Reproducibility of peripapillary retinal nerve fiber layer thickness measurements with cirrus HD-OCT in glaucomatous eyes

AIM: To assess the reproducibility of Cirrus high-definition optical coherence tomography (HD-OCT; Carl Zeiss Meditec, Dublin, CA, USA) for analysis of peripapillary retinal nerve fiber layer (RNFL) thickness in glaucomatous eyes METHODS: Forty-five eyes (one eye from each glaucomatous patient) were imaged with Cirrus HD-OCT. Each eye was imaged three times by two separate operators. Intraclass correlation coefficient (ICC), coefficient of variation (CV), and test-retest variability were evaluated for both intraobserver and interobsever measurements RESULTS: In intraobserver measurements, the average RNFL thickness ICC was 0.983. CV and test-retest variability were 2.3% and 4.4 μm respectively. In quadrants ICC ranged from 0.886 to 0.956, the lowest associated with nasal quadrant and CV ranged from 3.6% to 7.7%. In interobsever measurements, the average RNFL thickness ICC was 0.979. CV and test-retest variability were 2.4% and 4.5 μm respectively. In quadrants ICC ranged from 0.886 to 0.957, the lowest associated with nasal quadrant and CV ranged from 3.8% to 8.6%. CONCLUSION: The reproducibility of Cirrus OCT for RNFL thickness is sufficiently good to be useful clinically as a measure of glaucoma progression.     

应用视神经纤维分析仪检测正常人视网膜神经纤维层厚度

目的 探讨正常人的视网膜神经纤维层厚度及其象限比值与年龄的关系。方法 应用视神经每人义检测１９８例（１９８只眼）正常志愿者,并按年龄分组进行统计分析。结果 ＲＮＦＬＴ与年龄成负相关,上、下方象限厚度较鼻、颞侧大,与年龄相关、鼻、颞侧无此特点。上、下方象限厚度比值平均为１．０４１。结论 ＮＦＡ是测量ＲＮＦＬＴ的可靠方法,正常人的ＲＮＦＬＴ随年龄的增长而减少。     

SD-OCT测量视网膜神经纤维层厚度在青光眼诊断中的应用

青光眼是世界上第二大致盲眼病,其早期诊断及远期监测非常重要。光学相干断层成像(opticalcoherencetomo-graphy,OCT)自问世以来,一直广泛地被应用于青光眼的诊断,尤其在视网膜神经纤维层厚度的测量上。频域光学相干断层成像(spectraldomainOCT,SD-OCT)是最新一代的OCT扫描技术,相比之前三代OCT,其技术参数愈加完善,具有分辨率更高、扫描速度更快的特点,理论上其在青光眼的早期诊断和远期随访上的应用价值可能更高。本文就SD-OCT对比前三代OCT在青光眼的早期诊断和监测中的价值作一综述。     

剥脱性青光眼患者视网膜神经纤维层厚度变化分析

目的：比较维吾尔族假性剥脱综合征(PEX)患者、剥脱性青光眼(PEXG)患者视网膜神经纤维层(RNFL)厚度,为早期诊断剥脱性青光眼提供理论依据。

方法：回顾性病例对照研究。选取2018-04/ 2020-06在我院就诊治疗的维吾尔族假性剥脱综合征患者70例70 眼,剥脱性青光眼患者 80例80 眼,按照视野缺损分期分为早中期剥脱性青光眼患者56眼、晚期剥脱性青光眼患者24眼,选取同期本院收治的维吾尔族年龄相关性白内障病例60例60 眼作为对照组。比较四组患者视盘不同位置RNFL厚度。

结果：对照组、假性剥脱综合征组及剥脱性青光眼组患者视野缺损(MD)逐渐加重且剥脱性青光眼组患者MD显著高于假性剥脱综合征组(P<0.01); 假性剥脱综合征组、早中期剥脱性青光眼组及晚期剥脱性青光眼组视盘不同位置RNFL厚度较对照组均变薄(均P<0.01); 假性剥脱综合征组患者视盘平均RNFL、下方、上方RNFL厚度均低于对照组(均P<0.01)); 晚期剥脱性青光眼组患者视盘各个位置RNFL厚度明显低于早中期剥脱性青光眼患者(均P<0.01)。

