光学相干断层扫描检测黄斑区厚度及其在青光眼诊断中的应用研究

Measurement of macular thickness with optical coherence tomography and its investigation in glaucomatous eyes

目的 探讨光学相干断层扫描（optical coherence tomography，OCT）测量黄斑厚度对青光眼的诊断价值。方法采用OCT2000型对正常人42例（60）和原发性开角型青光眼患者43例（66眼）的黄斑区厚度进行测量，观察两组人群黄斑厚度地形图的图像特征；并将正常人和青光眼患者黄斑厚度值进行比较；用受试者特征曲线下面积（areaunder the receive operator characteristic curve，AROC）的分析方法找出青光眼早期诊断的最佳指标。结果正常人黄斑厚度地形图呈“马蹄形”，青光眼患者“马蹄形”特征不典型或“马蹄形”特征消失；青光眼患者黄斑各分区视网膜厚度均比正常人减少，差异有统计学意义（P〈0．05）；早期青光眼患者的黄斑外环各分区厚度也较正常人减少，差异也有统计学意义（P〈0．05）；正常人和青光眼患者之间比较，黄斑下方外环区的AROC值最大（早期青光眼患者为0．719；青光眼患者为0．881），表明该指标对青光眼的诊断价值最大。结论OCT测量黄斑厚度是青光眼诊断和早期诊断的新型敏感的有效手段。

Objective To determine the diagnosis of measurement of macular thickness with optical coherence tomography（OCT） in glaucoma. Methods OCT was used to measure the macular thickness in 60 eyes of 42 normal persons and 66 eyes of 43 patients with glaucoma, Observing the image feature of macular thickness mapping in normal persons and glaucoma patients comparing the macular thickness between both groups ,finding the strongest discriminating power parameter for glaucoma detection by area under the receive operator characteristic curve. Results The macular thickness mapping in normal persons was ＂house shoe＂ shaped. Diffuse on lo- cal thinning of macular thickness was shown in glaucoma patients. All macular parameters were statistically significantly different compared with normal subjects and glaucoma（ P 〈 0. 05 ）. Macular outer ring in four quadrants ,total maeular volume were statistically significantly different comparing normal subjects and early glaucoma （ P 〈 0.05 ）. The highest AROC was maeular inferior outer ring between normal persons and glaucoma patients （0. 881 and 0. 719 respectively）. Conclusion Measurement of maeular thickness with OCT is effective in early diagnosis of glaucoma.