FD-OCT及HRT-Ⅲ测量近视性屈光不正的青光眼诊断参数比较

Analysis of the glaucoma diagnostic parameters measured by FD-OCT and HRT-III in myopia

目的探讨FD-OCT与HRT-Ⅲ两种检测手段测量近视眼的主要青光眼诊断参数差异性、一致性及其特征。设计前瞻性比较性病例系列。研究对象2012年10月至2013年3月在北京地区招募的131例近视患者及82例正视眼者。方法行常规眼科检查及验光、眼轴测量,符合入选条件者行FD-OCT("ONH"模式)、HRT-Ⅲ(青光眼模块)检查,随机选取一眼作为研究对象。根据屈光度的不同将近视眼分成高度(高于-6.00 D)、中度(-3.00^-6.00 D)、低度(低于-3.00 D)近视三组。运用单因素方差分析和LSD法以及秩和检验分别比较FD-OCT、HRT-Ⅲ两种测量手段测得的近视眼组与正视眼组之间,各青光眼诊断参数的结果是否存在差异。运用Pearson相关分析,评价重要青光眼诊断参数结果与屈光度和眼轴的关系。主要指标视网膜神经纤维层(RNFL)厚度参数和视盘参数。结果(1)RNFL厚度:FD-OCT(除低度近视)HRT-Ⅲ(除高度近视)两种方法测得近视组与正视组的平均视网膜神经纤维层(m RNFL)厚度均有差异(P均<0.05),FD-OCT测量的近视组m RNFL较正视眼组薄,而HRT-Ⅲ的测量值较正视眼组厚。分区指标中,近视组FD-OCT的大部分16分区RNFL较正视组薄(P均<0.05),高、中度近视较低度者有更多具有统计学差异的参数;而HRT-Ⅲ的6分区RNFL,主要表现为中度近视的大部分参数较正视组厚(P均<0.05),高、低度近视与正视组间基本无差异(P均>0.05)。(2)视盘参数:FD-OCT及HRT-Ⅲ一致表现为所测得的近视组视盘面积、盘沿面积较正视组小(P均<0.01),其他大部分参数无统计学差异(P均>0.05)。(3)FD-OCT测得的m RNFL厚度以及部分分区的RNFL厚度、盘沿面积和容积与屈光度和眼轴长度呈负相关(P均<0.01),而HRT测量的RNFL及视盘指标与两者均无相关性(P均>0.05)。结论 FD-OCT和HRT-Ⅲ测量近视眼的青光眼诊断参数存在差异性及一致性,FD-OCT测得的RNFL相关参数多较正视眼者小,而HRT获得的结果多较正视眼者大;两种手段测得近视眼的视盘和盘沿面积较正视眼者小。这可能会干扰近视患者的青光眼早期诊断。

Objective To investigate if there are any differences and consistency of the glaucoma diagnostic parameters measured by FD-OCT and HRT-Ⅲ in myopia.Design Prospective comparative case series.Participants 131 myopia patients and 82 emmetropia subjects recruited in Beijing from Oct 2012 to Mar 2013 were included.Methods All the subjects underwent FD-OCT（ONH module）and HRT-Ⅲ（glaucoma module） in addition to routine ocular examination,refraction and axial length measurement.One eye of each subject was selected for this study by randomization.Myopia subjects were assigned into three groups according to their refractive power：low（≤-3.00 D）,moderate（-3.00 D to-6.00 D） and high（-6.00 D）.The difference between myopia groups and emmetropia control group regarding glaucoma diagnostic parameters of FD-OCT and HRT-Ⅲ were analyzed with one-way ANOVA,LSD,and rank sum test respectively.Pearson correlation analysis was performed to investigate the association between those diagnostic parameters and refractive powers as well as axial length.Main Outcome Measures RNFL thickness parameters and optic disc parameters.Results（1）RNFL thickness analyses：The difference in mean RNFL（m RNFL） thickness between myopia and emmetropia group was significant（P〈0.05 with FD-OCT measurement（in moderate and high groups） and HRT-Ⅲ measurements（in low and moderate groups）.However,the m RNFL thickness measured by FD-OCT was thinner than that measured with HRT-Ⅲ.For quadrants parameters,most of the 16 sectors values of FD-OCT were thinner in myopia group（P〈0.01 or P〈0.05）,especially in the moderate and high groups.On the contrary,for the 6 sectors of HRT-Ⅲ,the RNFL was thicker in moderate myopia group than that of control group（P〈0.01 or P〈0.05）,while the high and low myopia groups showed no difference compared with emmetropia group.（2） Optic disc parameters：the disc area and rim area of myopia group obtained from both FD-OCT and HRT-Ⅲ were found to be statistically less than those of the emmetropia group（P〈0.01）whereas no significant difference of other disc parameters（P〈0.05） was found.（3） Negative correlations were found in OCT between m RNFL thickness,RNFL thickness in some quadrants,rim area,rim volume and refractive power,axial length（P〈0.01）,whereas no significant correlation was found in regard to HRT RNFL thickness with refractive power and axial length（P〈0.05）.Conclusions The glaucoma diagnostic parameters of myopia patients showed difference and consistency between FD-OCT and HRT-Ⅲ.RNFL related parameters were thinner in myopia group comparared to that of emmetropia group measured by FD-OCT,but vise versa by HRT-Ⅲ.With regard to parameters of optic disc measured by FD-OCT and HRT-Ⅲ in myopia group,the disc area and rim area were both smaller comparared to emmetripia group.This would make early diagnosis of primary open-angle glaucoma with myopia more challenging.