视网膜神经纤维层及黄斑厚度不对称参数在POAG早期诊断中的应用

Application of asymmetric parameters of retinal nerve fiber layer and macular thickness in early diagnosis of primary open angle glaucoma

目的:研究视网膜神经纤维层及黄斑厚度不对称参数在原发性开角型青光眼(primary open angle glaucoma,POAG)早期诊断中的应用。方法:临床研究对象包括正常受试者50例100眼和单侧早期POAG的患者50例100眼,使用Humphrey视野计记录视野平均缺损(MD)和模式标准差(PSD)、Cirrus HDOCT、扫描视网膜神经纤维层(RNFL)厚度、黄斑厚度,并进行后极部不对称参数分析,后者主要为双眼RNFL厚度及黄斑厚度的比较、眼内上/下方RNFL厚度的比较,眼内上/下方黄斑厚度的比较,并计算所有OCT、参数的曲线下面积(AUC)。结果:除眼内上/下方视盘RNFL厚度差值比较无统计学意义(P=0.265),两组研究对象视盘RNFL厚度、黄斑厚度、双眼上方/下方/总体RNFL厚度或黄斑厚度的不对称性差异、眼内上/下方黄斑厚度的差值均有统计学意义(P<0.05)。视盘RNFL总体厚度的AUC值为0.827。视盘RNFL总体厚度差值的敏感性最高,95%特异性的敏感度为67%。黄斑总体厚度平均值的AUC值为0.822。黄斑厚度差值的AUC值为0.777。结论:后极部视网膜厚度不对称参数分析对早期POAG患者提供了良好的诊断效能,且与RNFL厚度的诊断精度相似。然而,眼内不对称分析参数表现不佳,需要在其用于早期单侧青光眼诊断之前进一步细化。

·AIM：To report the application of asymmetric parameters of retinal nerve fiber layer and macular thickness in early diagnosis of primary open angle glaucoma. ·METHODS： The clinical study included 100 eyes of 50 normal subjects and 100 eyes of 50 unilateral early primary open angle glaucoma. The mean field defect （ MD） and pattern standard deviation （ PSD ） were recorded using a Humphrey perimeter. All eyes underwent Cirrus HD-OCT for thickness of total, inferior, superior retinal nerve fiber layer （ RNFL） and macular, then calculated their intereye differrence and intraeye difference respectively （ posterior pole asymmetry parameters analysis ） . The area under curve （ AUC） was calculated for all OCT parameters. ·RESULTS：In addition to the difference in the intraocular RNFL thickness around optic disc （ P = 0. 265 ）, the parameters of the RNFL thickness, macular thickness, intereye differrence of superior / inferior / total macular thickness, intraocular superior / inferior difference of macular thickness were statistically significant （P〈0. 05）. The AUC of the total thickness of RNFL was 0. 827. The sensitivity of the intereye RNFL thickness difference was the highest, with a 95% specificity of 67%. The mean AUC of the total macular thickness was 0. 822. The AUC of the intereye difference of macular thickness was 0. 777.·CONCLUSION： The asymmetric analysis of retinal thickness in the posterior pole provides a good diagnostic performance for patients with early POAG, similar to the diagnostic accuracy of RNFL thickness. However, intraocular asymmetric analysis parameters perform poorly and require further refinement before they are used for early unilateral glaucoma diagnosis.