原发性慢性闭角型青光眼视网膜神经纤维层损害及相关因素研究

目的 观察原发性慢性闭角型青光眼患者(chronic primary angle closure glaucoma,CACG)活体视网膜神经纤维层(retinal nerve fiberlayer thickness,RNFL)损害;分析CACG不同房角粘连程度间RNFL差异及平均RNFL厚度和视野平均缺损(mean visual fielddefects,MD)的相关性.方法 对CACG患者36例(64只眼)和正常人82名(82只眼)用光学相干断层扫描仪(optical coherence tomography,OCT)测量RNFL厚度,比较两者间的差异;比较CACG中无房角粘连、房角粘连范嗣＜1/2和≥1/2圆周眼的RNFL损害的差异;对CACG平均RNFL与相应视野的MD值进行Pearson直线相关分析.结果 CACG平均RNFL(80.61±23.96)μm与正常人(103.7±9.92)μm比较有统计学差异(P＜0.05);CACG平均RNFL厚度在无房角粘连眼(98.46±12.34)μm、粘连范围＜1/2(93.93±14.78)μm和粘连≥1,2圆周眼(69.78±23.82)μm的RNFL的差异有统计学意义(P＜0.05).CACG平均RNFL厚度与视野缺损(MD值)呈正相关(r=0.652,P＜0.001).结论 CACG的RNFL较正常人明显减少;随着CACG病程的发展,平均RNFL厚度减少,视野平均缺损增加.

Damage of retinal nerve fiber layer in chronic primary angle closure glaucoma

Objective To observe the damage of retinal nerve fiber layer thickness(RNFLT)in chronic primary angle closure glaucoma (CACG)and analyze its effect factors.Method Sixty-four eyes of 36 patients with CACG and 82 eyes of 82 normal subjects were examined by optical coherence tomography(OCT).The RNFLT were compared between patients with CACG and normal persons.The RNFLT were also compared among eyes without peripheral anterior synechiae(PAS) ,PAS extent less then 2 quadrants and PAS more than 2 quadrants in CACG patients.The correlationship between mean RNFLT and MD values of visual field in CACG were analyzed.Result There was significant difference of mean RNFLT between CACG (80.61±23.96)μm and normal controls(103.73±9.92)μ m(P ＜0.05).The differences of RNFLT among CACG eyes without PAS(98.46:1:12.34)μm,PAS extent less then 2 quadrants(93.93±14.78)μm and PAS more than 2 quadrants (69.78±23.82)μm were significant (P ＜0.05).There was positive correlation between average RNFLT of CACG and visual field(MD)(r = 0.652,P ＜0.001).ConclusionThe RNFLT of CACG is significantly thinner than normal controls.The RNFLT decreases and the mean visual field defects increase gradually along with the extension of PAS and progress in CACG.