正常老年人群黄斑内层视网膜厚度和视盘周围神经纤维层的改变

Age-associated changes in the inner macular thickness and peripapiUary retinal nerve fiber layer thickness

目的比较Cirrus HD—OCT测得正常老年人群和年轻人群黄斑神经节细胞一内丛状层（mGCIPL）厚度和视盘周围视网膜神经纤维层（pRNFL）厚度之间的差异，从而对青光眼性视神经病变进展分析提供依据。方法采用前瞻性系列病例分析方法。纳入2016年6—7月北京同仁医院眼科进行体检的某事业单位退休职工（60-80岁）67人114眼作为老年人群组，另选取同期行体检的20～40岁24人42眼作为年轻人群组。应用CirrusHD—OCT测量各组黄斑区总的及各个区域GCIPL和pRNFL厚度参数并比较。结果除pRNFL鼻侧区域外，老年人群组mGCIPL和pRNFL各参数测量值均较年轻人群组薄，差异均有统计学意义（均P〈0．05），其中年龄影响最大的黄斑内层厚度参数是mGCIPL最小值，老年人群组与年轻人群组比较，差异有统计学意义[（74．02±11．01）μm与（82．74±3．94）μm；t=-7．290，P〈0．001]。在pRNFL厚度参数中，颞侧pRNFL厚度受年龄影响最大，老年人群组与年轻人群组比较差异有统计学意义[（70．83±12．30）μm与（82．10±17．02）μm；t=-3．930，P〈0．001]；而鼻侧pRNFL受年龄影响最小，老年人群组鼻侧pRNFL厚度与年轻人群组比较，差异无统计学差异（P=0．056）。结论除pRNFL鼻侧区域外，CirrusHD—OCT测得老年人群mGCIPL厚度参数与pRNFL厚度参数均较年轻人群明显变薄，在青光眼性视神经病变的随访中需要考虑年龄因素的作用。

Objective To determine the difference of macular ganglion cell-inner plexiform layer （mGCIPL） thickness and peripapillary retinal nerve fiber layer （pRNFL） thickness using Cirrus HD-OCT between older and young people in order to provide information for glaucomatous progressive analysis. Methods A prospective case series study was adopted. Sixty-seven old persons （ 114 eyes） aged 60-80 years old were selected from retired staff of an institution who underwent routine physical examinations between June and July 2016 in Beijing Tongren Hospital as older group and 24 young persons（42 eyes） aged （20-40 years old） who underwent routine physical examination at the same period were selected as young group. The total superior, superonasal,inperonasal,inferior,inferotemporal and superotemporal mGCIPL thickness and PRNFL thickness were measured by Cirrus HD-OCT. The research followed the Declaration of Helsinki. The ethics committee of the Tongren Eye Center approved the study and all participants provided an informed consent. Results There were statistical differences in all measurement parameters （mGCIPL and pRNFL） between older and young people （all at P〈0. 05） except nasal pRNFL thickness. Minimum mGCIPL thickness was significantly different between older and young group [ （74. 02 ± 11. 01 ） μm vs. （ 82.74 ± 3.94） μm ; t =-7. 290,P〈0. 001 ] ,while in the pRNFL parameters, temporal pRNFL thickness was siginicantly changed between older and young group [ （ 70.83 ± 12.30 ） μm vs. （ 82. 10 ± 17.02 ） μm ; t = - 3. 930, P 〈 0. 001 ]. The nasal pRNFL thickness showed no significant difference between the two groups. Conclusions All mGCIPL and most pRNFL parameters in older people were obviously thinner than young people except nasal pRNFL, age factor should be considered seriously in the progression analysis of glaucomatous neuropathy.