频域光学相干断层扫描测量黄斑区视网膜神经节细胞层厚度

Application of Spectral-domain Optical Coherence Tomography in the Measurement of Macular Ganglion Cell Layer

目的 利用频域光学相干断层扫描（SD-OCT）测量正常人和青光眼患者黄斑区视网膜神经节细胞层（GCL）厚度,并对测量结果进行重复性检验。方法 本研究纳入正常志愿者24例（正常对照组）、青光眼患者21例（青光眼组）,随机选择受试者一侧眼进行测量。利用海德堡Spectralis SD-OCT后极部非对称性分析软件对黄斑区视网膜进行扫描,以早期糖尿病视网膜病变治疗研究标准对黄斑区进行分区,分析比较正常对照组和青光眼组黄斑各分区视网膜GCL厚度,并计算组内标准差（Sw）、变异系数（CV）和组内相关系数（ICC）。结果 正常对照组黄斑中央区GCL厚度为（12.58±2.69）μm,内环平均GCL厚度为（48.87±3.81）μm,外环平均GCL厚度为（37.28±1.75）μm,呈开口向颞侧的“马蹄形”分布;青光眼组黄斑中央区GCL厚度为（9.57±2.06）μm,内环平均GCL厚度为（34.70±9.67）μm,外环平均GCL厚度为（28.20±5.51）μm,各区视网膜GCL均较正常对照组明显变薄。正常对照组各分区GCL厚度的Sw为0.46~0.87μm,CV为0.67%~3.71%,ICC为0.904~0.977;青光眼组Sw为0.53~1.65μm,CV为1.18%~5.75%,ICC为0.833~0.993,2组均具有良好的重复性。结论 利用Spectralis SD-OCT测量视网膜黄斑区GCL厚度在正常人和青光眼患者中均具有良好的可重复性,可用于临床青光眼的检查和长期随访。

Objective To evaluate the reproducibility of macttlar ganglion cen layer （GCL） measurements with high-resolution spectral domain- optical coherence tomography （SD-OCT） in both normal people and glaucoma patients. Methods In this study, 24 normal subjects and 21 glauco- ma patients Were prospectively included. Macular GCL thickness in 9 areas defined by Early Treatment Diabetic Retinopathy Study was measured with Spectralis SD-OCT applying posterior pale asymmetry analysis pattern. Within-subject standard deviation （Sw）, coefficient of variation （CV） and intraclass correlation coefficient （ICC） in normal subjects and glaucoma patients were assessed. Results In normal subjects, the GCL thick- ness in mactilar central area was 12.58~2.69μm, the average GCL thickness in inner ring area was 48.87~3.81μ m, the average GCL thickness in outer ring area was 37.28~ 1.75 μm, and the GCL thickness mapping in normal subjects was horseshoe-shaped with opening to temporal. In glauco- ma patients ,the GCL thickness in central area was 9.57~2.06 μm, the average GCL thickness in inner ring area was 34.70~9.67 μm, the average GCL thickness in outer ring area was 28.20±5.51 μm, and the GCL thickness in every macular area in glaucoma eyes was thinner than that in normal eyes （P 〈 0.001 ）. For measurements of GCL thickness in normal subjects, Sw was 0.46 to 0.87 μm, CV was 0.67% to 3.71%, and ICC was 0.904 to 0.977. For measurements of GCL thickness in glaucoma patients, Sw was 0.53 to 1.65 μm, CV was 1.18% to 5.75%, and ICC was 0.833 to 0.993. Conclusion Spectralis SD-OCT had an excellent reproducibility for measurements of GCL thickness in both normal people and glaucoma patients, which is a reliable technique for evaluating longitudinal change and follow-up in glaucoma.