光学相干断层成像术对近视眼视网膜神经纤维层厚度的临床研究

目的研究人视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度随近视屈光度变化的特点及对开角型青光眼早期诊断的意义。方法选择2011年7月²013年6月62例(106眼)近视眼患者,分为低、中、高度3组和对照组25例33眼,用光学相干断层成像术(optical coherence tomography,OCT)进行视网膜神经纤维层厚度测量,研究近视眼平均视网膜神经纤维层厚度与屈光度的相关性,并比较各近视组与正常组神经纤维层厚度的差别,及鼻、上、颞、下4个象限的分区视网膜神经纤维层厚度的特点。计量资料用采用t检验。近视眼平均神经纤维层厚度与屈光度之间关系采用直线相关分析,P<0.05为差异有统计学意义。结果低、中、高度近视组平均RNFL厚度测量值分别为(116.52±9.60)、(116.96±7.89)、(102.13±12.54)μm,对照组平均RNFL厚度测量值为(109.45±8.29)μm。高度近视组平均RNFL厚度与对照组相比差异有统计学意义(P<0.05)。近视眼平均神经纤维层厚度与屈光度成负相关关系(r=-0.534,P<0.05)。低度近视组只有鼻侧RNFL厚度与正常组相比差异有统计学意义(P<0.05);中度近视组鼻侧RNFL厚度与正常组比较差异有统计学意义(P<0.05),而且下方也有差异有统计学意义(P<0.05);高度近视组上方、下方及鼻侧RNFL厚度均变薄,与正常组相比差异有统计学意义(P<0.05),高度近视组上方、下方和鼻侧RNFL厚度分别与中度近视组相比差异有统计学意义(P<0.05)。结论近视眼平均RNFL厚度随屈光度的增加而减少,分区分析可以发现:除颞侧外,上、下及鼻侧视网膜神经纤维层变化与平均相一致。对近视眼患者应采用不同的指标结合RNFL厚度下降辅助诊断早期青光眼。

Characteristics of optical coherence tomography on thickness of retinal nerve fiberlayer in myopia

Objective To study the characteristics and clinical significance of retinal nerve fiber layer （RNFL） thickness along with increase of myopia degree and diagnose glaucoma correcely . Methods According to the myopia degree, 139 eyes were divided into four groups as normal, slight, medium and high myopic group. Optical coherence tom ography （OCT） was used to measure the RNFL thickness. The correlation between the thickness of the mean RNFL and refraction were calculated. The mean and different quadrants RNFL thickness in different groups was analyzed. Results The mean RNFL thickness in four groups as normal, slight, medium and high myopic group was （ 109.45±8.29）μm ,（ 116.52±9. 60） ,（ 116.96±7.89） ,（ 102.13 ±12.54） μm. Compared with normal groups,the mean RNFL thickness values in the high myopic groups were thinner. There was signifiant inverse linear correlation between the thickness of the mean RNFL and re- fraction . Compared with normal groups, RNFL thickness values in slight myopic groups were significantly thinner in nasal quadrant. Compared with normal groups, RNFL thickness values in medium myopic groups were significantly thinner in na- sal and linferior. Compared with the normal group and medium myopic group , RNFL thickness values in high myopic groups were significantly thinner in nasa,linferior and superior quadrant. Conclusions The mean RNFL thickness in myo- pia groups decreases with refraction. Apart from temporal quadrant, the thickness of RNFL in other quadrants decrease with refraction. For patients with myopic , RNFL should be taken into consideration for scrwwning of glaucoma.