近视眼神经纤维层光学相干断层扫描检测的临床研究

目的研究人视网膜神经纤维层厚度随近视眼屈光度加深而变化的特点及临床意义。方法将近视眼108例(197眼)和正常对照者42例(60眼)分为低度近视组、中度近视组、高度近视组和正常对照组,应用光学相干断层扫描仪进行以视盘为中心,直径3.46mm圆周的视网膜神经纤维层(retinal nerve fiberlayer,RNFL)厚度测量,计算各组平均RNFL厚度及鼻、颞、上、下4个象限的RNFL厚度,各近视组分别与正常组对比,并进行统计学分析。结果低度、中度近视患者平均RNFL分别为(119.33±37.23)μm、(117.84±36.57)μm,已变薄但与正常人(123.74±35.68)μm无显著差异(P>0.05);高度近视平均神经纤维层厚度为(112.89±37.09)μm明显变薄,与正常人相比有显著性(P<0.01)。近视眼各象限RNFL最早变薄的是鼻侧,低度近视即与正常人有显著性差异(P<0.01)。高度近视眼鼻、下、上方RNFL均明显变薄(P<0.01),而颞侧RNFL反而增厚,与正常人相比差异具有显著性(P<0.01)。结论近视眼中平均RNFL厚度变薄,随着近视度数的加深,近视眼RNFL厚度变薄越来越明显。分区分析上、下、鼻侧变化与平均相一致,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指导意义。     

OCT检测儿童青少年近视眼视网膜神经纤维层厚度的临床研究

目的：探讨8~17岁儿童青少年近视眼视网膜神经纤维层( retinal nerve fibre layer,RNFL)厚度临床变化特点,为儿童青少年青光眼的诊断提供依据,避免漏诊及误诊。方法：将8~17岁儿童青少年99例165眼按屈光度分为正常对照组、低度近视组、中度近视组及高度近视组,应用Cirrus HD OCT分别对4组研究对象进行以视盘为中心,直径为3.46 mm圆周的RNFL厚度测量,分别得出各组平均、各象限、各钟点RNFL厚度。将各近视组与正常组RNFL厚度进行比较,观察近视眼RNFL厚度变化特点。
　　结果：各近视组与正常组相比,平均RNFL厚度均变薄,高度近视组差异有统计学意义(P<0.05),上、下、鼻侧象限RNFL厚度均变薄,颞侧象限厚度均变厚;中度、高度近视组,上方、下方象限厚度变薄,差异有统计学意义(P<0.05),颞侧象限厚度均变厚,差异有统计学意义( P<0.05);1：00,5：00,6：00,12：00位RNFL厚度变薄,差异有统计学意义( P<0 .05),8：00,9：00,10：00位RNFL厚度增加,差异有统计学意义(P<0.05),低度近视3：00位RNFL厚度增加,差异有统计学意义( P<0 .05)。
　　结论：儿童青少年近视眼与正常眼相比,Avg(平均RNFL厚度),S(上方象限 RNFL 厚度),I(下方象限 RNFL 厚度),1：00,5：00,6：00,12：00位RNFL厚度变薄,且随着屈光度增加其RNFL厚度变薄, T (颞侧),8：00,9：00,10：00位RNFL厚度变厚,且随着屈光度增加其RNFL厚度变厚。在对近视眼进行 RNFL 厚度测量时,发现有异常RNFL厚度变化时,应该考虑到屈光度的影响,综合评价其临床意义,以免造成对青光眼的误诊。对于青光眼诊断效能最高的颞下(7：00~8：00位)、颞上(10：00~11：00位) RNFL并未出现变薄,当对儿童青少年近视眼进行RNFL厚度测量时,如果出现上述方位的 RNFL 厚度变薄,应考虑青光眼的可能性,以免漏诊。     

