FD—OCT对原发性急性闭角型青光眼视网膜厚度和体积的测量

背景原发性急性闭角型青光眼（PAACG）大发作后可引起不同程度的视功能损害，了解PAACG发作眼视盘及黄斑区视网膜的结构改变对于判断患眼的预后具有重要的临床意义。傅里叶域OCT（FD-OCT）是测量视网膜结构的有用工具。目的采用FD—OCT对PAACG大发作后视盘区视网膜神经纤维层厚度（RNFLT）、黄斑区厚度以及黄斑区体积的变化进行测量，并与正常眼进行比较。方法采用病例对照临床试验方法。收集2011年4月至2012年2月在温州医学院眼视光医院确诊为PAACG且有一侧眼大发作的患者25例，并纳入同期年龄和性别相匹配的正常志愿者25人25眼为正常对照眼，于PAACG患眼大发作后2周由同一位操作熟练的检查者采用FD—OCT测量患者发作眼、对侧眼和正常对照眼RNFLT、黄斑区厚度及黄斑区体积。结果PAACG发作后2周内发作眼组视盘区平均RNFLT值为（125．72±28．57）μm，明显高于对侧眼组的（108．36±9．31）μm和正常对照眼组的（106．10±10．97）μm，差异均有统计学意义（P〈0．05）；此外，发作眼组视盘上方、下方、鼻侧象限RNFLT值均明显高于对侧眼组和正常对照眼组，差异均有统计学意义（P〈0．05），而视盘颞侧象限和颞下象限RNFLT值的差异均无统计学意义（P=0．081、0．766）。发作眼组、对侧眼组和正常对照眼组黄斑区视网膜平均厚度分别（283．72±18．33）、（280．28±16．85）和（289．14±10．60）“m，3个组间黄斑区各象限视网膜厚度值差异无统计学意义（FH镕=2．048，P=0．136），其中对侧眼组视网膜厚度值均明显低于正常对照眼组（P〈0．05），发作眼组与正常对照眼组间差异无统计学意义（P=0．224）。发作眼组、对侧眼组和正常对照眼组黄斑区总体积分别为（5．589±O．355）、（5．532±0．325）和（5．720±0．241）mm。，黄斑区各象限体积比较差异无统计学意义（F＊。=1．027，P=0．363）。各组外环各象限厚度值均明显小于内环厚度值，内环及外环黄斑区视网膜厚度值均呈鼻侧〉上方〉下方〉颞侧的趋势。PAACG患者发作眼和对侧眼在视盘内环颞侧、上方、鼻侧、下方和外环颞侧、中央区黄斑区厚度值及其体积值均明显低于正常对照眼，差异均有统计学意义（P〈0．05）。结论PAACG发作眼发作2周内视盘区RNFL水肿比黄斑区更明显，发作眼和对侧眼的黄斑区视网膜均比正常对照眼变薄，其黄斑区体积均小于正常对照眼。

Measurement of retinal thickness and volume after onset of primary acute angle-closure glaucoma

Background Attack of primary acute angle-closure glaucoma （PAACG） often cause damage of retinal function. To measure the structural change after acute angle-closure glaucoma attack is of an important clinical significance. Flourier domain OCT（FD-OCT） is available. Objective This study was to measure and compare the thickness of peripapillary and macular retinal nerve fiber layer （RNFL） and macular volume in PAACG patients and normal subjects. Methods A case-controlled study was designed. Twenty-five eyes after acute angle-closure glaucoma attack and 25 fellow eyes were collected from April,2011 to February,2012 in Affiliated Eye Hospital of Wenzhou Medical College, and 25 eyes of normal subjects with the matched age and gender were enrolled at the same period. The thicknesses of RNFL and macula as well as the volumes of macula were measured by FD-OCT in all the eyes 2 weeks after acute angle-closure glaucoma attack. The outcomes were compared among the attacked eyes,fellow eyes and normal control eyes. Results The average thicknesses of RNFL were （ 125.72 ± 28.57 ） , （ 108.36 ± 9.31） and （106.10± 10.97）Ixm in the attacked eyes,fellow eyes and normal control eyes, showing a significant increase in the attacked eyes （ all at P 〈 0. 05 ）. The RNFL thickness values in the superior, interior and nasal quadrants at optical disc were significantly higher in the attacked eyes than those of the fellow eyes and normal control eyes （ all at P〈0.05） ,but no significant differences were found in temporal and temporal-lower quadrants among the three groups （P=0. 081,0. 766）. The thickness values of macular area were （283.72±18.33） , （280. 28±16. 85） and （289.14±10.60）txm in the attacked eyes, fellow eyes and normal control eyes, with no significant difference among them （Fgroop-2. 048, P = 0. 136）, and fellow eyes were significantly reduced in comparison with the normal control group （ P〈0. 05 ） , and those in the attacked eyes was not significantly reduced in comparison with the normal control group （ P = 0. 224）. The macular volumes were （5. 589±0. 355 ）, （5. 532±0. 325 ） and （ 5. 720±0.241 ） mm3 in the attacked eyes, fellow eyes and normal eyes, without statistically significant difference among them （Fgroup = 1. 027,P=0. 363）. The macular thickness values were lower in the outer race than those of the inner race and followed the pattern of nasal 〉 superior 〉 inferior 〉 temporal quadrants. At the temporal, superior, nasal and inferior quadrants of inner race,the temporal quadrant of the outer race, the central area, the macular thickness and volume values were declined in the attacked eyes and fellow eyes compared with the normal control eyes （ all at P〈0. 05）. Conclusions The edema of RNFL is more serious than that of macula in the eyes within 2 weeks after acute angle-closure glaucoma attack. The retinas of macular zone are thinner,and the macular volumes are smaller in the attacked eyes and fellow eyes than those in the normal control eyes.