结论：维吾尔族假性剥脱综合征患者早期RNFL厚度较未患有剥脱综合征人群开始变薄,早期对于假性剥脱综合征患者RNFL进行检测有助于剥脱性青光眼疾病诊断并进行治疗。     

近视眼视网膜神经纤维层厚度分析

目的:分析近视眼患者与正常人视网膜神经纤维层厚度的差异,探讨近视程度对视网膜神经纤维层厚度的影响。方法:采用视神经分析仪-GDxVCC(美国激光技术诊断公司生产)测量正常人23例42眼和近视眼患者85例166眼视网膜神经纤维层厚度,近视眼患者按等效球镜屈光度分为低、中、高、超高度近视四组,将所得结果用SPSS11.5统计软件包进行统计分析。结果:视乳头周围2.4～3.2mm的环形区域视网膜神经纤维层平均厚度正常人与低、中、高度及超高度近视组比较无显著性差异,不同程度近视眼组两两之间进行比较无显著性差异;上方120°区域视网膜神经纤维层厚度高度、超高度近视眼组与其他各组进行比较有非常显著性差异(P<0.01),高度与超高度近视组之间进行比较有显著性差异(P<0.01),其他各组两两之间进行比较无显著性差异;下方120°区域视网膜神经纤维层厚度各组之间进行比较无显著性差异;环形区域RNFL厚度平均值的标准差超高度近视组与其余各组之间的差异具有显著性(P<0.05);神经纤维指数高度近视组、超高度近视组与其他各组差异有显著性,且与屈光度呈线性关系(P<0.05)。结论:随着近视程度的增加,近视眼患者上方120!范围内视网膜神经纤维层厚度逐渐变薄,神经纤维指数逐渐增加。     

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     

Diffuse nerve fiber layer loss in normal tension glaucoma

14 eyes of 14 normal tension glaucoma (NTG) patients with the maximum intraocular pressure (IOP) 19 mmHg and 16 eyes of 16 NTG patients with the maximum IOP<19 mmHg were examined. All patients had a scotoma confined to the upper or lower hemifield. Eyes with the maximum IOP a 19 mmHg showed significantly diffuse retinal nerve fiber layer (RNFL) loss in the RNFL area corresponded to the spared visual hemifield as compared to those with the maximum IOP<19 mmHg. The result suggests that, even in NTG, IOP may be an important factor causing optic nerve damage.Abbreviations NTG Normal Tension Glaucoma     

Evaluation of ganglion cell-inner plexiform layer thickness in the diagnosis of preperimetric glaucoma and comparison to retinal nerve fiber layer

Purpose:The aim of this study was to evaluate the diagnostic ability of optic nerve head (ONH), RNFL, and GC-IPL parameters in differentiating eyes with PPG from normals.Methods:This was a retrospective, cross-sectional, observational study. We studied 73 eyes of 41 patients and compared them to 65 eyes of 34 normal persons. Each patient underwent detailed ocular examination, standard automated perimetry, GC-IPL, ONH, and RNFL analysis. PPG was defined as eyes with normal visual field results and one or more localized RNFL defects that were associated with a glaucomatous disc appearance (e.g., notching or thinning of neuroretinal rim) and IOP more than 21 mm Hg. Diagnostic abilities of GC-IPL, ONH, and RNFL parameters were computed using area under receiver-operating curve (AUROC), sensitivity and specificity, and likelihood ratios (LRs).Results:All GC-IPL parameters differed significantly from normal. The ONH, RNFL, and GC-IPL parameters with best area under curves (AUCs) to differentiate PPG were vertical cup to disc ratio (0.76), inferior quadrant RNFL thickness (0.79), and inferotemporal quadrant GC-IPL thickness (0.73), respectively. Similarly, best LRs were found for clock hour 5, 6, and 12 thicknesses among RNFL; inferior sector and inferotemporal sector thicknesses among GC-IPL parameters.Conclusion:Diagnostic abilities of GC-IPL parameters were comparable to RNFL parameters in differentiating PPG patients from normals. The likelihood of ruling in a disease was greater with GC-IPL parameters.     

