青光眼与非炎症性缺血型视神经病变的傅立叶OCT扫描视神经形态学对比

Comparison of optic nerve morphology in glaucoma and non-arteritic ischemic optic neuropathy by fourior optic coherence tomography

目的比较青光眼与非炎症性缺血型视神经病变(non-arteritic ischemic optic neuropathy,NAION)患者患眼的视盘及盘周视网膜神经纤维层(peripapillary retinal nerve fiber layer,pRNFL)参数变化情况及诊断能力。方法选择我院眼科年龄≥40岁就诊患者71例(71眼)。受试者分为青光眼组26例、NAION组15例、对照组30例,排除视野缺损范围大于两个象限或等效球镜度数大于±6D的受试眼以及发病时间小于6个月的NAION患眼。所有患者均接受眼部常规检查,使用傅立叶OCT测量视盘及pRNFL各参数。结果 3组之间除视盘面积外(P=0.059),其余视盘及pRNFL各参数差异均有统计学意义(均为P<0.05)。经LSD两两比较发现:青光眼组的视杯面积(1.438±0.714)mm2最大(均为P<0.05),盘沿面积(0.965±0.652)mm2最小(均为P<0.05),盘沿容积和视神经盘容积[(0.103±0.089)mm3、(0.195±0.168)mm3]最小(均为P<0.05),视杯容积(0.482±0.420)mm3最大(均为P<0.05),杯盘比最大(均为P<0.05);NAION组的视杯面积(0.493±0.344)mm2最小(均为P<0.05),盘沿面积(1.255±0.294)mm2与对照组(1.243±0.509)mm2差异无统计学意义(P>0.05),盘沿容积(0.196±0.094)mm3、视神经盘容积(0.339±0.109)mm3与对照组差异均无统计学意义(均为P>0.05),视杯容积(0.083±0.073)mm3最小(均为P<0.05),杯盘比最小(均为P<0.05)。在pRNFL方面,经LSD两两比较发现:3组在平均值及TU、ST、SN、NU、IT区之间两两比较差异均有统计学意义(均为P<0.05);在NL、IN、TL区,青光眼组与对照组两两比较差异均有统计学意义(均为P<0.05)。将青光眼组与对照组进行AROC分析发现:视盘参数中除视盘面积外(P>0.05),其他参数及所有pRNFL各参数差异均有统计学意义(均为P<0.05)。将NAION组与对照组进行AROC分析发现:pRNFL中的上方(即ST、SN区)、鼻上(即NU区)和下方偏颞侧(即IT区)AROC差异均有统计学意义(均为P<0.05),视盘所有参数及pRNFL其余部位差异均无统计学意义(均为P>0.05)。将NAION组与青光眼组进行AROC分析发现:视盘参数中视杯面积、视杯容积、杯盘比(包括面积、水平和垂直)的AROC差异均有统计学意义(均为P<0.05),而pRNFL中的颞上方(即TU区)、鼻上方(即NU区)和平均值AROC差异均有统计学意义(均为P<0.05),其余部位差异均无统计学意义(均为P>0.05)。结论通过傅立叶OCT检测可发现青光眼与NAION在视盘及pRNFL方面的差异,为理解此两种视神经疾病的发病特点及鉴别诊断提供临床依据。

Objective To compare the changes and diagnostic capabilities of the parameters of optic nerve head（ONH） and peripapillary retinal nerve fiber layer（ pRN- FL） thickness in glaucoma and non-arteritic ischemic optic neuropathy （NAION） by fourior optical coherence tomography （OCT）. Methods A total of 71 patients （71 eyes） whose ages were no less than 40 were selected from the department of ophthal- inology in our hospital. They were divided into glaucoma group （25 cases）, NAION group（15 cases） and normal control group（30 cases）. Eyes with visual field defects more than two quadrants, spherical equivalent refraction more than _± 6 D or NAION with less than six months since occurrence were all excluded. All patients received eye rou- tine examination and parameters of pRNFL and optic disc were measured by Fourier OCT. Results Parameters of pRNFL and optic disc except disc-area（P = 0.059） were significantly different among the three groups（ all P 〈 0.05 ）. Through LSD pairwise com- parison,eyes in glaucoma group had the largest cup area（ 1. 438 ± 0. 714） mm2 （ all P 〈 0. 05）,the smallest rim area（0. 965 _± 0. 652）mm2 （P 〈 0.05 ）, the largest cup volume （0. 482 ±_ 0. 420 ） IlntI^l3 （ all P 〈 0.05 ） and the largest cup/disc ratio （ all P 〈 0.05 ） ; NAION eyes had the smallest cup area （ 0. 493 _± 0. 344 ） inm2 （ all P 〈 0. 05 ）, more rim area （ 1. 255 _± 0.294） mm2 than that in control group （ 1. 243 _± 0. 509 ）mm2 , and there was no significant difference （ P 〉 0. 05 ）, there were not significantly different with control group in rim volume （ 0. 196 ± 0.094 ） mm3 and nerve head-volume （ 0.339 ± 0. 109 ） rnm3 （ both P 〉 0. 05 ）, the smallest cup volume （ 0. 083 ± 0. 073 ） mm3 （ all P 〈 0.05 ） and the smallest cup/disc ratio （P 〈 0.05 ） ;In pRNFL, the mean values were significantlt differ- ent compared in TU, ST, SN, NU and IT zones （ all P 〈 0.05 ）, and there was significantlt different between glaucoma group and normal group when compared in NL, IN and TL zones （ all P 〈 0. 05 ）. The area under receiver operator characteristic curve （ AROC ） of pRNFL parameters, of which anodic （ ST, SN zone ） superior （ NU zone ） and inferior （ IT zone） were significantly different （ all P 〈 0.05 ）, all optic disc parameters and other are- as of pRNFL were not significantly different （ all P 〉 0. 05 ）. The ananlysis of NAION group and glaucoma group by AROC showed that cup area, cup volume mid cup/disc ra- tio（ included area,level and perpendieurity） were significantly different（ all P 〈 0.05 ）, while temporal anodic （ TU zone）, nasal anodic （ NU zone） and mean value were signifi- cantly different （ all P 〈 0.05 ） and other places were not significantly different （ all P 〉 0.05）. Conclusion Fourier OCT detects significant quantitative differences in mor phology of the optic disc and pRNFL thickness between glaucoma and NAION eyes,which might provide a clinical clue in understanding the mobility properties and diagnosis of these two optic nerve injuries.