Cirrus HD OCT检测近视眼视网膜神经纤维层厚度的研究

目的：应用Cirrus HD OCT检测近视眼视网膜神纤维层厚度,探讨近视眼神经纤维层厚度分布特点及其与屈光度的关系。 方法：将近视眼106例196眼分为低、中、高度近视组和正常对照组38例60眼,应用Cirrus HD OCT进行以视盘为中心,直径3.46 mm圆周的RNFL厚度测量,计算各组平均、各象限及各钟点RNFL厚度,各近视组分别与正常对照组对比,研究近视眼RNFL厚度与屈光度的关系。 结果：各近视组平均、上方象限及下方象限RNFL厚度较正常对照组变薄,其中中度、高度近视与正常对照组相比有统计学差异（ P〈0.05）,鼻侧象限RNFL厚度变薄,无统计学显著性差异（ P〉0.05）,颞侧象限RNFL厚度增加,有统计学差异（ P〈0.05）;各近视组2：00,6：00,12：00位RNFL厚度较正常对照组变薄,有统计学差异（ P〈0.05）,8：00,9：00,10：00位RNFL厚度较正常对照组增加,有统计学差异（ P〈0.05）,中、高度近视1：00,5：00位厚度较正常对照组变薄,有统计学差异（P〈0.05）。 结论：近视眼平均、上方及下方象限、2：00,6：00,12：00位RNFL厚度较正常对照组变薄,颞侧象限、8：00,9：00,10：00位RNFL厚度较正常对照组相比明显增加,这是近视眼RNFL厚度的特点,当临床出现RNFL厚度异常时,应考虑屈光度的影响,综合评价其临床意义;近视眼7：00,8：00,10：00,11：00位RNFL厚度与正常对照组相比均未变薄,出现异常变薄时,应考虑青光眼可能。     

LASIK术前近视眼神经纤维层厚度光学相干断层扫描分析

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。     

单纯性近视鼻侧象限视网膜神经纤维层变薄与眼轴及屈光度的相关性研究

目的通过对单纯性近视眼变薄的鼻侧视网膜神经纤维层（RNFL）厚度与眼轴及屈光度的相关性研究，并探讨其原因。方法选取LASIK术前光学相干断层扫描（OCT）检查中发现鼻侧象限视网膜神经纤维层变薄的患者进行验光检测眼屈光度及眼A超检测眼轴并进行统计学分析。结果103例单纯性近视眼患者206眼中OCT检查发现鼻侧象限RNFL变薄者为31例61眼，占29．6％。其鼻侧象限RNFL厚度与眼轴长度成负相关关系（r=-0．885，p〈0．01）；鼻侧象限RNFL厚度与屈光度成负相关关系（r=-0．747，p〈0．01）。结论单纯性近视眼鼻侧象限RNFL层厚度随眼轴长度及眼屈光度的增加而减少。在出现异常数值时，需考虑其眼轴及屈光度的影响，综合评价数值意义。     

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....     

相干光断层扫描仪检测视网膜神经纤维层厚度影响因素分析

目的运用相干光断层扫描仪(OCT)测量正常人视网膜神经纤维层(RNFL)厚度并探讨其影响因素。方法运有Stratus OCT 4.0测量202例不同年龄及不同屈光度正常人(年龄8～74岁,屈光度-8～ 4D)各钟点、象限及平均RNEL厚度,建立多元线性回归方程探讨年龄、屈光度、性别及视盘面积对RNEL厚度的影响。结果①正常人RNFL平均厚度为108.63±9.70μm,下方象限RNFL(I):139.17±15.79μm最厚,其次为上方象限(S):134.61±17.80μm,颞侧象限(T):85.37±21.25μm,鼻侧象限(N):75.19±17.06μm最薄,即I>S>T>N。②平均及上、下、颞侧象限RNFL厚度均随年龄增长而变薄,40岁以后趋势明显,50岁以上者显著变薄,仅鼻侧象限RNFL厚度与年龄无关;平均及上、下、鼻侧象限RNFL厚度均随近视度数增加而变薄,且高度近视者显著薄于正视者。而颞侧象限RNFL厚度却随近视度数增加而变厚,高度近视者显著薄于正视者。而颞侧象限RNFL厚度却随近视度数增加而变厚,高度近视者显著厚于正视者;平均及各象限RNFL厚度除下方外均与性别无关,仅下方像限女性较男性厚;应用机器自动辨认视盘边界时,未发现RNFL厚度与视盘面积有关。结论OCT测得的正常RNFL厚度主要与年龄、屈光度有关;仅下方象限RNFL厚度与性别有关;应用机器自动辨认视盘边界时,未发现RNFL厚度与视盘面积有关;儿童可以较好地配合OCT检查并获得较为可靠的测理结果;应用规范、统一的OCT测量标准,建立人群为基础的并经相关影响因素校正的中国人RNFLJE常值数据库对青光眼的早期诊断是非常必要的。     

