恶性青光眼黄斑及视盘周围脉络膜厚度观察

Choroidal thickness of macular and peripapillary area in malignant glaucoma

目的 观察恶性青光眼（MG）患眼黄斑、视盘周围脉络膜厚度,探讨脉络膜厚度与MG发病的相关性.方法 系列病例研究.检查确诊的MG患者16例32只眼（MG组）、原发性慢性闭角型青光眼（CPACG） 31例31只眼（CPACG组）纳入研究.其中,MG组中又分为MG患眼与对侧非MG患眼进行观察.选取同期健康体检者32名32只眼作为正常对照组.采用光相干断层扫描增强深部技术测量黄斑中心凹和距黄斑中心凹1、3 mm处以及视盘周围的脉络膜厚度.测量经0°和90°黄斑中心凹扫描脉络膜厚度并取其平均值;取距黄斑中心凹1、3 mm处的颞侧、上方、鼻侧、下方脉络膜厚度平均值作为相应部位的脉络膜厚度值.取视盘周围颞侧、上方、鼻侧、下方脉络膜厚度平均值作为视盘周围平均脉络膜厚度.比较MG组、CPACG组、正常对照组及MG组中MG患眼与对侧非MG患眼间脉络膜厚度差异.结果 校正年龄因素后,MG组黄斑中心凹,距黄斑中心凹1、3 mm平均脉络膜厚度均较CPACG组、正常对照组增厚,差异有统计学意义（P=＜0.001-0.021）;CPACG组黄斑中心凹,距黄斑中心凹1、3 mm平均脉络膜厚度均较正常对照组增厚,差异有统计学意义（P=＜0.001-0.034）.MG组视盘周围颞侧、上方、下方的平均脉络膜厚度较CPACG组、正常对照组增厚,差异有统计学意义（P=＜0.001-0.003）;CPACG组与正常对照组视盘周围各方位的平均脉络膜厚度比较,差异无统计学意义（P=0.438-0.935）.MG患眼、对侧非MG患眼黄斑中心凹、距黄斑中心凹1、3 mm平均脉络膜厚度以及视盘周围各方位脉络膜厚度比较,差异均无统计学意义（t=-1.029--0.130,P=0.32-0.90）.结论 MG患眼黄斑及视盘周围脉络膜厚度较CPACG和正常人增厚;黄斑及视盘周围脉络膜增厚可能是MG发生的解剖基础之一.

Objective To compare the choroidal thickness （CT） of macular and peripapillary area among malignant glaucoma（MG）,chronic primary angle-closure glaucoma （CPACG） and normal control eyes.And to investigate the correlation between CT and MG.Methods Sixteen subjects （32 eyes） with MG,31 （31 eyes） with CPACG and 32 （32 eyes） normal controls were collected.MG eyes and the fellow non-MG eyes were included in the MG group.CT of all subjects was measured in the fovea,1mm and 3mm to the fovea and peripapillary area using enhanced-depth imaging technique of optical coherence tomography （OCT-EDI）.The average of CT in fovea by horizontal and vertical macular scan was defined as the average CT in fovea.The average of temporal,superior,nasal and inferior CT in 1 mm and 3 mm to the fovea were measured respectively.The average of temporal,superior,nasal and inferior CT was defined as the average CT in peripapillary area.The differences of CT among MG,CPACG and normal controls were compared.And the differences of CT between MG eyes and the fellow non-MG eyes were compared.Results After eliminating the influence of age,the average CT of MG in the fovea,1mm and 3mm to the fovea was significantly thicker than that of CPACG and normal controls （P＜0.05）.And the average CT of CPACG in the fovea,1mm and 3mm to the fovea was significantly thicker than that of normal controls （P＜0.05）.In peripapillary area,the temporal,superior and inferior CT of MG was significantly thicker than that of CPACG and normal controls （P＜0.05）.There was no significant difference of CT in peripapillary area between CPACG and normal controls （P＞0.05）.In the fovea,1mm and 3mm to the fovea and peripapillary area,there was no significant difference of CT between MG eye and the fellow non-MG eye in MG group （t=1.029--0.130,P＞0.05）.Conclusions The choroid thickness of macular and peripapillary area in MG eyes is thicker than that of CPACG and the normal controls.An increased CT of macular and peripapillary area may be one of the risk factors for MG.