光学相干断层扫描在原发性开角型青光眼早期诊断中的应用

The application 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(optical coherence tomography,OCT)检测视乳头旁神经纤维层(retinal nerve fiber layer,RNFL)厚度和黄斑区视网膜厚度对于早期原发性开角型青光眼(primary open angle glaucoma,POAG)的诊断价值。方法应用Spectralis SD-OCT对正常人30例(40眼)、高眼压症无危险因素35例(40眼)、高眼压症有危险因素38例(40眼)、早中期原发性POAG 38例(40眼)进行视乳头旁RNFL厚度扫描和黄斑厚度扫描。测量视乳头旁上方象限、下方象限、鼻侧象限、颞侧象限以及平均RNFL厚度,黄斑上方、下方及平均视网膜厚度等参数。对各组测量所得参数进行比较分析。结果正常组与高眼压症无危险因素组间各参数差异无统计学意义(P>0.05),高眼压症有危险因素组RNFL厚度和黄斑厚度均小于正常组和高眼压症无危险因素组(P<0.05),POAG组RNFL厚度和黄斑厚度均低于正常组、高眼压症无危险因素组和高眼压症有危险因素组(P<0.05)。结论OCT成像法可以观察到青光眼早期及高眼压症有危险因素患者的视神经损害,并对其进行定量评估,对于早中期原发性POAG具有明确的诊断意义,可以为高眼压症有危险因素患者的早期治疗提供重要参考依据。

Objective To study the value of optical coherence tomography （OCT） measurement of the retinal nerve fiber layer（RNFL） and the macular thickness in the early diagnosis of primary open angle glaucoma（POAG）. Methods In the case-control study, normal eyes（30 cases, 40 eyes）, ocular hypertension without risk factor（35 cases, 40 eyes）, ocular hypertension with risk factor（38 cases, 40 eyes） and primary open angle glaucoma（38 cases, 40 eyes） were examined with Spectralis SD-OCT to obtain the RNFL thickness and the macular thickness. All parameters were observed including superior, inferior, nasal and temporal quadrants and the mean RNFL thickness, also including superior, inferior and the total average maeular thickness. Measurement results were analyzed and were compared. Results No significant difference in the RNFL and macular thickness were found between normal group and the group of ocular hypertension without risk factor （P〉0.05）. The RNFL and maeular thickness in the group of ocu group and the group of ocu ar hypertension with risk factor was lower than that in the normal ar hypertension without risk factor （P〈 0.05）. The RNFL and macular thickness in the POAG group was lower than that in the other three groups（P〈0.05）. Conclusion Optic nerve damage of early glaucoma and ocular hypertension with risk factor can be observed and quantitatively measured by optical coherence tomography. OCT has clear significance for the early diagnosis of POAG, which can provide important reference for the early treatment of ocular hypertension with risk factor.