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1.
目的 利用OCT比较LASIK术前、术后早期黄斑区特定范围视网膜体积以及黄斑和视盘周围视神经纤维层厚度的变化。方法 31例近视病人59眼术前和术后第一天分别行OCT检查,测量黄斑中心凹,黄斑和视盘周围上方、下方、鼻侧、颞侧四个方位视神经纤维层的厚度,以及黄斑区6mm直径范围视网膜的体积,将所得手术前、后的参数值进行配对t检验,观察其变化。结果 LASIK术后黄斑中心和视盘上方视神经纤维层厚度同术前相比变薄,P值分别为0.003和0.016,其厚度变化有统计学意义;视盘下方和鼻侧,黄斑周围6mm圆圈的颞侧较术前轻度增厚,差别无统计学意义;其他部位视神经纤维层厚度手术前后差别无统计学意义。结论 LASIK术后早期黄斑中心和视盘上方视神经纤维层厚度变薄,有显著统计学意义;而对黄斑特定范围视网膜体积、黄斑和视盘周围他部位视神经纤维层厚度的影响无统计学意义。  相似文献   

2.
目的 利用光学相干断层扫描(optical coherence tomography,OCT)比较准分子激光原位角膜磨镶术(laser in situ kera-tomileusis,LASIK)术前与术后早期视盘周围视网膜神经纤维层(retinal nerve fibre layer,RNFL)厚度变化,探讨LASIK对RNFL厚度的影响.方法 对143例286眼拟行LASIK的患者术前及术后1 d进行OCT检查,测量以视盘为中心3.4 mm直径范围内上方、下方、鼻侧、颞侧RNFL厚度变化,所得数据用统计学方法 进行配对t检验.结果 LASIK术后1 d视盘上方及下方RNFL厚度分别为(130.88±13.22)μm及(132.91±14.89)μm,与术前(128.22±13.86)μm、(128.76±14.64)μm相比变厚,差异有统计学意义(t分别为-5.132、-8.744,P均<0.01),其余各区域RNFL厚度与术前相比略有增加,但差异均无统计学意义(P均>0.01).结论 LASIK术后早期视盘上方及下方RNFL变厚,有临床意义.  相似文献   

3.
目的 探讨飞秒激光LASIK手术中负压吸引对近视眼黄斑区视网膜厚度和视网膜神经纤维层(RNFL)厚度的影响。设计 前瞻性对照研究。研究对象 接受飞秒激光手术的近视眼患者143例(279眼)。方法 采用相干光断层扫描(OCT)仪对中低度近视组(≥-6.00 D)和高度近视组(<-6.00 D)患者飞秒激光LASIK手术前、手术后1周~1年进行检查,测量以黄斑中心凹为中心3 mm半径内的视网膜平均厚度,以及以视盘为中心直径为3.4 mm的视网膜神经纤维层厚度,并以地形图分4个区域显示。主要指标 黄斑中心凹厚度及视盘周围RNFL厚度。结果 术前两组间各参数比较差异均无统计学意义(P均>0.05)。术后1年中低度近视组黄斑中心凹视网膜平均厚度为(147.2±18.3)μm;视盘鼻侧、颞侧、上方、下方的RNFL厚度分别是(62.4±15.7)μm、(94.3±20.2)μm、(136.4±17.6)μm、(131.3±21.7)μm,与术前比较差异均无统计学意义(P均>0.05);术后1年高度近视组黄斑中心凹视网膜平均厚度为(149.3±18.7)μm;视盘鼻侧、颞侧、上方、下方的RNFL厚度分别是(59.3±19.0)μm、(90.7±17.2)μm、(129.2±25.1)μm、(123.3±21.8)μm,与术前比较差异均无统计学意义(P均>0.05)。结论 飞秒激光LASIK术中吸力环负压吸引未对视网膜神经纤维层厚度造成明显影响。(眼科, 2012, 21: 340-343)  相似文献   

