原发性慢性闭角型青光眼黄斑区结构损害的定量研究及相关分析

目的　探讨慢性原发性闭角型青光眼（ｃｈｒｏｎｉｃｐｒｉｍａｒｙａｎｇｌｅ-ｃｌｏｓｕｒｅｇｌａｕｃｏｍａ，ＣＰＡＣＧ）患者黄斑区神经节细胞复合体（ｍａｃｕｌａｒｇａｎｇｌｉｏｎｃｅｌｌｃｏｍｐｌｅｘ，ｍＧＣＣ）厚度变化及与视网膜神经纤维层（ｒｅｔｉｎａｌｎｅｒｖｅｆｉｂｅｒｌａｙｅｒ，ＲＮＦＬ）厚度的相关性。方法　采用ＲＴＶｕｅ１００-２ＯＣＴ检测ＣＰＡＣＧ患者５５例（５５眼）早期、中期及晚期与正常人３０例（３０眼）平均、上方、下方ｍＧＣＣ厚度及平均、上方、下方ＲＮＦＬ厚度，比较组间各检测指标的差异，分析ｍＧＣＣ厚度与ＲＮＦＬ厚度的相关性。结果　早期ＣＰＡＣＧ组、中期ＣＰＡＣＧ组、晚期ＣＰＡＣＧ组平均、上方、下方ｍＧＣＣ厚度值分别为（９５．１５±８．２１）μｍ、（９６．１１±７．７７）μｍ、（９５．０５±９．９４）μｍ，（７６．０４±８．５８）μｍ、（８３．０４±８．７２）μｍ、（７４．１７±９．７１）μｍ，（６４．４０±１０．１３）μｍ、（６８．８３±１３．２６）μｍ、（６３．３４±１２．６１）μｍ。早期ＣＰＡＣＧ组、中期ＣＰＡＣＧ组、晚期ＣＰＡＣＧ组各ＲＮＦＬ及ｍＧＣＣ厚度值均较正常对照组降低，差异均有统计学意义（均为Ｐ＜０．０５）；随着青光眼病情的进展，ＲＮＦＬ厚度及ｍＧＣＣ厚度逐渐变薄，中期ＣＰＡＣＧ组各ＲＮＦＬ及ｍＧＣＣ厚度值均较早期ＣＰＡＣＧ组降低，差异均有统计学意义（均为Ｐ＜０．０５），晚期ＣＰＡＣＧ组各ＲＮＦＬ及ｍＧＣＣ厚度值均较中期ＣＰＡＣＧ组降低，差异均有统计学意义（均为Ｐ＜０．０５）。ＣＰＡＣＧ患者平均ｍＧＣＣ厚度和平均ＲＮＦＬ厚度、上方ｍＧＣＣ厚度和上方ＲＮＦＬ厚度、下方ｍＧＣＣ厚度和下方ＲＮＦＬ厚度均呈高度正相关（ｒ＝０．９８７、０．９７６、０．９７１，均为Ｐ＝０．０００）。结论　频域ＯＣＴ检测的ＣＰＡＣＧ患者的ｍＧＣＣ厚度随青光眼病情的进展逐渐变薄，与ＲＮＦＬ厚度有良好的相关性。

Quantitative study of macular structural damage in primary chronic angle-closure glaucoma and correlation analysis

Objective To explore the changes of macular ganglion cell complex ( mGCC) thickness in chronic primary angle-closure glaucoma( CPACG) and its correlation with retinal nerve fiber layer ( RNFL) thickness. Methods Fivty-five CPACG patients(55 eyes) at early , moderate and advanced stages , and 30 normal cases ( 30 eyes) were enrolled in the study. The average, superior and inferior mGCC and RNFL thickness were measured by RTVI00-2 0CT and compared among groups. The correlation between mGCC thickness and RNFL thickness was analyzed. ReSHlts The average mGCC thickness in the early , moderate and advanced CPACG group were ( 95 . 15 + 8. 21 ) ym , ( 96. 11 + 7. 77 ) ym , ( 95. 05 + 9. 94 ) ym , respectively , the superior were ( 76. 04 + 8. 58) ym, ( 83. 04 + 8. 72 ) ym, ( 74. 17 + 9. 71 ) ym, respectively, the inferior were ( 64. 40 + 10. 13) Vm , ( 68. 83 + 13. 26 ) ym , ( 63. 34 + 12. 61 ) ym , respectively. The measurement values of mGCC and RNFL thickness in the early, moderate and advanced CPACG group were significantly lower than those in the normal control group ( all P < 0. 05 ) ; With the progression of glaucoma . the mGCC thickness and RNFL thickness gradually reduced ,the measurement values of mGCC and RNFL thickness in the moderate CPACG group were significantly lower than those in the early CPACG group( all P < 0. 05 ) ,the measurement values of mGCC and RNFL thickness in the advanced CPACG group were significantly lower than those in the moderate CPACG group ( all P < 0. 05 ) . Average mGCC and RNFL thickness , superior mGCC and RNFL thickness .inferior mGCC thickness and inferior RNFL thickness showed a high positive correlation( r = 0. 987 .0. 976 ,0. 971 . all P < 0. 05 ) . Conclusion mGCC thickness detected by frequency domain OCT in CPACG patients gradually decrease with the progression of glaucoma,there is a good correlation with RNFL thickness.