傅立叶光学相干断层扫描测量黄斑区节细胞复合体和视网膜神经纤维层的可重复性研究

Reproducibility of macular ganglion cell complex and retinal nerve fiber layer thickness measurements using Fourier-domain optical coherence tomography

目的采用傅立叶光学相干断层扫描(OCT)对正常眼压性青光眼(NTG)与原发性开角型青光眼(POAG)患者的黄斑区节细胞复合体(mGCC)和视网膜神经纤维层(RNFL)进行测量,评估其可重复性和诊断能力。方法以NTG患者(NTG组,n=15)、POAG患者(POAG组,n=15)和正常人(正常对照组,n=15)作为研究对象,采用傅立叶OCT测量各组RNFL厚度以及mGCC厚度及其整体丢失体积(GLV)和局部丢失体积(FLV),首先由检查者A测量,重复5次,间隔时间为4 h,检查者B于次日行相同检查。以检查者内和检查者间的类内相关系数(ICC)评估可重复性,受试者工作特征曲线下面积(AROC)分析诊断能力。结果三组mGCC和RNFL测量的ICC均>0.75。NTG组和POAG组的各项测量参数与正常对照组比较差异均有统计学意义(P<0.05);NTG组与POAG组RNFL厚度和FLV%比较差异无统计学意义(P>0.05),而mGCC厚度和GLV%比较差异有统计学意义(P<0.01,P<0.001);RNFL与mGCC参数间的AROC比较差异无统计学意义(P>0.05)。结论对于NTG和POAG患者,傅立叶OCT测量mGCC和RNFL的可重复性好,RNFL具有良好的诊断能力,mGCC可作为良好的补充诊断依据。

Objective To investigate the reproducibility of macular ganglion cell complex（mGCC） and retinal nerve fiber layer（RNFL） thickness measurements using Fourier-domain optical coherence tomography（OCT） in patients with normal tension glaucoma（NTG） and primary open angle glaucoma（POAG）.Methods Normal people（normal control group,n=15）,patients with NTG（NTG group,n=15） and those with POAG（POAG group,n=15） were selected,and Fourier-domain OCT was employed to measure RNFL thickness,mGCC thickness and its general loss of volume（GLV） and focal loss of volume（FLV） in each group.After 5 times of measurements by operator A at 4-h intervals,the same job was done by operator B on the following day.Inner-operator and inter-operator intraclass correlation coefficient（ICC） were adopted to evaluate the reproducibility of measurements,and area under the receiver operator characteristic curve（AROC） was used to analyse the diagnosis performance.Results ICC were 0.75 for mGCC and RNFL thickness measurements.All the measured parameters in NTG group and POAG group were significantly different from those in normal control group（P0.05）.There was no significant difference in RNFL thickness and FLV% between NTG group and POAG group（P0.05）,while there were significant differences in mGCC thickness and GLV% between these two groups（P0.01,P0.001）.There was no significant difference in AROC between RNFL parameters and mGCC parameters（P0.05）.Conclusion The reproducibility of mGCC and RNFL thickness measurements using Fourier-domain OCT in patients with NTG and POAG is favorable.RNFL works well in diagnosis,and mGCC may serve as a good supplement.