颈内动脉重度狭窄患者视网膜神经纤维层与神经节细胞复合体的改变

目的探讨颈内动脉狭窄患者视盘周围视网膜神经纤维层(peripapillary retinal nerve fiber layer,p RNFL)、黄斑区神经节细胞复合体(ganglion cell complex,GCC)厚度的改变,RNFL缺损、GCC丢失比例的情况。方法回顾分析2015年7月-2016年7月在首都医科大学附属北京天坛医院诊治的单侧颈内动脉重度狭窄(≥70%)或闭塞患者的病例资料,并纳入经颈动脉超声检查明确颈内动脉无明显狭窄的健康者作为对照组,通过光学相干断层扫描(optical coherence tomography,OCT)检测病例组及对照组双眼p RNFL及GCC厚度、RNFL缺损、GCC丢失比例。比较病例组狭窄同侧眼和对侧眼及对照组右眼的上述数据的差异。结果共入组56例颈内动脉狭窄患者和56例对照组。颈内动脉狭窄同侧眼的p RNFL平均厚度、黄斑区GCC平均厚度(99.44±14.60)μm,(92.61±10.63)μm]较对侧眼(107.01±9.96)μm,(96.48±9.73)μm]均薄(P=0.008,P=0.047);较正常对照组眼的p RNFL平均厚度、黄斑区GCC平均厚度(110.47±6.48)μm,(96.86±5.00)μm]均薄(P=0.001,P=0.013)。狭窄同侧眼出现RNFL缺损、GCC丢失的比例(33.9%,53.6%)较对侧眼(12.5%,26.8%)均显著增高(P=0.007,P=0.004)。结论颈内动脉重度狭窄可导致pR NFL和GCC厚度变薄,通过OCT检查可以更早发现颈内动脉狭窄对眼部血供的影响。

The Change of Retinal Nerve Fiber Layer and Ganglion Cell Complex Thickness

Objective To evaluate the changes of peripapillary retinal nerve ifber layer (pRNFL) and ganglion cell complex (GCC) thickness, RNFL defect and GCC loss rate.
Methods Patients with unilateral severe stenosis (≥70% on angiography) or occlusion of internal carotid artery (ICA) who were diagnosed and treated in Beijing Tiantan Hospital from July, 2015 to July, 2016 were taken as study group and their data were retrospectively studied. Those who had no obvious stenosis by carotid artery ultrasound examination were taken as control group. Thicknesses of pRNFL and GCC and prevalence of RNFL defects and GCC loss measured by optical coherence tomography (OCT) in the eyes ipsilateral to ICA stenosis were compared with the contralateral eyes and with the eyes of control group.
Results Fifty six patients with unilateral severe stenosis of ICA and 56 normal controls were analyzed. Mean thicknesses of pRNFL and GCC in the ipsilateral eyes (99.44±14.60 μm, 92.61±10.63 μm) of study group were significantly thinner than those of the contralateral eyes (107.01±9.96 μm, 96.48±9.73 μm,P=0.008,P=0.047) and the control group (110.47±6.48 μm, 96.86±5.00 μm,P=0.001, P=0.013). A higher prevalence of RNFL defects and GCC loss were found in eyes ipsilateral to ICA (33.9%, 53.6%) compared with contralateral side (12.5%, 26.8%,P=0.007,P=0.004).
Conclusion Thicknesses of pRNFL and GCC decrease in patients with severe stenosis of ICA. RNFL and GCC assessed by OCT may be helpful in early detection of hypoperfusion induced by ICA stenosis.