三维光学相干断层扫描测量视网膜神经节细胞复合体厚度对原发性开角型青光眼诊断的意义

目的　应用三维光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ，ＯＣＴ）测量原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎａｎｇｌｅｇｌａｕｃｏｍａ，ＰＯＡＧ）患者的黄斑区各部位神经节细胞复合体（ｍａｃｕｌａｒｇａｎｇｌｉｏｎｃｅｌｌｃｏｍｐｌｅｘ，ｍＧＣＣ）厚度，评价其在ＰＯＡＧ诊断中的意义。方法　选取早期ＰＯＡＧ患者３０例（３０眼），中晚期ＰＯＡＧ患者３０例（３０眼），以正常人３０例（３０眼）作为对照，应用Ｔｏｐ-ｃｏｎ３ＤＯＣＴ-２０００测量并记录所有受试者的视盘周围各部位视网膜神经纤维层（ｐｅｒｉｐａｐｉｌｌａｒｙｒｅｔｉｎａｌｎｅｖｅｒｆｉｂｅｒｌａｙｅｒ，ｐＲＮＦＬ）和ｍＧＣＣ［包括黄斑区视网膜神经纤维层（ｍａｃｕｌａｒｒｅｔｉｎａｌｎｅｖｅｒｆｉｂｅｒｌａｙｅｒ，ｍＲＮＦＬ）、黄斑区神经节细胞层＋内丛状层（ｇａｎｇｌｉｏｎｃｅｌｌｌａｙｅｒｗｉｔｈｔｈｅｉｎｎｅｒｐｌｅｘｉｆｏｒｍｌａｙｅｒ，ＧＣＩＰ）、神经节细胞复合体（ｇａｎｇｌｉｏｎｃｅｌｌｃｏｍｐｌｅｘ，ＧＣＣ）］厚度，并对所有数据进行统计分析，应用受试者工作特征曲线下面积（ａｒｅａｕｎｄｅｒｔｈｅｒｅｃｅｉｖｅｒｏｐｅｒａｔｉｎｇｃｈａｒａｃｔｅｒｉｓｔｉｃｃｕｒｖｅ，ＡＵＲＯＣ）评价各参数对ＰＯＡＧ的诊断效力。结果　早期、中晚期ＰＯＡＧ患者各部位的ｐＲＮＦＬ厚度及ｍＧＣＣ厚度值随着青光眼的严重程度逐渐变薄。早期ＰＯＡＧ患者与正常人相比，除了ｍＲＮＦＬ厚度和部分ｐＲＮＦＬ厚度（鼻侧和颞侧）参数差异无统计学意义（均为Ｐ＞０．０５）外，其余的各项参数间差异均有统计学意义（均为Ｐ＜０．０５）。中晚期ＰＯＡＧ患者与正常人相比、早期ＰＯＡＧ患者与中晚期ＰＯＡＧ患者相比，各项参数间差异均有统计学意义（均为Ｐ＜０．０５）。早期ＰＯＡＧ患者ｍＲＮＦＬ、ＧＣＩＰ、ＧＣＣ、ｐＲＮＦＬ平均值的ＡＵＲＯＣ值分别为０．６４１、０．７３１、０．７２４、０．７７５；中晚期为０．９３１、０．８３０、０．９１５、０．９４７。早期ＰＯＡＧ患者ｍＲＮＦＬ、ＧＣＩＰ、ＧＣＣ最小值的ＡＵＲＯＣ值分别为０．６７４、０．７４６、０．７３２，中晚期为０．９４２、０．８４１、０．９２８，均高于其平均值的ＡＵＲＯＣ值。除了鼻侧及颞侧ｐＲＮＦＬ厚度参数外，其余各项参数均能有效地诊断ＰＯＡＧ，差异均有统计学意义（均为Ｐ＜０．０５）。结论　ｍＧＣＣ厚度参数与ｐＲＮＦＬ厚度参数对ＰＯＡＧ的诊断效力相当，可作为ＰＯＡＧ诊断的一个新指标。

Diagnostic performance of macular ganglion cell complex by three-dimension optical coherence tomography in primary open angle glaucoma

Objective To measure the thickness of macular ganglion cell complex ( mGCC) of primary open angle glaucoma( POAG) by three-dimension optical coherence tomography ( 3D OCT) , and evaluate its diagnosibility for POAG. Methods Thirty patients (30eyes) with early POAG and 30 patients ( 30eyes) with moderate-tosevere POAG were recruited as early POAG group and moderate-to-severe POAG group , 30 healthy people( 30eyes) were chosen as control. The thickness of peripapillary retinal never fiber layer ( pRNFL) and mGCC . including macular retinal never fiber layer ( mRNFL) ,ganglion cell layer with the inner plexiform layer ( GCIP) and ganglion cell complex ( GCC) .were measured by 3D OCT( Topcon 3D OCT-2000 ver8. 0) , and the parameters were analyzed statistically. The ability of each parameter to discriminate POAG was assessed by area under receiver operating characteristic curve ( AUROC) . Results The thicknesses of pRNFL and mGCC at all parts gradually decreased as glaucoma degree aggravating. There were significant differences in the thicknesses of pRNFL and mGCC at all part between normal group and early POAG group except for all part mRNFL and nasal , temporal parameters ( all P < 0. 05 ) . All the parameters showed sigruficant differences between moderate-to-severe POAG group and normal group and between the early POAG group and moderate-to-severe POAG group ( all P < 0. 05 ) . The AUROC of mRNFL , GCIP . GCC , pRNFL in average of early POAG group were 0. 641 .0. 73 I ,0. 724 ,0. 775 , respectively , in moderate-tosevere POAG group were 0. 931 ,0. 830 ,0. 915 ,0. 947 , respectively. The AUROC of mRNFL , GCIP, GCC in mirumum of early POAG group were 0. 674 , 0. 746 , 0. 732 , respectively ,in moderate-to-severe POAG group were 0. 942 .0. 841 .0. 928 , respectively ,which were higher than the average. A1l parts of pRNFL and mGCC parameters showed significantly positive diagnostic value for POAG ( all P < 0. 05 ) , except for the nasal and temporal pRNFL. Conclusion As a new diagnostic parameter for POAG .mGCC shows similar diagnostic potential compared with pRNFL.