早期青光眼不同类型视盘视网膜神经纤维层厚度分析

目的　探讨早期青光眼患者不同类型视盘的视网膜神经纤维层（ｒｅｔｉｎａｌｎｅｒｖｅｆｉｂｅｒｌａｙｅｒ,ＲＮＦＬ）厚度,以了解不同类型视盘的早期青光眼患者的ＲＮＦＬ厚度的特点。方法　应用光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）技术检查视盘ＲＮ-ＦＬ厚度,将收集到的ＯＣＴ视盘检查结果分为６组:对照组大视盘组、中视盘组、小视盘组,每组各２０眼,早期青光眼大视盘组、中视盘组、小视盘组各２０眼。ＯＣＴ测量１２０眼各钟点平均ＲＮＦＬ厚度。检测对照组和早期青光眼患者１２个钟位的视盘ＲＮＦＬ厚度。结果　对照组不同类型视盘组的ＲＮＦＬ厚度曲线均在下方和上方形成双峰,在鼻侧和颞侧形成波谷,各组下方峰均高于上方峰。其中大视盘组患者ＲＮＦＬ厚度（１０５．６０±５．８７）μｍ,其次是中视盘组（１０７．０５±７．２９）μｍ和小视盘组（１０８．４０±７．２７）μｍ。对照组大、中、小视盘组的ＲＮＦＬ厚度差异无统计学意义（Ｐ＞０．０５）。早期青光眼ＲＮＦＬ厚度曲线的上或下方峰值降低,但仍然具备上、下方的双峰特征,各组的下方峰皆高于上方峰。其中大视盘组患者ＲＮＦＬ厚度最薄（７０．２５±１４．７１）μｍ,其次是中视盘组（８５. ５５±１５．３９）μｍ和小视盘组（８７．５５±９．４６）μｍ,大视盘组与中视盘组、小视盘组的视盘ＲＮＦＬ厚度的差异有统计学意义（均为Ｐ＜０．０５）,中视盘组与小视盘组的ＲＮＦＬ厚度差异无统计学意义（Ｐ＞０．０５）。早期青光眼患者与对照组不同类型视盘的ＲＮＦＬ均为厚度差异均有统计学意义（均为Ｐ＜０．０５）。结论　对照组不同大小的视盘并不影响ＲＮＦＬ厚度,早期青光眼患者视盘的ＲＮＦＬ厚度明显变薄,但仍然具备上、下方的双峰特征,各组的下方峰皆高于上方峰,其中大视盘患者的ＲＮＦＬ比中、小视盘受损更严重。     

不同类型闭角型青光眼患者的视网膜神经纤维层厚度的变化

目的：分析急慢性闭角型青光眼患者的视网膜神经纤维层厚度的变化及其意义。

方法：选取2016-01/2018-01我院收治的急性闭角型青光眼患者37例40眼和慢性闭角型青光眼患者35例38眼为研究对象,并选取同期在我院进行检查的正常体检者30例为正常组。所有研究对象均进行视野检查和OCT检查,根据视野检查结果将患病组分为视野缺损和视野未缺损2个亚组,对三组及亚组上方、下方、鼻侧、颞侧和平均RNFL厚度进行比较; 研究RNFL厚度与视野缺损的关系。

结果：急性组的上方、下方、鼻侧和平均RNFL厚度均明显高于正常组(160.41±39.87μm vs 124.50±14.86μm、155.38±31.79μm vs 127.75±20.08μm、96.12±32.01μm vs 75.79±13.10μm、121.49±21.46μm vs 101.79±10.34μm),而慢性组的各象限(上方：91.57±30.22μm; 下方：96.23±30.68μm; 鼻侧：65.46±16.94μm; 颞侧：63.28±16.94μm)及平均RNFL厚度(80.58±22.18μm)均明显低于正常组,差异有统计学意义(P<0.05)。急性组视野正常者上方、下方的RNFL厚度低于本组视野缺损者(159.68±27.49μm vs 163.32±37.76μm,152.31±21.86μm vs 161.27±32.09μm),差异有统计学意义(P<0.05),而鼻侧、颞侧和平均RNFL厚度两者间差异无统计学意义(P>0.05); 慢性组视野缺损者各象限RNFL厚度显著低于视野正常者(120.83±13.19μm vs 88.82±25.18μm、124.83±17.01μm vs 85.89±30.91μm、76.06±11.79μm vs 62.03±12.13μm、75.17±9.99μm vs 63.09±8.24μm),差异有统计学意义(P<0.05)。

