreased with age. Age has to be taken into consideration when we compare RNFL thickness between normal and glaucomatous eyes.     

高度近视人群视盘周围血流密度与神经纤维层厚度的变化特征

目的：应用光学相干断层扫描血管造影（OCTA）分析年轻成人中高度近视人群视盘周围血流密度及 神经纤维层厚度的变化特征及其之间的相关性。方法：系列病例研究。纳入温州医科大学附属眼视 光医院2020年10—12月门诊近视患者90例（90眼）。根据等效球镜度（SE）将患者分为对照组27眼（-3.00 D ≤SE≤+0.75 D）、高度近视组34眼（-9.00 D≤SE＜-6.00 D）和超高度近视组29眼（SE≤-9.00 D）。采用 OCTA测量眼球矫正前后视盘周围平均、上颞、颞上、上鼻、鼻上、鼻下、下鼻、下颞、颞下侧浅 层毛细血管血流密度（RPC VD）以及视盘周围神经纤维层（pRNFL）厚度。3组间RPC VD及pRNFL 厚度比较采用单因素方差分析或非参数分析,RPC VD、pRNFL厚度、眼轴长度、SE的相关性采用 Spearman或Pearson相关分析。结果：在眼球矫正前,与对照组相比,高度近视组在颞上、颞下侧 pRNFL变厚,下鼻侧pRNFL变薄（H=14.75, P=0.001; H=11.20, P<0.001; F=11.30, P<0.001）,在鼻上、 鼻下侧RPC VD降低（H=6.82, P=0.033; H=10.90, P=0.004）。在平均、颞上、上鼻、鼻上、鼻下、下鼻 及颞下侧pRNFL与RPC VD呈正相关（r=0.29、0.25、0.35、0.44、0.50、0.40、0.48,均P<0.05）。在 眼球矫正后,平均pRNFL、RPC VD与眼轴长度呈正相关（r=0.40, P<0.001; r=0.63, P<0.001）,与SE 呈负相关（r=-0.29, P=0.006; r=-0.48, P<0.001）,且在平均、上颞、颞上、上鼻、鼻上、鼻下、下鼻、 下颞、颞下侧pRNFL与RPC VD呈正相关（r=0.48、0.40、0.58、0.38、0.47、0.57、0.29、0.43、0.56, 均P<0.05）。结论：高度近视患者RPC VD和pRNFL在眼球矫正前颞上、颞下增大,下鼻、鼻上及鼻 下侧减小,而在眼球矫正后平均RPC VD和pRNFL增大。     

高度近视RNFL厚度在诊断原发性开角型青光眼中的临床意义

目的 评估光学相干断层成像术(Optical Coherence Tomography,OCT)定量测量视网膜神经纤维层厚度(Retinal Nerve Fiber Layer,RNFL)在诊断高度近视合并原发性开角型青光眼(primary open-angleglaucoma,POAG)中的临床意义.方法 收集高度近视患者(屈光度≥-6.00D)共40例73只眼,分为单纯高度近视组(A组)及高度近视合并POAG组(B组),所有的患者均行眼压、前房角镜、全自动视野及OCT检查.结果 (1)A组患者平均眼压(16.57±2.43)mmHg,视野检查平均敏感度(MS)23.63±3.70;OCT检查RNFL平均厚度(单位μm)分别为上象限:117.64±15.78,下象限:126.05±22.55,鼻象限:95.69±34.99,颞象限:100.1±27.25;(2)B组患者平均眼压为(26.45±6.02)mmHg,视野检查平均敏感度(MS)15.41±7.63;OCT检查RNFL平均厚度(单位μm)分别为上象限:99.38±36.39,下象限:95.10±33.85,鼻象限:68.00±17.56,颞象限:70.62±25.57.(3)分别对两组RNFL各象限厚度值进行t检验,结果显示两组间差异显著均有统计学意义(P＜0.01).结论 正确评估高度近视RNFL的定量测量在原发性开角型青光眼早期诊断中具有重要意义.     

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.     

近视及近视性弱视儿童视网膜神经纤维层OCT检测及分析

目的分析近视及近视性弱视儿童视网膜光学相干断层扫描（OCT）各项指标的变化,研究近视及近视性弱视儿童的视网膜结构的变化特征。方法对52只眼近视性弱视组和32只眼单纯近视组行视网膜OCT检查,记录黄斑中心凹中心视网膜厚度和视盘上方、下方、鼻侧、颞侧及平均视网膜神经纤维层（RNFL）厚度,并与32只眼正常对照组进行比较。结果近视性弱视组和正常对照组比较,视盘下方和视盘周围平均RNFL厚度变薄,且有统计学意义（P〈0.05）,而视盘上方、颞侧和鼻侧RNFL厚度和黄斑中心凹中心视网膜厚度均无显著差异（P〉0.05）。单纯近视组和正常对照组比较,视盘周围RNFL厚度和黄斑中心凹视网膜厚度均无显著差异（P〉0.05）。近视性弱视组高度近视儿童的视盘上方、下方、鼻侧和视网膜平均RNFL厚度较健眼变薄（P〈0.05）,而颞侧和黄斑中心凹中心视网膜厚度无明显变化（P〉0.05）,单纯近视组中高度近视儿童的视盘颞侧RNFL层厚度和黄斑中心凹中心视网膜厚度增加明显（P〈0.05）。结论近视及近视性弱视儿童的视网膜结构存在异常。     

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。     

Retinal nerve fiber layer thickness in the fellow eyes of normal-tension glaucoma patients with unilateral visual field defect

PURPOSE: To quantitatively evaluate retinal nerve fiber layer (RNFL) thickness in the fellow eyes of normal-tension glaucoma (NTG) patients with unilateral visual field defect. DESIGN: Observational case-control study. METHODS: Twenty-nine NTG patients with unilateral visual field defect were enrolled in this study. All 29 fellow eyes showed normal visual field. Thirty-one normal eyes of 31 subjects served as controls. The RNFL thickness around the optic disk was determined using Fast RNFL thickness (3.4) of optical coherence tomography. Average and segmental (4 quadrants and 12 clock- hours) RNFL thickness measurements were compared among the three groups. RESULTS: RNFL thicknesses were significantly different among the three groups in the average, superior quadrant (11 and 12 clock-hour segments), and inferior quadrant (6 clock-hour segment) (P = .00, one-way ANOVA and Tukey's tests). CONCLUSIONS: RNFL thickness reductions are already present in the fellow eyes of NTG patients with unilateral visual field defect.