急性闭角型青光眼视网膜神经纤维层改变的一年动态观察

目的观察急性闭角型青光眼视网膜神经纤维层（RNFL）厚度在发病后不同时间段的变化特征。设计前瞻性病例系列。研究对象2007—2009年就诊的急性闭角型青光眼单眼发病者35例35眼。方法人选患者经过临床治疗后眼压控制正常，利用相干光断层扫描（StratusOCT3）技术在发病后2周、3个月、6个月和12个月进行双眼RNFL扫描，并对发作眼压与RNFL厚度进行相关性分析。主要指标RNFL厚度。结果发作后2周发作眼RNFL明显较对侧眼增厚，分别为（141．85±25．22）μm、（112．95±10．54）μm（P=-0．000）；第3个月时两眼没有差异，RNFL厚度分别为（112．38±16．15）μm、（112．26±16．04）μm（P=0．966）；6个月时发作眼较对侧眼稍薄，分别为（101．22±14．06）μm、（108．65±15．03）μm（p=0．021）；12个月时发作眼明显较对侧眼薄，分别为（92．29±13．05）um、（106．77±14．90）μm（P=0．000）。发作眼在观察期内RNFL进行性变薄（阽51．48，P=0．000），而对侧眼则无显著改变（F=1．599，P=0．192）。早期（3个月内）眼压越高，RNFL越厚（r=0．692，P=-0．000），但在12个月RNFL的变化中，发作眼压与之无显著相关（r=0．242，P=0．081）。结论急性闭角型青光眼发作眼缓解后RNFL仍进行性丢失，发作时眼压的高低并不是决定最终病变的惟一因素；对侧眼在12个月的观察中也存在一定程度RNFL损害，其临床意义有待进一步研究。

One year dynamic changes of retinal nerve fibre layer thickness after acute attack in primary angle closure glaucoma

Objective To detect the dynamic changes of retinal nerve fibre layer （RNFL） thickness in different period after attack of primary acute angle closure glaucoma （PAACG）. Design Prospective case series. Participants 35 eyes （35 cases） with first attack of diagnosed PAACG in Department of Ophthalmology of Xuanwu Hospital, were enrolled from 2007-2009. Methods 35 patients with uni- lateral attack of PAACG who had all resolved after initial treatment were enrolled. Using Stratus OCT3, RNFL changes in both eyes were scanned by the time of two weeks, 3 months, 6 months and 12 months after the first attack. Differences between affected eyes and fellow eyes for the mean RNFL thickness at various periods were compared. Correlation between RNFL thickness and attacking intraocular pressure （IOP） was also analyzed. Main Outcome Measures Retinal nerve fibre layer thickness. Results The average thickness of RNFL in affected eyes after two weeks was significantly thicker than that in fellow eyes： （141.85±25.22） μm vs.（112.95±10.54）μm （P= 0.000）. After 3 months, the difference was no longer significant （112.38±16.15）μm, vs. （112.26±16.04）μm （P=0.966）. The average thickness of RNFL in affected eyes was significantly thinner than in the fellow eyes （101.22±14.06）μm vs. （108.65±15.03）μm （P=0.021） at the end of 6 months, and after 12 months （92.29±13.05）μm vs. （106.77±14.90） μm （P=0.000）. RNFL thickness was thinning gradually in affected eyes （F=51.48, P=0.000） than that in fellow eyes （F=1.599, P=0.192） during one year observation. The higher the attacking IOP, the thicker the RNFL would be within 3 months （r=0.692, P=0.000）. However, no association was demonstrated between the final RNFL thinning and the attacking lOP （r=0.242, P=0.081） after 12 months. Conclusions RNFL thickness was found to be thinning after long period of acute attack in PAACG with controlled IOP. Attacking IOP was not the only important factor which resulted in damage of RNFL in affected eyes. RNFL thickness in fellow eyes was also found to change without significance. The clinical significance needs further studies.