高度近视性弱视儿童视盘周围视网膜神经纤维层厚度分析

目的：分析高度近视性弱视儿童视盘周围视网膜神经纤维层厚度特点,并探讨与眼轴、年龄的关系。
　　方法：选择收集2014-01/07间在我院眼科门诊就诊的儿童35例59眼,平均年龄9.59±2.90岁,所有受检眼排除眼底的疾病和眼前节的病变。根据扩瞳验光的结果,分成高度近视性弱视组(22眼)、高度近视组(15眼)、正视眼组(22眼),运用频域OCT对视盘周围视网膜神经纤维层进行检测,通过A超测量出所有受检者眼轴长度。对各组视盘周围各方位视网膜神经纤维层厚度进行比较分析,探讨视盘周围各方位视网膜神经纤维层与眼轴、年龄的关系。
　　结果：高度近视性弱视组视盘颞侧RNFL厚度薄于高度
　　近视组,厚于正视眼组;视盘鼻侧、上方、下方、周围平均RNFL厚度与高度近视组、正视眼组相比均最薄,其中视盘下方及周围平均RNFL厚度与高度近视组相比变薄,有统计学差异(P<0.05),视盘鼻侧、上方、下方、周围平均RNFL厚度与正视眼组相比明显变薄,有统计学差异( P<0.01)。高度近视组视盘颞侧RNFL厚度与正视眼组相比明显增厚,视盘鼻侧、上方、下方、周围平均RNFL厚度与正视眼组相比均明显变薄,有统计学差异(P<0.05)。高度近视性弱视组视盘下方RNFL厚度与眼轴呈负相关性( R=0.474, R2=0.225, F=4.933, P=0.040)。高度近视组视盘上方RNFL厚度与眼轴呈负相关性(R=0.642, R2=0.412,F=9.104,P=0.010)。高度近视性弱视组、高度近视组、正视眼组各方位RNFL厚度与年龄均无明显相关性。
　　结论：高度近视性弱视儿童视网膜结构存在异常。     

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。     

近视人群视盘旁神经纤维层厚度和视盘形态学相关性研究

目的：应用OCT研究近视人群视盘旁神经纤维层厚度和视盘形态学变化以及两者的关系。

方法：前瞻性研究。共纳入近视患者61例95眼,平均年龄27.76±7.05岁; 对照组15例30眼,平均年龄28.33±3.08岁。根据屈光度将近视患者分为中低度近视组14眼(-3D≤屈光度<-6D)、高度近视组56眼(-6D≤屈光度≤-9D)和超高度近视组25眼(屈光度>-9D)。所有受试者均行标准综合验光(SE)、眼轴长度(AL)、眼压(IOP)、散瞳眼底和OCT检查。分析视盘旁平均视网膜神经纤维层厚度和上、下、鼻、颞四个象限的神经纤维层厚度,以及视盘旁萎缩灶面积(PPA)、视盘椭圆度(OI)和视盘水平倾斜角(HOT)。

结果：各象限的神经纤维层厚度,四组受试者均有差异(均P<0.01)。平均神经纤维层厚度、上方和鼻侧神经纤维层厚度比较,对照组显著高于三个近视组(均P<0.05)。颞侧神经纤维层厚度比较,对照组低于高度近视组和超高度近视组(P<0.001、0.002),中低度近视组亦低于超高度近视组(P=0.043); 四组受试者PPA比较有差异(P<0.001),其中超高度近视组和高度近视组大于中低度近视组和对照组(均P<0.01); 四组受试者HOT有差异(P=0.020),其中高度近视组和超高度近视组高于对照组(P<0.001)。上、下象限神经纤维层厚度与OI、HOT和PPA均呈负相关(均P<0.05),而颞侧神经纤维层厚度与OI、HOT和PPA均呈正相关(均P<0.05)。

结论：近视患者平均和上、下方神经纤维层厚度变薄,颞侧变厚,鼻侧无变化。高度近视患者HOT和PPA增大,且与神经纤维层厚度有密切联系。     

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...     