4.
目的比较飞秒激光准分子激光原位角膜磨镶术(LASIK)前后视网膜神经纤维层(RNFL)厚度和黄斑区视网膜参数的变化。方法前瞻性连续病例研究。选择接受飞秒激光LASIK术的高度近视眼患者17例(33眼) (等效球镜度>-6.00 D),采用RTVue-100频域光学相干断层成像仪(OCT)观察术眼术前、术后1 d、1周及1个月时RNFL厚度以及黄斑厚度和容积变化。采用单因素方差分析比较手术前后测量参数的变化。结果RNFL厚度(全部、颞侧、上方、鼻侧、下方)术前与术后各时间点差异无统计学意义(F=0.003、0.503、0.285、0.164、0.277,P>0.05)。黄斑区(包括中心凹、旁中心凹、颞侧、上方、鼻侧、下方)视网膜厚度(F=0.491、0.281、0.234、0.341、0.614、0.192,P>0.05)及容积(F=0.484、0.968、0.200、0.314、0.622、0.206,P>0.05)术前与术后1 d、1周、1个月各时间点差异均无统计学意义。结论飞秒激光LASIK手术对RNFL厚度和黄斑区视网膜参数无明显影响。  相似文献   

5.
近视及近视性弱视儿童视网膜神经纤维层OCT检测及分析   总被引:2,自引:0,他引:2  
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。  相似文献   

6.
目的 通过频域OCT检查探讨开角型青光眼(open-angle glaucoma,OAG)患者视网膜及脉络膜各参数的变化。方法 回顾性病例对照研究。临床检查确诊为OAG的19例(30眼)患者为OAG组,健康人15名(30眼)为对照组。采用频域OCT的EDI模式测量2组视盘周围神经纤维层厚度、视盘周围脉络膜厚度及黄斑中心凹处神经纤维层厚度、黄斑中心凹处脉络膜厚度,并作对比。结果 OAG组受检眼6方位视盘周围神经纤维层厚度均明显低于对照组,差异均有统计学意义(均为P<0.05);5方位(颞上方、颞侧、鼻上方、鼻侧及鼻下方)视盘周围脉络膜厚度均明显低于对照组(均为P<0.05),尤其以鼻侧及鼻下方变薄更明显。OAG组黄斑处神经纤维层厚度[(11.27±1.93)μm]及黄斑中心凹处脉络膜厚度[(217.37±11.46)μm]与正常对照组[(11.57±1.65)μm、(215.65±12.42)μm]相比,差异均无统计学意义(均为P>0.05);两组间黄斑部直径3 mm的内环鼻侧、颞侧区域和直径6 mm的外环鼻侧、颞侧区域脉络膜厚度差异均无统计学意义(均为P>0.05)。结论 OAG患者与正常人相比,视盘周围脉络膜厚度减少,且视盘鼻侧及鼻下方脉络膜厚度变薄更为显著,可能与脉络膜血供减少造成的青光眼缺血性损伤相关。OAG患者黄斑部脉络膜厚度并未发生明显变化。  相似文献   

7.
华绒利  陈辉 《国际眼科杂志》2016,16(12):2261-2263
目的:研究全视网膜光凝术( PRP)对重度非增生性糖尿病视网膜病变( non-proliferative diabetic retinopathy,NPDR)与早期增生性糖尿病视网膜病变( proliferative diabetic retinopathy,PDR )患者的视盘周围视网膜神经纤维层( retinal nerve fiber layer,RNFL)厚度影响。方法:选取我院2014-01/2015-12门诊部确诊为糖尿病眼病患者56例,根据实际病情分为早期 PDR 组和重度NPDR组,两组均给予PRP。结果:重度NPDR组术前上方为114.26±18.26μm,明显高于术后的105.55±11.73μm,差异有统计学意义( t=2.085,P=0.042);术前下方为118.85±20.16μm,明显高于术后的107.37±16.38μm,差异有统计学意义( t=2.296,P=0.026);术前鼻侧、颞侧略高于术后,但差异均无统计学意义( P>0.05);术后平均厚度为90.16±14.81μm,明显低于术前(99.85±17.28μm),差异有统计学意义(t=2.212,P=0.031);早期PDR组术后上方、下方均明显低于术前,差异有统计学意义(P<0.01);术后鼻侧、颞侧均略低于术前,两组差异均无统计学意义(P>0.05);术后平均厚度为87.58±16.08μm,明显低于术前(97.17±13.46μm),差异有统计学意义(t=2.463,P=0.017);重度NPDR组术后6 mo的上方、下方、颞侧与平均厚度与早期PDR组差异均无统计学意义( P>0.05);重度NPDR组术后6mo鼻侧为66.29±9.36μm,明显高于早期PDR 组(59.88±11.71μm),差异有统计学意义(t=2.252,P=0.028)。结论:PRP对视网膜上下象限厚度及平均厚度影响较为显著,导致视网膜RNFL变薄,临床应注意PRP对视网膜神经细胞的损伤。  相似文献   

