原发性开角型青光眼与慢性原发性闭角型青光眼视网膜神经纤维层厚度与视野缺损的关系

Correlations between retinal nerve fiber layer thickness and visual field defect in primary open-angle glaucoma and chronic primary angle-closure glaucoma

目的探讨原发性开角型青光眼(primary open-angle glaucoma,POAG)和慢性原发性闭角型青光眼(chronic primary angle-closure glaucoma,CPACG)患者频域光学相干断层扫描(optical coherence tomography,OCT)检测的视网膜神经纤维层(reti-nal nerve fiber layer,RNFL)厚度与视野平均缺损(mean defect,MD)的相关性。方法采用RTVue100-2频域OCT和OCTO-PUS101视野计对POAG患者22例(22眼)及CPACG患者22例(22眼)进行检测,将两组患者RNFL厚度及视野MD值进行比较,应用Pearson积矩相关分析法确定RNFL厚度与视野MD值、上方和下方RNFL厚度与相对应半侧视野MD值的相关性。结果 POAG患者RNFL厚度、上方RNFL厚度及下方RNFL厚度分别为(91.19±15.85)μm、(94.93±18.76)μm、(87.82±15.65)μm,CPACG患者相应的RNFL厚度分别为(88.22±13.01)μm、(90.41±14.16)μm、(86.49±16.63)μm,两组患者各RNFL参数的比较差异均无统计学意义(均为P>0.05)。POAG组总MD值、上方半侧视野MD值、下方半侧视野MD值分别为(8.41±6.07)dB、(8.46±5.39)dB、(6.79±6.67)dB,CPACG组相应的MD值分别为(10.69±3.76)dB、(11.17±3.52)dB、(9.71±5.86)dB,两组患者各MD参数比较,差异均无统计学意义(均为P>0.05)。POAG组总RNFL厚度、上方RNFL厚度及下方RNFL厚度与视野相对应区域MD值呈中度负相关(r分别为:-0.574、-0.464、-0.600,均为P<0.05),CPACG组总RNFL厚度、上方RNFL厚度及下方RNFL厚度与视野相应区域MD值呈高度负相关(r分别为-0.819、-0.884、-0.812,均为P=0.000);两组患者RNFL厚度与MD的相关系数和下方RNFL厚度与上方半侧视野MD的相关系数的差异均无统计学意义(P>0.05),两组患者上方RNFL厚度与下方半侧视野MD的相关系数的差异有统计学意义(P<0.05)。结论 POAG患者RNFL厚度与视野MD呈中度负相关,CPACG患者RNFL厚度与视野MD呈高度负相关;相对于POAG患者,CPACG患者上方RNFL厚度与下方半侧视野MD具有更好的相关性。

Objective To explore the correlations between retinal nerve fiber layer（RNFL） thickness and visual field mean defect（MD） measured by spectral domain optical coherence tomography （OCT） in primary open angle glaucoma （ POAG ） and chronic primary angle-closure glaucoma （CPACG）. Methods 22 patients （ 22 eyes） with POAG and 22 patients （22 eyes） with CPACG were examined by RTVuel100-2OCT and OCTOPUS101 visual field analyzer. The RNFL thickness and visual field MD in two groups were compared;Correlations between RNFL thickness and visual field MD, and the superior and inferior RNFL thickness and corresponding visual field MDs were determined by Pearson product moment correlation analysis. Results In POAG group, the RNFL thickness,superior average RNFL thickness and inferior average RNFL thickness were （91.19 ± 15.85 ）μm, （94.93 ± 18.75 ） μm and （ 87.82 ± 15.65 ） μm, respectively;In CPACG group, the corresponding RNFL thickness were （ 88. 22 ± 13. 01 ）μm, （ 90.41 ± 14.15 ） μm and （ 86.49 ± 15.53 ） μm, respectively; Differences of RNFL parameters were no significant between POAG group and CPACG group （all P 〉 0.05 ）. In POAG group, mean defect（ MD）, superior hemi-visual field average MD and infrior henri-visual field average MD were （8.41 ± 5.07 ）dB, （8.45 ± 5.39 ）dB and（ 6.79 ± 6.57 ） dB, respectively ;In CPACG group, the corresponding MD were （ 10.69 ± 3.76 ） dB, （ 11.17 ± 3.52 ） dB and （ 9.71 ± 5.85） dB, respectively; Differences of MD were no significant between POAG group and CPACG group （ all P 〉 0.05 ）. In POAG group,RNFL thickness,superior and inferior average RNFL thickness were moderately negatively correlated with MD in the corresponding visual field（ r = - 0.574, - 0.454, - 0.600, respectively, all P 〈 0.05 ） ; In CPACG group, RNFL thickness, superior and inferior average RNFL thickness were highly negatively correlated with MD in the corresponding visual field（ r = - 0.819, - 0. 884, - 0. 812, respectively, all P = 0.000）. The RNFL thickness and correlation coefficient of MD, and RNFL thickness and superior hemi-visual field correlation coefficient of MD were not significantly different （P 〉 0.05 ） ;RNFL thickness and inferior hemi-visual field average MD were significantly different（ P 〈 0.05 ）. Conclusion RNFL thickness and visual field MD in POAG patients has moderate negative correlations,and RNFL thickness and visual field MD in CPACG patients has high negative correlations;Compared with POAG patients,superior RNFL thickness and inferior hemi-visual field MD in CPACG oatients has better correlations.