急性闭角型青光眼急性发作早期的视网膜神经纤维层厚度变化特征分析

目的　观察急性闭角型青光眼急性发作早期视网膜神经纤维层厚度的变化特点。方法　收集急性闭角型青光眼单次急性发作患者４５例，在病程２周内采用光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ，ＯＣＴ）测量双眼视网膜神经纤维层（ｒｅｔｉｎａｌｎｅｒｖｅｆｉｂｅｒｌａｙｅｒ，ＲＮＦＬ）厚度，将发作眼与对侧眼的数据进行比较，并分析ＲＮＦＬ厚度与治疗前眼压、高眼压持续时间和年龄的相关性。结果　急性发作眼ＲＮＦＬ厚度为（１１８．８０±３８．４５）μｍ，上方、下方、鼻侧、颞侧分别为（１４８．６７±５８．５９）μｍ、（１５９．８０±５７．８２）μｍ、（８９．６０±３１．３７）μｍ、（７９．４７±２７．５４）μｍ；对侧眼ＲＮＦＬ厚度为（９８．２０±１６．８９）μｍ，上方、下方、鼻侧、颞侧分别为（１２０．１３±２３．６１）μｍ、（１３１．６０±２７．４１）μｍ、（７４．０１±１８．０７）μｍ、（６７．８０±１３．４１）μｍ。急性发作眼比对侧眼的ＲＮＦＬ厚度增加，且发作眼上方、下方、鼻侧和颞侧各个象限的ＲＮＦＬ较对侧眼均增厚，差异均有统计学意义（均为Ｐ＜０．０５）。急性发作眼的ＲＮＦＬ厚度与治疗前眼压呈正相关（ｒ＝０．３７０，Ｐ＜０．０５），与高眼压持续时间呈正相关（ｒ＝０．６０３，Ｐ＜０．０１）；与年龄无关（ｒ＝－０．３１７，Ｐ＞０．０５）。结论　急性闭角型青光眼单次急性发作后，ＲＮＦＬ明显水肿，这种变化可持续到发作后２周，且治疗前眼压越高、高眼压持续时间越长，ＲＮＦＬ水肿越严重。

Characteristics analysis of retinal nerve fiber layer thickness change of acute angle closure glaucoma in early acute episodes

Objective To observe characteristics of retinal nerve fiber layer (RNFL) thickness change in early acute episodes of acute angle closure glaucoma. Methods Forty-five patients with single acute episode of acute angle closure glaucoma were collected,and RNFL thickness was measured by optical coherence tomography (OCT) imaging within 2 weeks after acute attack. The data of the attacked eyes were compared with the fellow eyes. The correlation of RNFL thickness with intraocular pressure before treatment,intraocular pressure duration and age were analyzed. Results The average RNFL thickness of the attacked eye was ( 118. 80 + 38. 45 ) ym,superior was ( 148. 67 + 58. 59) ym ,inferior was ( 159. 80 + 57. 82 ) ym ,nasal was ( 89. 60 + 31. 37 ) ym , and temporal was ( 79. 47 + 27. 54 ) ym. The average RNFL thickness of the fellow eye was (98. 20 + 16. 89) Vm, superior was ( 120. 13 + 23. 61 ) Vm,inferior was ( 131. 60 + 27. 41) Vm,nasal was ( 74. 00 + 18. 07 ) ym, and temporal was ( 67. 8 + 13. 41) Vm. Average RNFL and RNFL of each quadrant ( superior,inferior,nasal and temporal) of the attacked eyes were thicker than those of the fellow eyes,and all these differences were statistically sigruficant ( all P < 0. 05 ) . The average RNFL thickness of the attacked eyes was positively correlated with intraocular pressure before treatment ( r = 0. 370,P < 0. 05 ) and it was also positively correlated with high intraocular pressure duration ( r = 0. 603 ,P < 0. 01). However,it was not correlated with age ( r = 0. 317 ,P > 0. 05 ) . Conclusion After a single acute attack of acute angle closure glaucoma,RNFL edema is obvious ,which can last 2 weeks. In addition,the degree of RNFL edema is aggravated by higher intraocular pressure before treatment and longer duration of high intraocular pressure.