8.
目的:观察超高度近视患者超声乳化白内障吸出术后黄斑区光学相干断层扫描(optical coherence tomography,OCT)的改变。方法:眼轴≥27mm,屈光度>-10.00D的超高度近视患者27例和单纯老年性白内障患者30例,白内障超声乳化吸出术前及术后1,3mo的黄斑区OCT检查,对比观察手术眼黄斑区OCT图象的变化。结果:超高度近视患者术前及术后1mo黄斑区中心凹神经纤维层的厚度分别是:133±24μm和173±32μm两者比较,差异有统计学意义(t=2.648,P<0.01),术后3mo黄斑区中心凹神经纤维层的厚度138±30μm,与术后1mo的神经纤维层的厚度相比,差异有统计学意义(t=2.794,P<0.01),与术前的神经纤维层的厚度相比,差异无统计学意义(t=1.246)。视网膜厚度的增加与术后视力呈负相关(r=-0.56)。术后OCT检查还发现,黄斑区的全层裂孔1例,视网膜牵拉1例,黄斑区出血1例,黄斑区神经纤维层撕裂1例。单纯老年性白内障超声乳化吸出术前及术后1mo的神经纤维层厚度分别是:147±5μm和149±5μm,两者比较,差异无统计学意义(t=1.0416),术后3mo黄斑区中心凹神经纤维层的厚度150±5μm,与术前及术后1mo的视网膜厚度相比,差异无统计学意义(t=1.034和t=1.316)。结论:超高度近视患者术后1mo大部分发生黄斑区水肿,视网膜厚度明显增加,且视网膜厚度的增加与视力呈负相关。部分患者出现黄斑区的全层裂孔,视网膜牵拉,黄斑区出血,黄斑区神经纤维层撕裂。3mo左右,大部分患者黄斑区水肿消退,并与术前相比无明显差异。  相似文献   

9.
目的 观察非动脉炎性前部缺血性视神经病变(NAION)患者的荧光素眼底血管造影(FFA)与光相干断层扫描(OCT)检查等影像特征.探讨其与视力、病程转归的关系.方法 回顾分析47例临床确诊的NAION患者47只眼的FFA、OCT检查资料.所有患者均接受视力、眼底、视野等常规眼科检查.初诊时同时进行FFA和OCT检查.FFA及视野检查按常规方法进行;OCT检查分别选择线性和环形扫描方式,进行黄斑和视盘的扫描.其中35例NAION患者分别于发病后0.5、1、2、3、6个月时进行OCT复查.回顾分析时,以36例患者的对侧健眼作为对照组,对比分析患眼FFA、视野、视盘OCT图像特征与视力、病程转归的相互关系.结果 FFA检查结果显示,所有患眼均表现为早期视盘充盈迟缓,晚期视盘呈强荧光渗漏,24只患眼在黄斑区出现强荧光渗漏.OCT检查结果显示,所有患眼视盘隆起,生理凹陷变窄或消失;视盘与黄斑(盘斑)之间神经上皮层组织增厚或神经上皮层隆起,下方有液性暗区.对照眼中,14只跟有正常视盘生理凹陷,22只眼无生理凹陷或较小的生理凹陷.NAION组0.5个月时黄斑中心凹处神经上皮层厚度、盘斑间神经上皮层最大厚度,视盘周围视网膜神经纤维层厚度均高于对照组,差异均有统计学意义(F=6.51,26.12,75.49;P<0.05).2个月时盘斑间神经上皮层最大厚度、视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度较0.5个月时变薄.3个月时视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度较0.5个月时明显变薄,低于对照组,差异有统计学意义(F=75.49,37.92;P<0.05).视野检查结果显示,下方视野缺损21例,占45.7%.OCT检查结果显示,随病程进展,视盘上方神经纤维层厚度下降的程度更明显,与视野的表现相一致.视力与黄斑中心凹处神经上皮层厚度、盘斑间神经上皮层最大厚度、视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度呈显著负相关关系(r=-0.394,-0.424,-0.412,-0.464;P<0.05).结论 NAION患者FFA特征为早期视盘充盈迟缓,晚期视盘呈强荧光渗漏;OCT特征为随病程发展,视网膜神经上皮层增厚,神经纤维层变薄.视盘形态及视网膜神经纤维层变化的OCT检查与视野检查结果一致;患者视力与神经上皮层厚度的OCT检查结果呈负相关关系.  相似文献   