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。     

【In Press】 Comparison of peripapillary retinal nerve fiber layer thickness between myopia severity groups and controls

AIM: To compare the peripapillary retinal nerve fiber layer (RNFL) thickness measured via optical coherence tomography (OCT) between different groups of myopia severity and controls. METHODS: This was a prospective cross-sectional study. All subjects underwent a full ophthalmic examination, refraction, visual field analysis and A-scan biometry. Myopic patients were classified as low myopia [spherical equivalent (SE) from greater than -0.5 D, up to -3.0 D], moderate myopia (SE greater than -3.0 D, up to -6.0 D) and high myopia (SE greater than -6.0 D). The control group was emmetropia, defined as a SE from +0.5 D to -0.5D. A Zeiss Cirrus HD-OCT machine was used to measure the peripapillary RNFL thickness of both eyes of each subject. The mean peripapillary RNFL thickness between groups was compared using both analysis of variance and analysis of covariance. RESULTS: A total of 403 eyes of 403 subjects were included in this study. The mean age was 31.48±10.23. There were 180 (44.7%) eyes with emmetropia, 124 (30.8%) with low myopia, 73 (18.1%) with moderate myopia and 26 (6.5%) with high myopia. All groups of myopia severity had a thinner average RNFL than the emmetropia group, but after controlling for gender, age, and axial eye length, only the high myopia group differed significantly from the emmetropia group (P=0.017). Likewise, the superior, inferior and nasal RNFL was thinner in all myopia groups compared to controls, but after controlling for confounders, only the inferior quadrant RNFL was significantly thinner in the high myopia group, when compared to the emmetropia group (P=0.017). CONCLUSION: The average and inferior quadrant RNFL is thinner in highly myopic eyes compared to emmetropic eyes. Refractive status must be taken into consideration when interpreting the OCT of myopic patients, as RNFL thickness varies with the degree of myopia.     

Effect of myopia and optic disc area on ganglion cell-inner plexiform layer and retinal nerve fiber layer thickness

Purpose:The aim of this work was to study the impact of myopia and different optic disc areas on ganglion cell-inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL) thickness profiles in myopic patients by spectral-domain optical coherence tomography (SD-OCT).Methods:This was a cross-sectional study of 100 eyes of 50 myopic individuals. All patients underwent complete ophthalmic evaluation and SD-OCT examination. According to spherical equivalent (SE), patients were divided into M1, M2, and M3 (low, moderate, and high myopia group). According to optic disc area values, patients were divided into D1, D2 and D3 (small, medium and large disc groups). Average GCIPL and RNFL thickness recorded globally and separately for all quadrants and also according to 12 clock hours and analyzed with respect to different myopic groups, optic disc area groups, and axial length.Results:Quadrantic RNFL thickness profiles and their average RNFL thickness were significantly thinner in high myopic group compared to low myopic group, except for the temporal quadrant (P < 0.05). Average RNFL and RNFL thickness of all quadrants were significantly thicker in the large disc group than in the small disc group (P < 0.05). Average GCIPL and GCIPL thicknesses of all sectors were significantly thinner in high myopic group compared to low myopic group (P < 0.05). No significant correlation was observed between GCIPL and disc area changes. Average RNFL thickness correlated significantly with SE (3.667 μm/diopter), axial length (–5.3805 μm/mm) and optic disc area (9.4617 μm/mm²). Also, average GCIPL thickness correlated statistically significantly with SE (1.6807 μm/diopter) and axial length (–2.626 μm/mm).Conclusion:Myopia and axial length significantly reduce RNFL and GCIPL thickness profiles but the optic disc area significantly increases RNFL thickness, but not GCIPL thickness.     

