POAG患者视网膜各层厚度的OCT分析

Layer-by-layer analysis of retinal thickness in primary open-angle glaucoma using optical coherence tomography

目的 利用RTVue OCT对POAG患者黄斑区视网膜各层厚度进行分析,尤其是视神经节细胞层,探讨其在原发性开角型青光眼诊断中的价值.方法 前瞻性对照研究.临床诊断为POAG的病例76例（91眼）纳入本研究,分为早期30例（30眼）,中期25例（29眼）,晚期21例（32眼）;选择32例（32眼）年龄、性别构成相匹配的健康体检者作为正常对照组.采用RTVue OCT对受检眼黄斑区视网膜进行扫描,用自编程序图像处理软件将视网膜结构分为9层,早、中、晚期POAG与正常对照组黄斑区视网膜各层厚度比较采用LSD-t检验.结果 早期POAG组视网膜神经纤维层（RNFL）、节细胞层（GCL）平均厚度分别为（31.6±9.2）μm、（33.9±5.0）μm,较对照组薄（P＜0.05）,中期POAG组RNFL、GCL平均厚度分别为（31.2±3.4）μm、（34.1±3.9）μm,较正常组薄（P＜0.05）;晚期POAG组RNFL、GCL、内丛状层（IPL）、锥杆细胞内节（IS）、全视网膜（TR）平均厚度分别为（18.8±7.6）μm、（24.2±7.9） μm、（38.0±6.4） μm、（22.8±4.4）μm、（299.5±15.1）μm,均较正常组薄（均P＜0.05）;INL平均厚度（39.1±6.6）μm,较正常组厚（P＜0.05）.结论 POAG患者黄斑区视网膜厚度明显变薄,早期POAG对GCL的影响尤为突出,结合临床有助于POAG的早期诊断.

Objective To analysis each layer of retinal thickness,especially the ganglion cell layer （GCL） in the macular area,in patients with primary open-angle glaucoma （POAG） using an RTVue OCT; to assess its value in the diagnosis of glaucoma.Methods In this prospective case-control study,76 patients （91 eyes） with POAG （30 patients [30 eyes] in the early stage,25 patients [29 eyes] in the middle stage and 21 patients [32 eyes] in late stage） and 32 healthy age-and gender-matched controls （32 eyes） were recruited.The macular area was scanned with an RTVue OCT,and the retina was divided into nine layers with self-programming retinal image processing software.The thickness of each layer and the total retinal thickness were calculated and an LSD-t test was used to compare the average thickness of the macular area in each retinal layer for early,middle and late POAG patients and the control group.Results In the early stage of POAG,the mean thicknesses of the retinal nerve fiber layer （RNFL） and ganglion cell layer （GCL） were 31.6±9.2 μm and 33.9±5.0 μm,respectively,becoming thinner （P＜0.05） than healthy controls.In the middle stage,the mean thicknesses of the RNFL and GCL were 31.2±3.4 μm and 34.1±3.9 μm,respectively,which was thinner than the control group （P＜0.05）.In the late stage,the mean thicknesses of the RNFL,GCL,inner plexiform layer （IPL）,inner segment of the photoreceptor （IS）,and total retina （TR） were 18.8±7.6 μm,24.2±7.9 μm,38.0±6.4 μm,22.8±4.4 μm and 299.5±15.1 μm,respectively,and all measurements were thinner than the controls （P＜0.05）.The mean thickness of the inner nuclear layer （INL） was 39.1±6.6 μm,which was thicker than the controls （P＜0.05）.Conclusion The mean thickness of the retinal macular area of POAG patients became obviously thinner.The GCL was especially affected by early POAG.GCL combined with clinical observations can be used as an early diagnostic indicator of POAG.