结论：急性PACG的RNFL变厚主要原因为视神经水肿,而慢性PACG的RNFL变薄的主要原因是节细胞的损害和神经纤维的丢失,不同的原因导致不同类型PACG的RNFL厚度差异。     

不同近视程度儿童视神经纤维层厚度的改变

目的:探讨4 ～ 10岁不同近视程度儿童视神经纤维层(retinal nerve fiber layer,RNFL)厚度改变.方法:收集2012-01/2014-05于我院就诊的高度近视儿童12例(屈光度≥-6.00D),中度近视儿童14例(-3.00D≤屈光度＜-6.00D),轻度近视儿童14例(0D≤屈光度＜-3.00D),对所有患儿完善RNFL厚度测量,并进行组间对比.结果:高度近视组平均RNFL厚度为102.36±10.33μm,中度近视组平均RNFL厚度为106.52±9.46μm,轻度近视组平均RNFL厚度为112.66±9.79μm.高度近视组较轻度近视组儿童平均RNFL厚度变薄,差异具有统计学意义(P＜0.05);高度近视组与中度近视组、中度近视组与轻度近视组相比,RNFL差异无统计学意义(P＞0.05);在下方象限,高度近视组与轻度近视组,中度近视组与轻度近视组RNFL对比差异具有统计学意义(P＜0.05),其余三组各象限对比差异均无统计学意义.结论:在高度近视患者平均R较轻度近视组明显变薄,且在下方象限高度近视与中度近视组较轻度近视组均明显变薄.在对近视儿童的诊疗过程中,我们应当完善近视RNFL厚度检查辅助诊断,可为近视儿童的观察及随访提供客观指标.     

The investigation of retinal nerve fiber layer thickness in eyes with optic nerve head drusen

Purpose: To investigate the effect of optic nerve head drusen (ONHD) on the retinal nerve fiber layer (RNFL) thickness. Patients and methods: Twenty-one nonglaucomatous eyes with various degrees of ONHD and 27 age-matched control eyes were included in the study. Visual fields and RNFL thickness were assessed using Humphrey field analyzer and optical coherence tomography (OCT), respectively. The eyes with various degrees of ONHD and the control eyes were compared with regard to visual field (VF) indices and RNFL thicknesses. Results: VF indices of the eyes with ONHD were significantly different from those of the control eyes (p < 0.05), but no significant difference existed among the eyes with various degrees of ONHD (p > 0.05). The RNFL thicknesses of inferior quadrants of the eyes with ONHD were significantly thinner than those of the control eyes (p < 0.05). A significant thinning of the RNFL in the superior and nasal quadrants was observed in grade II and III discs, while temporal quadrants only in grade III discs presented a similar change (p < 0.05). A comparison between the RNFL thicknesses of various degrees of ONHD did not show a significant statistical difference (p > 0.05) except for the thickness in the temporal RNFL (p < 0.05). Conclusion: We found a significant decrease in the RNFL thickness of ONHD patients compared to that of the control subjects. The measurements of VF indices did not show a significant difference between various degrees of ONHD. In contrast, RNFL thickness was significantly correlated with the amount of ONHD. This suggests that OCT may allow the detection of early changes in RNFL thickness in ONHD patients before observable changes in the visual field are seen.     

