频域光学相干断层扫描（OCT）测量视盘参数及视网膜厚度在早期青光眼诊断中的作用

目的　探讨频域光学相干断层扫描（optical coherence tomography，OCT）测量视盘参数及视网膜厚度在早期青光眼诊断中的作用。方法　采用频域OCT测量40例（40眼）健康志愿者（对照组）和85例（85眼）原发性开角型青光眼（primary open angle glaucoma，POAG）患者［早期青光眼亚组（n=36）和进展期青光眼亚组（n=49）］视盘参数及视网膜神经纤维层（retinal nerve fiber layer，RNFL）厚度，比较各组RNFL厚度、视盘参数并与视野平均缺损（mean deviation，MD）值进行相关性分析，采用ROC曲线下面积评估视盘周围区RNFL厚度及视盘参数在青光眼中的诊断效果。结果　POAG组患者颞侧、上方、鼻侧及下方象限RNFL厚度和全周RNFL厚度均显著低于对照组（均为P<0.05），且与早期青光眼组比较，进展期青光眼组患者颞侧、上方、鼻侧及下方象限RNFL厚度和全周RNFL厚度均显著降低（均为P<0.05）。各组除视盘面积外，其他视盘参数比较差异均具有统计学意义（均为P<0.05）。Pearson相关性分析显示，POAG组患者视盘颞侧、上方、下方象限RNFL厚度及全周RNFL厚度与MD均呈负相关（均为P<0.05），而视盘参数中视杯容积和视杯/视盘面积比与MD均呈正相关（均为 P<0.05），盘缘面积、盘缘容积和视盘容积与MD均呈负相关（均为P<0.05）。经ROC曲线分析显示，视盘周围区下方象限RNFL厚度的曲线下面积最大为0.886，其特异度和敏感度分别为0.775和0.924；视盘参数中视杯/视盘面积比曲线下面积最大，其特异度和敏感度分别为0.741和0.815。结论　OCT检测视盘结构和RNFL厚度能够用于青光眼早期诊断，且具有较高敏感度和特异度。

Role of the optic disc parameters and retinal thickness measured by frequency domain OCT in early glaucoma diagnosis

Objective　To explore the roles of frequency domain OCT in measuring the retinal thickness around the optic disc and optic disc parameters in early glaucoma diagnosis.Methods　The optic disc parameters and retinal nerve fiber layer （RNFL） thickness in the 40 healthy volunteers （control group） and 85 cases of primary open angle glaucoma （POAG），including 36 patients as the early glaucoma subgroup and 49 patients as the glaucoma evolutum subgroup，were measured by frequency domain OCT.Then，the correlation analysis of RNFL thickness，optic disc parameters and the mean deviation （MD） of visual field in each group was performed，and the area under the curve was used to evaluate the diagnostic efficiency of RNFL thickness around the optic disc and optic disc parameters in the diagnosis of glaucoma.Results　The RNFL thickness and the complete cycle mean RNFL thickness in the temporal，upper，nasal and inferior quadrant in the glaucoma patients were significantly lower than those in the controls （all P<0.05），and the above indexes in the glaucoma evolutum subgroup were significantly decreased compared with those in the early glaucoma subgroup （all P<0.05）.There were statistically significant differences in the optic disc parameters between the groups except the optic disc area （all P<0.05）.Pearson correlation analysis showed the RNFL thickness and the complete cycle mean RNFL thickness in the temporal，upper and inferior quadrant were negatively correlated with the MD in the glaucoma patients （all P<0.05），and the parameter of optic cup volume and cup/disc area ratio were positively correlated with the MD （both P<0.05），and the rim area，rim volume and disc volume were negatively correlated with MD （all P<0.05）.The ROC curve analysis showed that the largest area under the curve of RNFL thickness in the inferior quadrant of the optic disc region was 0.886，and the specificity and sensitivity was 0.775 and 0.924，respectively.Moreover，the area under the curve of the optic cup/optic disc area was the largest，with sensitivity and specificity of 0.741 and 0.815，respectively.Conclusion　OCT for measuring optic disc structure and RNFL thickness can be used for early diagnosis of glaucoma，and it has a high sensitivity and specificity.