OCT和视野对颅咽管瘤患者视功能损伤的评价

Assessment of visual function by optical coherence tomography and visual field for craniopharyngioma patients

目的:通过分析光学相干断层扫描(OCT)测量颅咽管瘤患者黄斑区视网膜神经节细胞复合体(GCC)及视盘周围视网膜神经纤维层(pRNFL)厚度的变化及其与视野平均缺损度(MD)及视野平均敏感度(MS)的相关性,探讨OCT检查应用于评估颅咽管瘤患者视路损伤的可行性。方法:对2014-09/2015-04在我神经外科就诊的颅咽管瘤患者95例175眼进行视野和OCT检查,测量神经纤维层厚度和GCC层厚度,利用Spearman等级相关系数(r s)评价其与MD、MS的相关性,并分析其视乳头及视野改变的特点。结果:pRNFL厚度异常眼占53.1%(93/175),其中,视乳头水肿占3.4%(6/175),视神经萎缩占47.4%(83/175),视乳头类青光眼样改变者占7.4%(13/175)。视野缺损占71.4%(125/175)。双眼的pRNFL平均厚度(r s右眼=-0.411,r s左眼=-0.354)及GCC平均厚度(r s右眼=-0.400,r s左眼=-0.314),与MD相关(P<0.01);双眼的pRNFL平均厚度(r s右眼=0.412,r s左眼=0.342)及GCC平均厚度(r s右眼=0.414,r s左眼=0.299),与MS相关(P<0.01)。结论:pRNFL和GCC厚度与视野损害相关,可定量的评估鞍区肿瘤患者的视神经损害程度。pRNFL和GCC厚度越薄,视功能损害越严重。在临床工作中,将视野检查和OCT检查结合起来,更有利于发现及评估患者的视路损害及预后。

AIM： To analyze the differences and correlations between ganglion cell complex （GCC）, peripapillary retinal nerve fiber layer （pRNFL） and mean defect （MD）, mean sensitivity （ MS ） of visual field （ VF ） in craniopharyngioma patients, to evaluate the feasibility of optical coherence tomography （OCT） in diagnosis of the visual pathway damage of craniopharyngioma patients. METHODS： Ninety- five craniopharyngioma patients treated in Beijing Tiantan Hospital, from September 2014 to April 2015 received the VF test by Octopus 900 automated perimeter with the central 30 degree program and the mean thickness measurements of GCC and pRNFL by R＇l-Vue OCT. Spearman rank correlation coefficient （rs） was used to assess the correlation between GCC, pRNFL and MD, MS. The changes of VF and optic disc were analyzed. RESULTS： Abnormal pRNFL findings occurred in 53.1% （93,/175）, which included optic disk edema 3.4% （6/175）, atrophic changes of optic nerve 47. 4% （83/175） and glaucoma-like optic neuropathy 7.4% （13/175）. Various visual field defect was 71. 4% （125/175）. The average thickness of binocular pRNFL （rs OD=-0.411, rs OS=-0.354） and GCC （rs OD =-0.400, rs OS=-0.314） had correlation with MD （P〈0.01）. The average thickness of pRNFL （rs OD = 0.412, rs OS=0.342） and GCC （rs OD=0.414, rs OS=0.299） had correlation with MS （P〈0.01）. CONCLUSION; The average thickness of pRNFL and GCC has correlation with VF damage, can evaluate the optic nerve damage of craniopharyngioma patients quantitatively. The thinner the thickness of pRNFL and GCC is, the serious damage of visual function is. During the clinical work, visual field test combined with OCT are helpful to find and assess the damage of visual pathway and prognosis.