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。     

Comparison of peripapillary retinal nerve fiber layer thickness between myopia severity groups and controls

AIM: To compare the peripapillary retinal nerve fiber layer (RNFL) thickness measured via optical coherence tomography (OCT) between different groups of myopia severity and controls. METHODS: This was a prospective cross-sectional study. All subjects underwent a full ophthalmic examination, refraction, visual field analysis and A-scan biometry. Myopic patients were classified as low myopia (LM) [spherical equivalent (SE) from greater than -0.5 D, up to -3.0 D], moderate myopia (MM; SE greater than -3.0 D, up to -6.0 D) and high myopia (HM; SE greater than -6.0 D). The control group consisted of emmetropic (EM) patients (SE from +0.5 D to -0.5 D). A Zeiss Cirrus HD-OCT machine was used to measure the peripapillary RNFL thickness of both eyes of each subject. The mean peripapillary RNFL thickness between groups was compared using both analysis of variance and analysis of covariance. RESULTS: A total of 403 eyes of 403 subjects were included in this study. The mean age was 31.48±10.23y. There were 180 (44.7%) eyes with EM, 124 (30.8%) with LM, 73 (18.1%) with MM and 26 (6.5%) with HM. All groups of myopia severity had a thinner average RNFL than the EM group, but after controlling for gender, age, and axial eye length, only the HM group differed significantly from the EM group (P=0.017). Likewise, the superior, inferior and nasal RNFL was thinner in all myopia groups compared to controls, but after controlling for confounders, only the inferior quadrant RNFL was significantly thinner in the HM group, when compared to the EM group (P=0.017). CONCLUSION: The average and inferior quadrant RNFL is thinner in highly myopic eyes compared to emmetropic eyes. Refractive status must be taken into consideration when interpreting the OCT of myopic patients, as RNFL thickness varies with the degree of myopia.     

Evaluation of the Ganglion Cell Complex and Retinal Nerve Fiber Layer in Low,Moderate, and High Myopia: A Study by RTVue Spectral Domain Optical Coherence Tomography

Purpose: To assess the effect of low, moderate, and high myopia on the thickness of the retinal nerve fiber layer (RNFL) and Ganglion cell complex (GCC) measured by Spectral Domain Optical Coherence Tomography (SD-OCT) in non-glaucomatous subjects. Methods: The subjects were divided into three groups: low (n = 81, 35.6%), moderate (n = 79, 34.8%), and highly myopic eyes (n = 67, 29.5%). The RNFL thickness profile, including the average, superior, nasal, inferior, and temporal quadrant and each of the eight directional thicknesses, was measured. GCC parameters, including the average, superior, and inferior values, the focal loss volume (FLV), and the global loss volume (GLV), were measured. The correlation between the OCT measurements and the axial length was evaluated. Results: The average, superior, inferior, and nasal RNFL thicknesses of low and moderate myopic eyes were found to be significantly higher than those of highly myopic eyes. The temporal RNFL thicknesses were not different among the three groups. The average, superior, and inferior ganglion cell complex values of low and moderate myopic eyes were significantly higher than those of highly myopic eyes. The FLV and GLV of low and moderate myopic eyes were significantly higher than those of highly myopic eyes (p = 0.001 for all). In the moderate and high myopia groups, the average RNFL thickness and GCC thickness were both negatively correlated with the axial length. Conclusion: Highly myopic subjects tend to have thinner RNFL and GCC thicknesses than subjects with low and moderate myopia.     

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.     

儿童屈光状态、眼轴与黄斑体积、厚度的关系

目的观察儿童不同屈光状态、眼轴与黄斑体积、厚度光相干断层扫描（OCT）测量值之间关系。方法100名正常儿童，选取右眼为研究对象，按屈光状态分为远视眼、正视眼、低度近视眼、中度近视眼、高度近视眼组，每一组各20只眼。经由睫状肌麻痹检影，光相干生物测量仪（IOLmaster）测 量眼轴，然后OCT快速黄斑测定方案测定黄斑体积和厚度值。对各组之间黄斑体积、各区厚 度与屈光度、眼轴的相关关系进行统计学分析。结果中心凹区最小厚度以及平均厚度各组之间的差异无统计学意义。黄斑体积与黄斑区视网膜平均厚度以及黄斑各区（除了内环鼻侧）均与屈光度成正相关，与眼轴成负相关。中心凹区最小厚度以及平均 厚度与屈光度和眼轴不相关。高度近视眼儿童与其他4组观察者相比有最小的黄斑体积和旁 中心凹区（特别是外环区）视网膜厚度。结论随着屈光度负增加，眼轴增长，黄斑体积变小，除中心凹区域和内环鼻侧之外的黄斑区视网膜厚度均减小。 （中华眼底病杂志，2008，24：114-117）