频域OCT测量高度近视黄斑区视网膜神经节细胞复合体厚度及视盘周围视网膜神经纤维层厚度

Thickness of Ganglion Cell Complex and Retinal Nerve Fiber Layer for High Myopia with Spectral-Domain Optical Coherence Tomography

目的：分析高度近视患者黄斑区视网膜神经节细胞复合体（GCC）厚度与视盘周围视网膜神经纤维层（RNFL）厚度的特征。方法：横断面研究。应用RTVue SD-OCT对2015 年11 月至2016 年7 月期间在北京同仁医院眼科就诊的46例（46眼）高度近视患者和31例（31眼）正常对照者进行黄斑区GCC厚度和视盘周围RNFL厚度检测，按照眼轴长度（AL）将高度近视患者分为A组（26 例，26 mm≤AL＜28 mm）、B组（12 例，28 mm≤AL＜30 mm）和C组（8 例，AL≥30 mm）。高度近视组和正常对照组的均数比较采用独立样本t 检验，多组均数间的比较采用非参数Kruskal-Wallis H 检验。高度近视组GCC厚度、RNFL厚度与AL的相关关系采用Pearson相关分析。结果：高度近视患者平均、上方、下方GCC厚度和平均、上方、下方、鼻侧RNFL厚度较正常对照组低（H =20.38、15.65、21.69、31.27、20.10、20.78、11.08，P ＜0.001），GCC局部丢失体积（FLV）和整体丢失体积（GLV）均较正常对照组大，差异均有统计学意义（H =20.02、27.24，均P ＜0.001）。高度近视患者平均、上方、下方GCC厚度和平均、上方、下方、颞侧RNFL厚度与AL均呈负相关（r=-0.462、-0.422、-0.462、-0.511、-0.502、-0.295、-0.408，均P ＜0.05），与屈光度均呈正相关（r=0.479、0.469、0.444、0.604、0.535、0.413、0.528，均P ＜0.05）；FLV、GLV与AL均呈正相关（r=0.643、0.590，均P ＜0.001），与屈光度均呈负相关（r=-0.666、-0.594，均P ＜0.001）。高度近视组RNFL厚度的变化率大于GCC厚度的变化率，差异有统计学意义（P ＜0.001）。结论：高度近视患者黄斑区GCC厚度降低，与AL呈负相关，与屈光度呈正相关。GCC厚度的变化率小于RNFL厚度的变化率。

Objective： To analyze the thickness of the ganglion cell complex （GCC） and retinal nerve fiber layer （RNFL） in high myopia patients. Methods： In this cross-sectional study, RTVue spectral domain optical coherence tomography （SD-OCT） was used to analyze the thickness of the macular GCC and the peripapillary RNFL in 46 high myopia patients （46 eyes） and 31 control subjects （31 eyes） from November 2015 to July 2016 at Beijing Tongren Hospital. The high myopia patients were divided into three groups by axial length （AL）： Group A （n=26, 26≤AL 〈 28 mm）, Group B （n=12, 28≤AL 〈 30 mm）, and Group C （n=8,AL≥30 mm）. Comparisons between the groups were made by nonparametric Kruskal-Wallis H test. The relationship between GCC thickness or RNFL thickness and the AL in the high myopia groups was tested by the Pearson correlation test. Results： The thicknesses of the average, superior, and inferior GCC, and the average, superior, inferior, nasal RNFL were decreased in the high myopia group （H =20.38, 15.65,21.69, 31.27, 20.10, 20.78, 11.08, all P 〈0.001）. In contrast, the thicknesses of the focal loss volume （FLV）and global loss volume （GLV） were significantly increased in high myopia patients compared with normal controls （H=20.02, 27.24, all P 〈 0.001）. There was a linear correlation between the AL and average GCC,superior GCC, inferior GCC, average RNFL, superior RNFL, temporal RNFL, inferior RNFL respectively（r=-0.462, -0.422, -0.462, -0.511, -0.502, -0.295, -0.408, all at P 〈 0.05）. There was also a linear correlation between the refractive diopter and average GCC, superior GCC, inferior GCC, average RNFL,superior RNFL, temporal RNFL, inferior RNFL respectively （r=0.479, 0.469, 0.444, 0.604, 0.535, 0.413,0.528, all at P 〈 0.05）. The rate of change for RNFL thickness was significantly larger than for the GCC rate of thickness change （P〈0.001）. Conclusions： The thickness of the macular GCC in patients with high myopia is decreased. It is negatively correlated with the AL and positively correlated with the refractive diopter. The change rate of GCC thickness is significantly less than for the RNFL thickness change rate.