视盘分级法评估原发性慢性闭角型青光眼视神经损害与OCT视神经纤维检查的相关性

Relationship of disc damage likelihood scale nomogram and optical coherence tomogram for primary chronic angle-closure glaucoma:report of 73 eyes

目的用视盘损害分级(disc damage likelihood scale,DDLS)方法评估原发性慢性闭角型青光眼(primarychronic angle-closure glaucoma,PCACG)视神经损害,探讨其与光学断层相干扫描仪(optical coherence tomography,OCT)检测视神经纤维厚度参数的相关性。方法收集2009年10月至2010年8月我院眼科PCACG患者共38例(73眼),通过双面Volk 90D前置镜在裂隙灯下对视盘直径及其盘沿最窄处宽度测量,按DDLS分级标准进行分级;Stratus OCT 3000成像仪、RNFL3.4程序获取象限位、钟点位及自选参数的视网膜神经纤维(retina nerve fiber layer,RNFL)厚度。运用SPSS15.0统计软件分析DDLS分级与OCT视盘周围3.4 mm处RNFL检测参数的相关性。结果共38例(73眼)中大直径视盘17眼(占23.3%),中等直径视盘41眼(占56.2%),小直径视盘15眼(占20.6%);上方、下方、颞侧象限RNFL厚度均值与DDLS分级评分相关(r=-0.673,P=0.0001;r=-0.605,P=0.0001,r=-0.499,P=0.0014),鼻侧方象限RNFL厚度均值与DDLS分级评分不相关(r=-0.352,P=0.0602);11、7、6、10、12钟点位RNFL厚度与DDLS分级评分具有相关性(r=-0.673,P=0.0001;r=-0.605,P=0.0001;r=-0.531,P=0.0006;r=-0.525,P=0.0007;r=-0.520,P=0.0008),而3、2、8点位无统计学意义(r=-0.320,P=0.0501;r=-0.320,P=0.0510;r=-0.297,P=0.0702);DDLS分级评分与OCT检查自选参数Avg、Smax、Imax的RNFL厚度也呈中度相关(r=-0.582,P=0.0001;r=-0.504,P=0.0012;r=-0.478,P=0.0024)。结论 DDLS分级方法对PCACG视神经损害的评估与OCT视网膜神经纤维厚度主要检查参数检查具有相关性,DDLS分级方法适用于PCACG视神经损害的评估。

Objective To evaluate relationships between the results of disc damage likelihood scale（DDLS） and the parameters of optical coherence tomography（OCT） for primary chronic angle-closure glaucoma.Methods Thirty-eight primary chronic angle-closure glaucoma patients（73 eyes） who admited in our department from October 2009 to August 2010 were enrolled in this study.Their DDLS score was assessed with a 90-diopters（D） Volk len under slit lamp for disc diameter and narrowest rim width,and then the eyes were graded according to the results of DDLS nomography.Retina nerve fiber layer（RNFL） thickness at different quadrants and clock positions and other parameters was tested by Stratus OCT 3 000 with RNFL3.4 program.The relationships of clinical DDLS score with OCT parameters were analyzed by correlation coefficients analysis.Results There were 17 eyes（23.3%） with large-diameter disc,41 eyes（56.2%） with moderate-diameter disc,and 15 eyes（20.6%） with small-diameter disc.Significant correlations were found between the DDLS scores and the RNFL thicknesses at superior,inferior and temporal quadrants（r=-0.673,P=0.000 1;r=-0.605,P=0.000 1;r=-0.499 P=0.001 4）.But no correlation was seen between the score with the thickness at nasal quadrant（r=-0.352,P=0.060 2）.There were significant correlations between the score with the thicknesses at 11,7,6,10 and 12 o＇clock positions（r=-0.673,P=0.000 1;r=-0.605,P=0.000 1;r=-0.531,P=0.000 6;r=-0.525,P=0.000 7;r=-0.520,P=0.000 8）,but not with those at 3,2 and 8 o＇clock positions（r=-0.320,P=0.050 1;r=-0.320,P=0.051 0;r=-0.297,P=0.070 2）.The thicknesses at Avg,Smax and Imax parameters were also correlated with the score（r=-0.582,P=0.000 1;r=-0.504,P=0.001 2;r=-0.478,P=0.002 4）.Conclusion Clinical DDLS assessment on optic nerve damage has a correlation with OCT parameters on RNFL thickness.DDLS is a useful method to evaluate the optic neuropathy of primary chronic angle-closure glaucoma.