10.
目的:探讨近视眼视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度的变化。方法:随机抽取准分子激光原位角膜磨镶术(LASIK)术前的近视眼患者53例106眼和正常对照组53例106眼利用光学相干断层扫描仪(OCT)进行以视盘为中心,3.4mm为半径的RNFL测量,计算上、下、鼻、颞四个象限及平均RNFL厚度,分别与正常组比较,并进行统计学分析。结果:近视组与正常对照组平均RNFL厚度相比变薄且有显著性差异(P<0.05)。近视组上方、下方、鼻侧象限RNFL厚度与正常组相比变薄且有显著性差异(P<0.05),颞侧象限亦变薄但无显著性差异(P>0.05)。结论:近视眼上方、下方、鼻侧象限及平均RNFL厚度变薄,鼻侧RNFL厚度差异明显,且具有显著性差异。  相似文献   

11.
Background: To evaluate the correlation between optic nerve head parameters and retinal nerve fiber layer thickness measured by Cirrus HD spectral‐domain optical coherence tomography (Cirrus HD‐OCT; Carl Zeiss Meditec) in healthy myopic eyes. Design: Cross‐sectional study. Participants: One hundred and sixty‐one right eyes from 161 healthy young myopic subjects. Methods: Optic nerve head parameters and retinal nerve fiber layer thickness were measured with the Cirrus HD‐OCT. The distance between optic disc margin and scan circle (disc margin‐to‐scan distance) was measured on the Cirrus HD‐OCT en‐face optic nerve head image with aid of National Institutes of Health ImageJ image‐analysis software (developed by Wayne Rasbands, National Institutes of Health, Bethesda, MD). Main Outcome Measures: The correlations among optic nerve head parameters, retinal nerve fibre layer thickness and the disc margin‐to‐scan distance were evaluated with and without adjustment of the magnification effect. Results: Without correction of the magnification effect, the thicker average retinal nerve fiber layer was correlated with greater rim area and lower degree of myopia (P < 0.001). When the magnification effect was corrected, thicker average retinal nerve fibre layer was associated with greater disc area and greater rim area in univariate and multivariate analyses (P ≤ 0.028); however, degrees of myopia and the disc margin‐to‐scan distance were not significantly associated with average RNFL thickness (P ≥ 0.104). Conclusions: Thicker average retinal nerve fibre layer thickness was associated with greater rim and disc areas. Disc margin‐to‐scan distance was not significantly correlated with average retinal nerve fibre layer thickness in healthy myopic eyes.  相似文献   

