OCT测量正常人与原发性开角型青光眼视网膜神经纤维层厚度的研究

目的：采用光学相干断层成像术(optical coherence tomography，OCT)测量正常人与原发性开角型青光眼(primary open angle glaucoma，POAG)视网膜神经纤维层(retinal nerve fiber layer，RNFL)厚度，为POAG的诊断提供理论依据。

方法：本组观察对象为2014-11/2017-11于我院就诊的POAG患者100例123眼，设为观察组，选择年龄、性别配对的正常体检人群50例100眼，设为对照组，根据视野平均缺损(mean defect，MD)将POAG患者分为早期组36例44眼、进展期组40例50眼与晚期组24例29眼； 采用OCT测量视盘全周、颞侧、鼻侧、下方、上方平均RNFL厚度，各象限MD采用全自动视野计测量，并进行相关性分析。

结果：观察组视盘全周、颞侧、鼻侧、下方、上方平均RNFL厚度均显著低于对照组，差异具有统计学意义(P<0.001)； 观察组视盘全周、颞侧、鼻侧、下方、上方MD均显著高于对照组，差异具有统计学意义(P<0.001)； 早期组、进展期组与晚期组平均RNFL厚度依次变薄，两两比较差异具有统计学意义(P<0.001)，早期组、进展期组与晚期组MD依次变增加，两两比较差异具有统计学意义(P<0.001)； 视盘全周、颞侧、鼻侧、下方、上方平均RNFL厚度与MD均呈负相关(r=-0.675、-0.667、-0.560、-0.711、-0.660，均P<0.001)。

结论：OCT检查显示POAG患者RNFL厚度较正常人群明显变薄，且随着病情进展RNFL厚度越薄，且与患眼MD有密切联系。

Measurement of RNFL thickness in the normals and open angle glaucoma patients by OCT

AIM: To investigate the retinal nerve fiber layer thickness(RNFL)in normal subjects and primary open angle glaucoma(POAG)patients by optical coherence tomography(OCT), and to provide a theoretical basis for the diagnosis of POAG.

METHODS: Totally 100 patients(123 eyes)with POAG treated in our hospital from November 2014 to November 2017 were selected as the observation group, and 50 cases(100 eyes)matched with age and sex were selected as the control group. Patients with POAG were divided into the early group(36 cases, 44 eyes), the advanced group(40 cases, 50 eyes)and the late group(24 cases, 29 eyes)according to the mean defect(MD). The average RNFL and the MD of the whole visual field, temporal visual field, nasal visual field, inferior visual field, and upper visual field were measured by OCT and automatic perimetry respectively, then their corrections were analyzed.

RESULTS: The average RNFL of the whole visual field, temporal visual field, nasal visual field, inferior visual field, and superior visual field of the observation group were significantly lower than those of the control group, the difference was statistically significant(P<0.001). The MD of the whole visual field, temporal visual field, nasal visual field, inferior visual field, and superior visual field of the observation group were significantly higher than those of the control group, with a statistically significant difference(P<0.001). The mean RNFL of the early group, the advanced group and the late group were thinned successively, paired comparison showed a statistically significant difference(P<0.001). The MD of the early group, the advanced group and the late group increased successively, paired comparison showed a statistically significant difference(P<0.001). The average RNFL of the whole visual field, temporal visual field, nasal visual field, inferior visual field, and superior visual field were negatively correlated with those fields of the MD(r=-0.675, -0.667,-0.560, -0.711, -0.660; all P<0.001).

CONCLUSION: OCT examination shows that the RNFL of POAG patients is thinner than that of the normal people, and the RNFL becomes thinner with the progression of the disease. And it has a close relationship with MD.