光学相干断层扫描仪对原发性开角型青光眼患者早期诊断价值

Value of optical coherence tomography in the early diagnosis of primary open angle glaucoma

目的探讨光学相干断层扫描仪(OCT)在原发性开角型青光眼(POAG)患者早期诊断中的价值。方法选取2015年4月至2016年4月于张家口市第四医院就诊的50例(50眼)POAG患者为研究对象,分为早期POAG组26例和中晚期POAG组24例,另同期选取30例健康无眼疾体检者为对照组,采用OCT检测3组对象视网膜神经纤维层(RNFL)厚度、视野缺损,测定视盘面积、视杯面积、盘沿面积、视杯容积、盘沿容积等视盘参数,并对3组检测数据进行比较。结果早期POAG组和中晚期POAG组患者上方、下方、鼻侧、颞侧4个视野RNFL厚度均显著低于对照组(P<0.05),中晚期POAG组患者上方、下方、鼻侧、颞侧4个视野RNFL厚度均显著低于早期POAG组(P<0.05);早期POAG组和中晚期POAG组患者上方、下方、鼻侧、颞侧4个视野缺损值均显著高于对照组(P<0.05),中晚期POAG组患者上方、下方、鼻侧、颞侧4个视野缺损值均显著高于早期POAG组(P<0.05);POAG患者视盘面积与对照组比较差异无统计学意义(P>0.05),早期POAG组和中晚期POAG组患者盘沿面积、盘沿容积低于对照组(P<0.05),视杯面积、视杯容积高于对照组(P<0.05),中晚期POAG组患者盘沿面积、盘沿容积显著低于早期POAG组(P<0.05),视杯面积、视杯容积显著高于POAG组(P<0.05)。结论 OCT可真实反映POAG患者RNFL厚度及视盘参数的改变,具有较高的敏感性和特异性,认为RNFL厚度及视盘参数可作为早期POAG诊断的敏感指标。

Objective To explore the value of optical coherence tomography （OCT） in the early diagnosis of primary open angle glaucoma （POAG）. Methods A total of SO patients（50 eyes） with POAG who were admitted in the Fourth Hos- pital of Zhangjiakou City from April 2015 to April 2016 were included in this study and divided into the early POAG group （n = 26 ） and the middle-advanced POAG group （n = 24）. Moreover,30 healthy individuals without eye diseases who came for physical examinations were selected as control group. OCT was used to detect the retinal nerve fiber layer （RNFL） thickness, visual field defect, disc area, cup area, rim area, cup volume, and rim volume. The data were compared among the three groups. Results The superior, inferior, nasal, temporal RNFL thickness in the early POAG group and middle-advanced POAG group was significantly lower than that in the control group （ P 〈 0.05 ）. The superior,inferior, nasal, temporal RNFL thickness in the middle-advanced POAG group was significantly lower than that in the early POAG group （ P 〈 O. 05 ）. The superior, inferior, nasal, temporal visual field defects in the early POAG group and middle-advanced POAG group were significantly higher than those in the control group （ P 〈 O. 05 ）. The superior, inferior, nasal, temporal visual field defects in the middle-advanced POAG group were significantly higher than those in the early POAG group （ P 〈 0.05 ）. There was no statistic difference of the disc ar- ea among the three groups （P 〉 0.05 ）. The disc area and disc volume in the early POAG group and middle-advanced POAG group were significantly lower than those in the control group （ P 〈 0.05 ） , while cup area and cup volume were significantly higher than those in the control group （P 〈 0.05 ）. The disc area and disc volume in the middle-advanced POAG group were significantly lower than those in the early POAG group （ P 〈 0.05 ） , while cup area and cup volume were significantly higher than those in the early POAG group （ P 〈 0.05 ）. Conclusion OCT can really reflect the changes of RNFL thickness and disc parameters in POAG patients, with a higher sensitivity and specificity;therefore, RNFL thickness and disc parameters can be as sensitive indicators in the early diagnosis of POAG.