12.
Partial optic nerve avulsion (ONA) secondary to finger gouging is an uncommon but devastating injury. A 21-year-old man who had an acute vision loss after accidentally getting poked by himself in his right eye when he fell down during jogging is reported. The patient was diagnosed with partial ONA. Magnetic resonance imaging revealed intact optic nerve. Optical coherence tomography (OCT) revealed deep cavity at the inferior-temporal half of the optic disc. Retinal nerve fiber layer thickness was also thin at the inferior quadrant with circumpapillary OCT scan. Visual field test and electrophysiological tests showed functional abnormality compatible with optic nerve lesion. Diagnostic tools for anatomical and functional evaluation may reveal the course of this injury.  相似文献   

13.
PURPOSE: To examine whether LASIK induces changes in the optic disc and retinal nerve fiber layer using scanning laser tomography. METHODS: Prospective, consecutive study of 53 myopic eyes in 38 patients (mean age: 35.7 +/- 10.4 years; range: 22 to 58 years). Preoperative average refractive error was -6.0 +/- 2.4 diopters (D) (spherical equivalent) (range: -2.0 to -10.0 D). Optic disc morphology and retinal nerve fiber layer thickness were evaluated with scanning laser tomography preoperatively and at 7 and 13 months postoperatively. RESULTS: No statistically significant differences were noted between the pre- and postoperative optic disc and retinal nerve fiber layer measurements. CONCLUSIONS: Our results suggest that transient extreme elevation of intraocular pressure during LASIK does not affect the optic disc morphology or retinal nerve fiber layer thickness in normal myopic eyes for at least 1 year after surgery.  相似文献   

14.
目的:通过光学相干断层成像(OCT)检测高度近视合并青光眼患者视神经纤维层厚度的变化规律。方法:选取2017-01/12于我院进行治疗的高度近视合并青光眼患者80例160眼作为观察组,并选择同期于我院进行体检的健康志愿者60例120眼作为对照组。采用OCT分析所有受检者视神经纤维层厚度。结果:与对照组受检者相比,观察组患者鼻侧、颞上、鼻下、鼻上、颞下及全周平均视神经纤维层厚度均降低,而颞侧视神经纤维层厚度升高(P<0.05),且观察组中屈光度-10.00^-11.00D的患者鼻侧、颞上、鼻下、鼻上、颞下及全周平均视神经纤维层厚度均显著高于屈光度≥-12.00D的患者(P<0.05)。Spearman相关分析结果显示,观察组患者屈光度的绝对值与鼻侧、颞上、鼻下、颞下及全周平均厚度视神经纤维层厚度呈负相关,与颞侧视神经纤维层厚度呈正相关。结论:高度近视合并青光眼患者除颞侧外各象限视神经纤维层变薄。  相似文献   

15.
Twenty-six patients (45 eyes) (median age 55 years) with optic disc drusen (ODD) (a study group) and 24 healthy volunteers (47 eyes) (median age 53 years) (a control group) were examined. Nerve fiber layer thinning determined by optic coherence tomography (OCT) was found in 65% of the ODD. In 20% of the patients with ODD, nerve fiber layer thinning, as evidenced by OCT, was observed with the normal field of vision, which suggests the higher sensitivity of a morphometric study of the retinal nerve fiber layer. According to OCT data, 11% of the patients with pathological changes in the field of vision had increased retinal nerve fiber layer thickness in some quadrants or from the mean value. These changes may be associated with the large-sized optic disc in these patients.  相似文献   

16.
目的:应用频域光学相干断层扫描成像(optical coherence tomography,OCT)技术研究病理性近视眼视盘神经纤维层厚度的变化特点及其与眼轴、性别和年龄的关系,为病理性近视合并原发性开角型青光眼的早期诊断提供帮助。方法:选取对照组正常眼96眼(眼轴23~24mm)和观察组病理性近视眼153眼(眼轴25~27mm 80眼,〉27mm 73眼); 应用频域OCT检测视盘神经纤维层的厚度; 比较对照组与观察组视盘神经纤维层厚度的差异; 使用多元线性回归分析观察组视盘全周的平均厚度与眼轴、性别和年龄的关系。结果:观察组视盘神经纤维层的全周平均、上下及鼻侧象限平均厚度值均变薄,与对照组相比均具有统计学意义(P〈0.05),颞侧象限相比较无统计学意义(P〉0.05); 观察组视盘神经纤维层的全周平均厚度与眼轴的偏相关系数为-1.31,与性别的偏相关系数为5.21,与年龄的偏相关系数为-0.12。结论:病理性近视眼的视盘神经纤维层厚度较正常眼变薄,眼轴、性别和年龄是病理性近视眼视盘神经纤维层平均厚度的影响因素,对诊断合并病理性近视患者的青光眼视神经损害时应注意排除病理性近视对视盘神经纤维层厚度产生的影响。  相似文献   

