OCT检测青光眼视网膜神经纤维层局部缺损的临床研究

背景传统眼底照相的方法诊断视网膜神经纤维层（RNFL）局部缺损依赖于检查者的主观经验，而光学相干断层扫描（OCT）可以客观判断RNFL的局部缺损，新的频域OCT对RNFI，缺损的显示更直观。目的评价频域OCT、时域OCT对青光眼RNFL局部缺损的诊断价值及其与眼底彩色照相的一致性。方法由2位青光跟专家通过眼底彩色照相一致确认存在RNFL局部缺损的青光眼患者55例55眼和正常对照41名41眼纳入研究，分析眼底彩色照相、频域CirrusHD-OCT、时域Stratus OCT分别检测的RNFL局部缺损的位置和宽度，进行三者检测结果的一致性和相关性研究，评价OCT对RNFL局部缺损的诊断价值。结果确认青光眼患者55眼中共有RNFL局部缺损75处，分别位于颞上和颞下象限。CirrusHD-OCT和Stratus OCT检测RNFL损害的灵敏度分别是88．O％和69．3％，特异度分别是927％和97．6％。CirrusHD-OCT和Stratus OCT检测RNFL缺损的位置均与眼底彩色照相结果的检测值呈高度正相关（r=0．993、r=0．992，P〈0．01）；二者检测的RNFL缺损宽度与眼底彩色照相结果的检测值呈正相关（r=0．420、r=0．432，P=0．019、P=0．002），CirrusHD-OCT和Stratus OCT检测RNFL缺损宽度与眼底彩色照相的检测值比较差异均无统计学意义（CirrusHD-OCT：P=0．114；Stratus OCT：P：0．074）。CirrusHD-OCT和Stratus-OCT检测RNFL缺损宽度值差异有统计学意义（P：0．002）。结论频域OCT和时域OCT均具有较好的诊断RNFL局部缺损的价值，与眼底彩色照相检测值有较好的一致性。

Pilot study of identifying retinal nerve fiber layer defects with optical coherence tomography

Background Fundus photography is a traditional method for detecting local retinal nerve fiber layer (RNFL) defects,but the evaluation of its result depends on the observer's experience.The spectral domain optical coherence tomography (OCT) exhibit the defects of RNFL very clearly.Objective This study was to evaluate the diagnosis value and correlation between topographic profiles of localized RNFL defects determined by spectral domain and time domain OCT with fundus photography.Methods Forty-one normal eyes of 41 subjects and 55 eyes of 55 glaucomatous patients with localized,wedge-shaped RNFL defects identified by two glaucoma specialists in fundus photographs were enrolled in the clinical study.The angular location and width of RNFL defects determined on the images of fundus photography,Cirrus HD-OCT and Stratus OCT were analyzed respectively using Pearson's correlation coefficient and linear regression analysis.This study followed the Helsinki declaration and was approved by Ethic Committee of Shenzhen Eye Hospital.Written informed consent was obtained from each individual before the clinical examination.Results Seventy-five RNFL defects were identified in 55 eyes by two glaucoma specialists unanimously with the defect position at superior-temporal and inferior-temporal quadrants.The sensitivity of Cirrus HD-OCT and Stratus OCT to determining RNFL defects were 88.0% and 69.3% respectively and their specificities were 92.7% and 97.6% respectively.The angular locations of RNFL defects by Cirrus HD-OCT and Stratus OCT were highly correlated with those by fundus photography(r=0.993,r=0.992,P＜0.001);while the angular widths of RNFL defects by Cirrus HD-OCT and Stratus OCT were moderately correlated with those by fundus photography(r=0.420,r=0.432,P=0.019,P=0.002).No significant differences were found in the defect width of RNFL between Cirrus HD-OCT or Stratus OCT and fundus photography(Cirrus HD-OCT:P=0.114;Stratus OCT:P=0.074),and significant difference was found in that between Cirrus HD-OCT and Stratus OCT(P=0.002).Conclusion Spectral domain OCT and time domain OCT can localize RNFL defects with high sensitivity and specificity.The measure value of Cirrus HD-OCT and Stratus OCT for RNFL defects shows a good diagnostic agreement with fundus photography.