高度近视眼视网膜神经纤维层光学相干断层扫描研究

Highly myopic retinal nerve fiber layer optical coherence tomography study

目的:比较正常眼及不同眼底、不同眼轴高度近视眼(HM)视网膜神经纤维层(RNFL)的厚度,以期发现HM的RNFL特点,为HM合并原发性开角性青光眼(POAG)的诊断提供帮助,减少HM-POAG的误诊率。方法:选取正常对照组30例60眼,HM组40例76眼,按眼底改变轻重将HM患者分为Ⅰ、Ⅱ、Ⅲ、Ⅳ4组,并根据眼轴长度分为23～24mm(正常组,60眼)、25～26mm(20眼)、26～27mm(24眼)、27～28mm(18眼)及>28mm(14眼)组,采用光学相干断层扫描(OCT)测定RNFL的厚度,比较正常对照组、HM组RNFL厚度以及HM与眼轴长度、眼底病变的关系。结果:HM患者RN-FL厚度上、下象限及鼻象限、平均值均变薄,与正常对照组相对应的象限相比差异均有统计学意义(P<0.05),颞象限差异无统计学意义(P>0.05);随着眼轴的增长,平均(Avg)RNFL厚度逐渐变薄,眼轴27～28mm组和眼轴>28mm HM组的Avg RNFL与正常对照组相比差异有统计学意义(P<0.05);Ⅰ、Ⅱ、Ⅲ、Ⅳ组的上、下、鼻象限及均值RNFL厚度较正常对照组均有所降低(P<0.05),各组颞象限与正常对照组差异均无统计学意义(P>0.05)。结论:HM的RNFL厚度随眼轴增长和眼底病变的加重而变薄,对HM患者应采用不同的指标结合RNFL厚度下降辅助诊断早期青光眼。

To compare the difference in thickness of retinal nerve tiber layer （RNFL） among person with normal version and patients with high myopia （HM） by optical coherence tomography （OCT） in order to explore the characters of RNFL in patients with HM and diagnose HM-POAG correctly. Methods：Thirty normal controls with normal vision （60 eyes）; and 40 patients with HM （76 eyes） were enrolled in this study. According to the severity of HM, patients were divided into I . II . m, IVgroup, and 23-24 mm group（normal group,60eyes）,25-26 mm group （20 eyes）,26 -27 mm group （24eyes）,27-28 mm group （18eyes） and 28 mm group（14 eyes）according to the length of axisoculi. Thickness of RNFL were determined and compared between the normal controls and HM patients by OCT. Relationship among HM, length of axisoculi and fundus oculi disease. Result. 1. HM patients showed significant smaller average thickness of superior, inferior, nasal quadrant RNFL comparing with the control group （P〈0.05）, Average RNFL thickness significantly decreased as the axisoculi increased, significant difference in the mean Avg thickness was found between the 27-28 mm group and 28 mm group （P〈0.05）. I . Ⅱ. Ⅲ. IV group showed significant smaller superior, inferior, nasal quadrant RNFL comparing with normal controls, but no significant difference in the temple quadrant RNFL was found between patients and the normal controls. Conclusions： Thickness of RNFL decreased as the axisoculi increased. For patients with HM, RNFL should be taken into consideration for screening of glaucoma.