17.
Laser in situ keratomileusis-induced optic neuropathy   总被引:10,自引:0,他引:10  
OBJECTIVE: To report a case of bilateral optic neuropathy after bilateral laser-assisted in situ keratomileusis (LASIK) surgery. DESIGN: Observational case report. METHODS: Complete eye examination with detailed evaluation of the optic nerve, detailed medical history, stereo disc photographs, GDx Nerve Fiber Analyzer testing, Humphrey 24-2 SITA visual field testing, diurnal intraocular pressure measurement, serologic evaluation, and magnetic resonance imaging of the brain and orbits. MAIN OUTCOME MEASURES: Optic nerve status, visual field status, and visual acuity. RESULTS: A subject with previously healthy optic nerves had bilateral optic neuropathy develop after LASIK surgery. This neuropathy manifested with a subjective decrease in visual field, normal visual acuity, normal color vision, relative afferent pupillary defect, increased cupping of the optic nerve with focal neuroretinal rim defects, decreased nerve fiber layer thickness, and nerve fiber bundle-type visual field defects. The subject had no other risk factors for optic neuropathy. No other cause of neuropathy was identified. CONCLUSIONS: Optic neuropathy is a potential vision-threatening complication of LASIK surgery. This complication may be due to barotrauma or ischemia related to extreme elevation of intraocular pressure by the suction ring. Careful examination of the optic nerve before and after LASIK surgery is warranted.  相似文献   

18.
PURPOSE: To report longitudinal retinal nerve fiber layer (RNFL) thickness measurements using optical coherence tomography (OCT) in a patient with traumatic optic neuropathy. DESIGN: Observational case report. METHODS: A 14-year-old boy with severe optic nerve trauma had repeated OCT scans of the peripapillary retinal nerve fiber layer at 3 days, 20 days, 40 days, and 70 days after injury. RESULTS: There was gradual loss of nerve fibers as shown by the OCT color-coded map, RNFL thickness profile, and RNFL thickness measurements around the optic disk. At 70 days of follow-up, severe thinning of the RNFL was observable. CONCLUSIONS: These findings suggest that OCT is able to assess and monitor axonal loss after traumatic optic neuropathy.  相似文献   

19.

Purpose

To clarify the usefulness of optical coherence tomography (OCT) for the objective and quantitative evaluation of retinal nerve fiber layer (RNFL) thickness around the optic disc in a rodent model of nonarteritic ischemic optic neuropathy (rNAION).

Methods

Inner retinal thickness was measured using OCT before and after rNAION induction. The thicknesses of the RNFL and the inner plexiform layer (IPL) were measured using a histologic preparation before and 56 days after induction. We compared the inner retinal thickness measured by OCT with that measured by the histologic preparation.

Results

The mean inner retinal thickness around the optic disc of normal rats measured using OCT was similar to that measured using a histologic preparation (73.50 ± 4.94 vs. 75.94 ± 5.90 μm). The mean inner retinal thickness of rNAION significantly increased until the 7th day, returned to baseline on the 14th day, and decreased until the 90th day after induction. On the 56th day after rNAION induction, histologic measurements indicated that the mean RNFL thickness had decreased but that the IPL thickness was similar to that at baseline.

Conclusion

The mean inner retinal thickness measured by OCT correlated with the RNFL thickness of rNAION. OCT is useful for the objective and quantitative evaluation of RNFL thickness around the optic disc in a model of rNAION.  相似文献   

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