早期青光眼不同类型视盘视网膜神经纤维层厚度分析

目的　探讨早期青光眼患者不同类型视盘的视网膜神经纤维层（ｒｅｔｉｎａｌｎｅｒｖｅｆｉｂｅｒｌａｙｅｒ，ＲＮＦＬ）厚度，以了解不同类型视盘的早期青光眼患者的ＲＮＦＬ厚度的特点。方法　应用光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ，ＯＣＴ）技术检查视盘ＲＮ-ＦＬ厚度，将收集到的ＯＣＴ视盘检查结果分为６组:对照组大视盘组、中视盘组、小视盘组，每组各２０眼，早期青光眼大视盘组、中视盘组、小视盘组各２０眼。ＯＣＴ测量１２０眼各钟点平均ＲＮＦＬ厚度。检测对照组和早期青光眼患者１２个钟位的视盘ＲＮＦＬ厚度。结果　对照组不同类型视盘组的ＲＮＦＬ厚度曲线均在下方和上方形成双峰，在鼻侧和颞侧形成波谷，各组下方峰均高于上方峰。其中大视盘组患者ＲＮＦＬ厚度（１０５．６０±５．８７）μｍ，其次是中视盘组（１０７．０５±７．２９）μｍ和小视盘组（１０８．４０±７．２７）μｍ。对照组大、中、小视盘组的ＲＮＦＬ厚度差异无统计学意义（Ｐ＞０．０５）。早期青光眼ＲＮＦＬ厚度曲线的上或下方峰值降低，但仍然具备上、下方的双峰特征，各组的下方峰皆高于上方峰。其中大视盘组患者ＲＮＦＬ厚度最薄（７０．２５±１４．７１）μｍ，其次是中视盘组（８５. ５５±１５．３９）μｍ和小视盘组（８７．５５±９．４６）μｍ，大视盘组与中视盘组、小视盘组的视盘ＲＮＦＬ厚度的差异有统计学意义（均为Ｐ＜０．０５），中视盘组与小视盘组的ＲＮＦＬ厚度差异无统计学意义（Ｐ＞０．０５）。早期青光眼患者与对照组不同类型视盘的ＲＮＦＬ均为厚度差异均有统计学意义（均为Ｐ＜０．０５）。结论　对照组不同大小的视盘并不影响ＲＮＦＬ厚度，早期青光眼患者视盘的ＲＮＦＬ厚度明显变薄，但仍然具备上、下方的双峰特征，各组的下方峰皆高于上方峰，其中大视盘患者的ＲＮＦＬ比中、小视盘受损更严重。

Analysis of retinal nerve fiber layer thickness for different types of optic disc in early glaucoma

Objective To investigate the peripapillary retinal nerve fiber layer ( RNFL) thickness with optical coherence tomography( OCT) for different types of optic disc in normal eyes and early glaucoma to understand the characteristics of RNFL thickness in normal eyes and early glaucoma. Methods The RNFL thickness was measured by optical coherence tomography ( OCT) .based on the OCT measurements , the subjects were divided into six groups : physiologic large disc group , physiologic normal size disc group,physiologic small disc group, early glaucoma large disc group, early glaucoma normal size disc group , early glaucoma small disc group ,20 eyes in each group. The RNFL thickness at 12 0 ’ clock position position of all patients was measured and compared. Results The RNFL characteristic of curve in normal eyes was that there were double humps in inferior and superior section . double valley in nasal and temporal section. The RNFL thickness in physiologic large disc group was ( 105 . 60 + 5 . 87 ) Vm , physiologic normal size disc group was ( 107. 05 +7. 29) ym , physiologic small disc group was ( 108. 40 +7. 27) ym , no significant difference was found among different disc in normal eyes(P > 0. 05 ) . The loss of double humps of inferior and superior section was at the curve of RNFL thickness in early glaucoma ,the RNFL thickness in early glaucoma large disc group was ( 70. 25 + 14. 71) ym, early glaucoma normal size disc group was ( 85. 55 + 15. 39) ym, early glaucoma small disc group was(87. 55 + 9. 46) ym. Compared with normal size and small disc.the RNFL thickness was significantly decreased in early glaucoma of large disc ( all P < 0. 05 ) . No significant difference of average RNFL thickness was found in early glaucoma with normal size disc and small disc(P > 0. 05 ) . The average RNFL thickness was significant difference between large size disc and normal size disc, small disc in early glaucoma( P < 0. 05 ) . The average RNFL thickness was sigruficant difference among different disc in early glaucoma and normal eyes( all P < 0. 05 ) . Conclusion Different disc does not affect the RNFL thickness in normal eyes , early glaucoma optic disk RNFL thickness is significantly thinner than the normal eyes ,but still has the characteristics of double humps in inferior and superior section. Compared with normal size and small disc , the RNFL thickness is significantly decreased in early glaucoma of large disc.