OCT及视野极性分析图检测对早期慢性青光眼诊断价值

THE DIAGNOSTIC VALUE OF OCT AND POLAR ANALYSIS IN EARLY CHRONIC GLAUCOMA

目的 应用光学相干断层扫描技术（OCT）及视野极性分析图，检测慢性青光眼视网膜神经纤维层（RNFL）厚度和视野缺损情况，分析两者的相关性及其在早期慢性青光眼诊断中的价值。方法 采用海德堡Spectralis OCT对42例（62只眼）青光眼（包括15例原发性开角型青光眼和27例慢性闭角型青光眼）病人颞上方、鼻上方、颞侧、鼻侧、颞下方、鼻下方RNFL厚度进行测量，计算RNFL出现缺损的阳性率，OCTOPUS 900全自动视野计进行视野检查，采用极性分析图观察相应区域有无视野缺损，并计算其阳性率。结果 OCT检测早期慢性青光眼病人颞上方、鼻上方、颞侧、鼻侧、颞下方、鼻下方RNFL损伤阳性率分别为54.8%、29.0%、30.6%、29.0%、54.8%、30.6%，其中颞上方和颞下方RNFL缺损的阳性率较高（χ^2=21.96，P〈0.001）；而极性分析图检测各象限视野缺损阳性率分别为96.8%、64.5%、91.9%、30.1%、98.3%、61.2%，颞上方和颞下方阳性率较高（χ^2=28.35，P〈0.001），与OCT检查结果具有较好的一致性，两种检测方法颞上方、鼻上方、颞侧、颞下方及鼻下方阳性率比较差异有显著性（χ^2=14.08～26.10,P〈0.001）。OCT及视野极性分析图均表现出鼻侧阳性率较低，且两者的阳性率相比差异无显著性（P＞0.05）。结论 视野极性分析图检测视野缺损与OCT检测RNFL变化具有较好的一致性,极性分析图是评估与随访青光眼病人RNFL结构与功能的桥梁，可能为临床早期诊断青光眼提供更多的信息。

Objective Using optical coherence tomography （OCT） and the polar analysis of automated perimeter, to determine the thickness of retinal nerve fiber layer （RNFL） and its correlation with visual field defects in chronic glaucoma, and their significance in the diagnosis of early chronic glaucoma （ECG）. Methods Forty-two patients （62 eyes） with glaucoma including 15 POAG and 27 CACG were enrolled. The thickness of RNFL of temporal top, nasal top, temporal, nasal, temporal inferior and nasal inferior was recorded by Heidelberg Spectralis OCT. The visual field of corresponding region was measured by the polar analysis of OCTOPUS 900 automated perimeter. Results The positive rates of RNFL damage, detected by OCT, of temporal top, nasal top, temporal, nasal, temporal inferior and nasal inferior were 54.8%, 29.0%, 30.6%, 29.0%, 54.8% and 30.6%, respectively, of which, the positive rates of RNFL defect of the temporal top and temporal inferior being the higher （χ^2=21.96,P〈0.001）. The polar analysis showed visual field defect in each quadrant was 96.8%,64.5%,91.9%,30.1%,98.3% and 61.2%, respectively and the higher positive rate also occurred at the temporal top and temporal inferior （χ^2=28.35,P〈0.001）, this test method was consistent with OCT, but there were statistically differences on temporal top, nasal top, temporal, temporal inferior and nasal inferior between the two methods （χ^2=14.08-26.10,P〈0.001）. Lower rate of nasal positive detected between the two methods was not statistically different （P〉0.05）.Conclusion The polar analysis of automated perimeter has a better agreement with OCT in detecting the changes of RNFL. Polar analysis can be served as a bridge to assess and follow up RNFL structure and function in patients with glaucoma, and provide more information for early clinical diagnosis of the disease.