原发性急性闭角型青光眼患眼眼压控制半年后视盘参数及环视盘神经纤维层和黄斑区视网膜厚度的三维光相干断层扫描观察

The changes in optic disc parameter and the thickness of circumpapiilary retinal nerve fiber layer and macular retina after acute primary angle closure

目的 观察分析原发性急性闭角型青光眼（APACG）患眼眼压控制半年后视盘参数及环视盘神经纤维层（CP-RNFL）、黄斑区视网膜厚度改变。方法 前瞻性临床病例对照研究。临床确诊为APACG的26例患者30只眼（APACG组）以及与之性别、年龄相匹配的正常健康者30名30只眼（对照组）纳入研究。所有受检眼均行三维（3D）光相干断层扫描（OCT）检查。APACG组患眼在经药物及虹膜周边切除或小梁切除手术控制眼压半年后进行3D-OCT检查。采用3D扫描模式或环扫模式对受检眼视盘进行扫描，同时对其黄斑区进行范围6 mm×6 mm的扫描。应用系统自带软件分析计算视盘面积、视杯面积、盘沿面积、杯盘比（C/D）面积比、C/D水平直径比、C/D垂直直径比等视盘参数以及CP-RNFL平均厚度及鼻侧、上方、颞侧、下方各象限的CP-RNFL厚度值。同时计算黄斑中心凹视网膜厚度，黄斑中心区（距黄斑≤1 mm）视网膜厚度，黄斑内环（距黄斑＞1 mm但≤3 mm）鼻侧、上方、颞侧、下方各象限视网膜厚度，黄斑外环（距黄斑＞3 mm但≤6 mm）鼻侧、上方、颞侧、下方各象限视网膜厚度，黄斑区平均视网膜厚度及黄斑区体积。结果 APACG组患眼视盘面积、视杯面积、C/D面积比、C/D水平直径比、C/D垂直直径比较对照组受检眼增大（t=3.22、4.12、3.90、3.00、3.23），盘沿面积（t=－2.63）减小，差异均有统计学意义（P＜0.05）。APACG组患眼CP-RNFL平均厚度（t=－6.68），上方（t=－5.90）、颞侧（t=－11.64）、下方（t=－5.06）CP-RNFL厚度，黄斑中心区（t=－2.50）视网膜厚度，黄斑内环各象限（t=－4.91、－4.88、－2.83、－3.59）视网膜厚度，黄斑外环鼻侧（t=－2.13）、上方（t=－2.49）视网膜厚度及黄斑区平均视网膜厚度（t=－2.65）较对照组受检眼降低，黄斑区体积减小（t=－2.69），差异有统计学意义（P＜0.05）。两组受检眼之间鼻侧CP-RNFL厚度（t=－0.11）、黄斑中心凹视网膜厚度（t=－0.59）及黄斑外环颞侧（t=－0.67）、下方（t=－1.02）视网膜厚度比较，差异无统计学意义（P＞0.05）。结论 与正常健康眼比较，APACG患眼在眼压控制后半年视盘面积、视杯面积、C/D面积比、C/D水平直径比、C/D垂直直径比增大，盘沿面积减小；除鼻侧CP-RNFL厚度外，其余象限CP-RNFL厚度均降低；黄斑区除黄斑中心凹及黄斑外环颞侧、下方视网膜厚度外，其余区域视网膜厚度均降低。

Objective To determine the long-term changes in optic disc parameter and the thickness of circumpapillary retinal nerve fiber layer （CP-RNFL） and macular retina after acute primary angle closure. Methods Prospective clinical case-control study. A total of 26 patients （30 eyes） with acute primary angle-closure glaucoma （APACG） were in the APACG group, whose intraocular pressure were control after a single episode acute primary angle closure; 30 age- and sex-matched healthy subjects （30 eyes） in the control group. All subjects underwent three dimensional optical coherence tomography （3D-OCT） examination with 3D optic disk scanning or circle optic disk scanning and 6 mm×6 mm macular scanning. The parameters included average thickness of entire CP-RNFL, thickness of nasal, superior, temporal and inferior quadrant of CP-RNFL, disc area, disc cup area, rim area, cup/disc （C/D） area ratio, C/D horizontal diameter ratio and C/D vertical diameter ratio. The foveal retinal thickness, center retinal thickness （≤1 mm from the fovea）, 4 quadrants of macular inner-ring （〉1 mm but ≤3 mm from the fovea） retinal thickness, 4 quadrants of macular outer-ring （〉3 mm but ≤6 mm from the fovea） retinal thickness, average thickness of macular retinal thickness and macular volume were measured and analyzed. Results The disc area, disc cup area, C/D area ratio, C/D horizontal diameter ratio and C/D vertical diameter ratio in APACG group were significantly bigger than the control group （t=3.22, 4.12, 3.90, 3.00, 3.23; P〈0.05）, rim area was smaller than the control group （t=-2.63, P〈0.05）. The average thickness （t=-6.68） and the thickness of superior （t=-5.90）, temporal （t=-11.64） and inferior （t=-5.06） quadrants of CP-RNFL, center retinal thickness （t=-2.50）, 4 quadrants of macular inner-ring retinal thickness （t=-4.91,-4.88,-2.83,-3.59）, nasal （t=-2.13） and superior （t=-2.49） quadrants of macular outer-ring retinal thickness as well as average thickness of macular retinal thickness （t=-2.65） were significantly thinner than the control group （P〈0.05）, and the macular volume （t=-2.69） was significantly smaller than the control group （P〈0.05）. There was no statistically difference at nasal CP-RNFL （t=-0.11）, foveal retinal thickness （t=-0.59）, temporal （t=-0.67） and inferior （t=-1.02） quadrants of macular outer-ring retinal thickness between two groups （P〉0.05）. Conclusions In comparison with the healthy subjects, the disc area, disc cup area, C/D area ratio, C/D horizontal diameter ratio, C/D vertical diameter ratio in APACG eyes were bigger, while rim area was smaller; the CP-RNFL and macular retinal thickness were thinner except nasal CP-RNFL, fovea, temporal and inferior quadrants of macular outer-ring retinal.