原发性慢性闭角型青光眼黄斑区结构损害的定量研究及相关分析

Quantitative study of macular structural damage in primary chronic angle-closure glaucoma and correlation analysis

目的探讨慢性原发性闭角型青光眼(chronic primary angle-closure glaucoma,CPACG)患者黄斑区神经节细胞复合体(macular ganglion cell complex,m GCC)厚度变化及与视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度的相关性。方法采用RTVue100-2 OCT检测CPACG患者55例(55眼)早期、中期及晚期与正常人30例(30眼)平均、上方、下方m GCC厚度及平均、上方、下方RNFL厚度,比较组间各检测指标的差异,分析m GCC厚度与RNFL厚度的相关性。结果早期CPACG组、中期CPACG组、晚期CPACG组平均、上方、下方m GCC厚度值分别为(95.15±8.21)μm、(96.11±7.77)μm、(95.05±9.94)μm,(76.04±8.58)μm、(83.04±8.72)μm、(74.17±9.71)μm,(64.40±10.13)μm、(68.83±13.26)μm、(63.34±12.61)μm。早期CPACG组、中期CPACG组、晚期CPACG组各RNFL及m GCC厚度值均较正常对照组降低,差异均有统计学意义(均为P<0.05);随着青光眼病情的进展,RNFL厚度及m GCC厚度逐渐变薄,中期CPACG组各RNFL及m GCC厚度值均较早期CPACG组降低,差异均有统计学意义(均为P<0.05),晚期CPACG组各RNFL及m GCC厚度值均较中期CPACG组降低,差异均有统计学意义(均为P<0.05)。CPACG患者平均m GCC厚度和平均RNFL厚度、上方m GCC厚度和上方RNFL厚度、下方m GCC厚度和下方RNFL厚度均呈高度正相关(r=0.987、0.976、0.971,均为P=0.000)。结论频域OCT检测的CPACG患者的m GCC厚度随青光眼病情的进展逐渐变薄,与RNFL厚度有良好的相关性。

Objective To explore the changes of macular ganglion cell complex （mGCC） thickness in chronic primary angle-closure glaucoma（CPACG） and its correla- tion with retinal nerve fiber layer（RNFL） thickness. Methods Fivty-five CPACG pa- tients（55 eyes）at early, moderate and advanced stages, and 30 normal cases （30 eyes） were enrolled in the study. The average, superior and inferior mGCC and RNFL thick- ness were measured by RTV100-2 OCT and compared among groups. The correlation be- tween mGCC thickness and RNFL thickness was analyzed. Results The average mGCC thickness in the early,moderate and advanced CPACG group were（95.15 ± 8.21 ）μm, （95.11 ± 7.77 ）μm, （95.05 ± 9.94 ） μm, respectively, the superior were （ 75.04 ± 8.58 ） μm, （ 83. 04 ± 8. 72 ）μm, （ 74. 17 ± 9. 71 ）μm, respectively, the inferior were （64.40 ± 10. 13 ）μm, （ 68.83 ± 13.26 ）μm, （ 63.34 ± 12.61 ） μm, respectively. The meas- urement values of mGCC and RNFL thickness in the early, moderate and advanced CPACG group were significantly lower than those in the normal control group （ all P 〈 0. 05 ） ;With the progression of glaucoma, the mGCC thickness and RNFL thickness gradually reduced ,the measurement values of mGCC and RNFL thickness in the moderate CPACG group were significantly lower than those in the early CPACG group （ all P 〈 0.05 ）, the measurement values of mGCC and RNFL thickness in the advanced CPACG group were significantly lower than those in the moderate CPACG group （ all P 〈 0.05 ）. Average mGCC and RNFL thickness, superior mGCC and RNFL thickness, inferior mGCC thickness and inferior RNFL thickness showed a high positive correlation（r = 0. 987,0. 975,0. 971, all P 〈 0.05 ）. Conclusion mGCC thickness detected by frequency domain OCT in CPACG patients gradually decrease with the progression of glaucoma,there is a good correlation with RNFL thickness.