青光眼视网膜神经纤维层厚度变化及其与视野缺损的相关性

目的　利用光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）检测早期原发性开角型青光眼和可疑青光眼患者视网膜神经纤维层（ｒｅｔｉｎａｌｎｅｒｖｅｆｉｂｅｒｌａｙｅｒ,ＲＮＦＬ）厚度的变化,并分析其与视野缺损的相关性。方法　收集来我院就诊的可疑青光眼患者３５例（６３眼）为Ａ组,早期原发性开角型青光眼患者４１例（７２眼）为Ｂ组,对照组３４例（６６眼）为Ｃ组,采用ＯＣＴ仪和Ｈｕｍｐｈｒｅｙ７４０ｉ全自动视野计分别对３组受检者进行视盘周围ＲＮ-ＦＬ厚度和视野检测,比较３组患者的ＲＮＦＬ厚度,分析青光眼组ＲＮＦＬ厚度与视野缺损间的关系。结果　Ａ组的上方、下方象限及平均ＲＮＦＬ厚度与Ｃ组对应象限比较,差异均有统计学意义（均为Ｐ＜０．０５）;Ｂ组与Ｃ组比较平均及各象限ＲＮＦＬ厚度差异均有统计学意义（均为Ｐ＜０．０５）;Ａ组与Ｂ组比较上方、下方、鼻侧象限及平均ＲＮＦＬ厚度差异均有统计学意义（均为Ｐ＜０．０５）。三组受检者各象限及全周视野缺损两两比较,差异均有统计学意义（均为Ｐ＜０．０５）。Ｂ组平均及各象限ＲＮＦＬ厚度与视野缺损程度均呈负相关（均为Ｐ＜０．０５）。结论　青光眼患者ＲＮＦＬ厚度变薄,并且与视野缺损程度呈负相关。     

Relation between size of optic disc and thickness of retinal nerve fibre layer in normal subjects

AIMS—To evaluate the relation between the optic disc size and the thickness of the peripapillary retinal nerve fibre layer (RNFL) in normal Japanese subjects by means of scanning laser polarimetry.
METHODS—Scanning laser polarimetry was performed in 60 normal subjects. One eye of each subject was randomly selected for study. Using a scanning laser polarimeter, the integral of RNFL thickness was measured totally and regionally within a circular band located 1.75 disc diameters from the centre of the optic disc. The correlation between the optic disc size and the integral of RNFL thickness was examined.
RESULTS—The optic disc size showed a significant correlation with the integral of RNFL thickness (R = 0.497, p <0.001). A significant negative correlation was observed between the optic disc size and the ratio of inferior integral to total integral of RNFL thickness (R = −0.274, p = 0.034).
CONCLUSIONS—The cross sectional area occupied by the RNF, measured by scanning laser polarimetry increased significantly with an increase in optic disc size while the ratio of inferior to total cross sectional area decreased significantly. These facts should be considered when one evaluates the RNFL thickness in patients with progressive optic neuropathies such as glaucoma.

Keywords: scanning laser polarimeter; normal subjects; optic disc; retinal nerve fibre layer     

丹参多酚酸盐对青光眼术后早期视网膜神经纤维层厚度的影响

目的：观察丹参多酚酸盐对急性闭角型青光眼术后视网膜神经纤维层厚度的影响。
　　方法：选取2012-09/2013-09急性闭角型青光眼小梁切除术后的患者65例65眼,A组按青光眼临床常规治疗, B组在常规治疗的同时应用丹参多酚酸盐200 lg静脉滴注,连续2wk。观察两组术前、术后1wk,3lo的眼压、视网膜神经纤维层( RNFL)厚度的变化情况。
　　结果：两组术后1wk,3lo的眼压均较术前明显下降,两组之间无统计学差异。 A组术后1 wk视乳头颞、上、鼻、下方的RNFL 厚度较术前减小,但无统计学意义;术后3 lo颞、上、鼻、下方的RNFL较术前及术后1 wk明显减小。 B组术后1 wk视乳头颞、上、鼻、下方的RNFL较术前减小,但颞、鼻侧无统计学意义;术后3 lo颞、上、鼻、下方的RNFL厚度较术前及术后1 wk减小,但较术后1 wk时无统计学意义。两组比较,术后1wk, B 组上、下方RNFL厚度明显小于 A 组;术后3lo,颞、上、下方 RNFL厚度明显大于A组。
　　结论：丹参多酚酸盐能够减轻急性闭角型青光眼发作后RNFL的水肿,延缓RNFL变薄。     

视网膜神经纤维层检测在诊断青光眼及近视合并青光眼中的价值

视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度的现代检测手段主要有海德堡视网膜断层扫描仪、光学相干断层成像术和偏振激光扫描仪等。检测RNFL厚度可以对青光眼的早期诊断提供依据。与青光眼一样,近视眼的RNFL也会变薄。所以近视合并青光眼时经常容易被误诊而延误青光眼的治疗时机。因此我们必须将单纯近视眼与近视合并青光眼区别开来。对RNFL的检测能否将单纯近视眼及近视合并青光眼区别开,国内外学者存在不同观点,现综述如下。     

