晚期青光眼患者光学相干断层扫描检测的视网膜神经纤维层厚度与视野缺损的相关性研究

The correlation between retinal nerve fiber layer thickness and visual field defects in late primary open angle glaucoma

目的探讨基于光学相干断层扫描(OCT)检测晚期青光眼患者视网膜神经纤维层(RNFL)厚度的应用价值及其与患者视野缺损的相关性。方法选择2014年4月-2015年12月新疆医科大学第一附属医院收治的青光眼患者90例(90眼)为研究对象,按照临床分期分成早中期组40例(40眼)、晚期组50例(50眼),采用OCT检测及比较两组患者RNFL厚度与视野缺损值,并分析其相关性。结果早中期组患者的平均眼内压(IOP)为(30.284±2.452)mm Hg,低于晚期组患者的平均IOP(34.453±3.568)mm Hg(P<0.05);早中期组患者的垂直杯盘比值为(0.441±0.076),低于晚期组患者垂直杯盘比值(0.873±0.065)(P<0.05);早中期组患者平均视网膜神经纤维层厚度(RNFL)厚度值、上方平均RNFL厚度值、下方平均RNFL厚度值均高于晚期组患者(P<0.05);早中期组患者全视野MD值、上方半侧视野MD值、下方半侧视野MD值均低于晚期组患者(P<0.05)。早中期组患者平均RNFL厚度与全视野MD值、上方半侧视野MD值、下方半侧视野MD值均呈负相关(分别为r=-0.448,r=-0.581,r=-0.634,P均<0.05);晚期组患者平均RNFL厚度与全视野MD值、上方半侧视野MD值、下方半侧视野MD值均无相关性。结论晚期青光眼患者相对早中期患者RNFL更薄,但是视野损伤程度更严重;早中期患者的RNFL厚度和视野缺损具有负相关性,而晚期患者的RNFL厚度和视野缺损的相关性不是很明显。

Objective To study the changes of retinal nerve fiber layer（ RNFL） thickness of late primary open angle glaucoma（ POAG） by optical coherence tomography（ OCT）,and to explore the correlation between the RNFL thickness and the visual field defect. Methods A total of 90 cases（ 90 eyes） with POAG in our hospital from April 2014 to 2015 December were chosen,in which 40 cases（ 40 eyes） with early and middle POAG went into early and middle groups and 50 cases（ 50 eyes） with late POAG went into late group. RNFL thickness of two groups was measured by OCT,and the visual field defect was examined by computer visual field analyzer. Results In the early and middle group,the mean intraocular pressure（ IOP） was（ 30. 284 ± 2. 452） mm Hg,which was lower than that in the late group（ 34. 453 ± 3. 568 mm Hg,P 0. 05）. Vertical cup to disc ratio in the early and middle group was（ 0. 441 ± 0. 076）,which was lower than that in the late group（ 0. 873 ± 0. 065,P 0. 05）. RNFL thickness value,above average RNFL thickness value and below average RNFL thickness value in the early and middle group were higher than the patients in the late group（ P 0. 05）; full field MD,above the half side of the MD value and below half side of the MD value in the early and middle group were lower than that in the late group（P 0. 05）. RNFL thickness and full field MD value,above the half side of the MD values and beneath the half side of the MD value in the early and middle group all showed negative correlations（ r =- 0. 448,r =- 0. 581,r=- 0. 63,and all P 0. 05）; the mean RNFL thickness and full field MD,above the half side of the MD values and beneath the half side of the MD value in the late group had no correlation. Conclusion OCT scanning can reflect the changes of RNFL thickness of POAG patients. For early and middle stage glaucoma patients,RNFL thickness was negative correlated with visual field defect. The correlation between RNFL thickness and visual field defect in patients with late stage was not very obvious.