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。     

应用GDx VCC检测原发性开角型青光眼视网膜神经纤维层

目的 采用GDx VCC检测青光眼和正常人视网膜神经纤维层厚度(retinal nerve fiber layer,RNFL),并进行对比分析.方法 选择正常人44人44眼,原发性开角型青光眼患者45例45眼行GDx VCC检查.将获取的参数(椭圆平均值、上方平均值、下方平均值、TSNIT标准差、眼间对称性、视神经纤维指征)进行分析.结果 所有参数在正常人组与青光眼组比较中均有统计学意义(P＜0.01).GDxVCC不同参数检测青光眼RNFL缺损敏感性为68.9%～82.2%,特异性84.1%～100.0%.其中下方平均值、视神经纤维指征ROC曲线下面积为0.959、0.964.结论 GDx VCC在RNFL检查中有较高的敏感性和特异性,可客观反应受检者的RNFL情况,对于青光眼的早期诊断有一定的临床价值.     

Characteristics of patients with a localized retinal nerve fiber layer defect and normal optic disc appearance

Purpose

To investigate the characteristics of patients with a localized retinal nerve fiber layer (RNFL) defect and normal optic disc appearance compared with normal tension glaucoma (NTG) patients.

Methods

A total of 40 patients with an unchanged RNFL defect for more than 5 years and normal optic disc appearance, who were presumed as non-glaucomatous patients, were enrolled (group A). We recruited 40 age-matched patients with NTG (group B). On the RNFL photographs, we evaluated angles of RNFL defects. Angle α and β were the angles made by the line ‘L'' from the center of the fovea to the disc center and the lines ‘A'' and ‘B'' from the disc center to the disc margin where the proximal and the distal border of the defect met, respectively. Angle θ was the angular width of the defect. Angle γ was the angle made by lines ‘L'' and ‘R'', which divides angle θ into a 2 : 1 ratio from line ‘A'' to line ‘B''. We compared systemic diseases, baseline IOP, and location and angles of the RNFL defects between the two groups.

Results

Systemic diseases and superotemporal RNFL defects in group A were significantly greater than those in group B (P<0.001). Angle α was greater in group A, but angle β, θ, and γ were smaller in group A (P<0.05).

Conclusion

If the patients with a superotemporal RNFL defect and normal optic disc appearance had systemic diseases and distal borders of the defects are closer to the macula, glaucoma is less likely.     

频域光学相干断层扫描在视网膜神经纤维层厚度测量中的应用

目的应用频域光学相干断层扫描（OCT）测量非青光眼受试者和青光眼患者的视盘周视网膜神经纤维层（RNFL）厚度,并对测量结果进行重复性检验。方法非青光眼受试者和青光眼患者各30例纳入研究,随机选取受试者一侧眼的数据进行统计分析。应用Spectralis OCT对每位受试者进行视盘周RNFL厚度测量,应用“随诊”模式进行3次扫描。计算出受试者内部标准筹（Sw）、变异系数（CV）和同类相关系数（ICC）,以评价该仪器测量的可重复性。应用Spearman秩相关系数分析评估每位受试者RNFL厚度平均数值与其3次测量的标准差之间的天系。结果非青光眼受试者的CV数值范围为1．44％（全周厚度平均值）～2．58％（颞侧象限）,青光眼患者的CV为1．73％（全周）～3．24％（颞侧象限）;非青光眼受试者的ICC数值范围为0．977（颞侧象限）～0．990（鼻下45。扇形区）,青光眼患者的ICC数值范围为0．981（颞侧象限）～0．997（下方象限）;非青光眼受试者的Sw为1．33μm（全周）～2．36μm（颞上45°扇形区）,青光眼患者的Sw为1．13μm（全周）～2．26μm（鼻上45。扇形区）;RNFL厚度数值与测量变异性间无明显相关性（P〉0．05）。结论高速扫描和眼跟踪系统使Spectralis OCT在测量非青光眼受试者和青光眼患者的视盘周RNFL厚度均有良好的可重复性,是青光眼长期随诊中对于其结构性损害可信赖的影像学检查技术。