应用三维光学相干断层扫描仪对原发性开角型青光眼和正常眼脉络膜厚度的对比分析

Assessment of choroidal thickness in healthy and primary open-angle glaucoma eyes using deep-range imaging optical coherence tomography

目的通过三维光学相干断层扫描仪比较原发性开角型青光眼(primary open-angle glaucoma,POAG)和正常眼的脉络膜厚度,并分析其影响因素,探讨脉络膜厚度与青光眼的关系。方法选取140例(216眼)POAG患者作为青光眼组,67例(106眼)正常受试者作为正常组。采用日本Topcon公司生产的超景深广角眼底断层扫描仪对各组受试者脉络膜厚度进行检测。通过单变量和多变量回归分析受试者年龄、眼轴长度、角膜厚度、收缩压、舒张压、收缩期灌注压、舒张期灌注压、眼压以及视野缺损值等因素与脉络膜厚度的关系。结果青光眼组受试者年龄、眼轴长度、收缩压、收缩期灌注压均高于正常组(均为P<0.05);青光眼组受试者视野损害更严重,视野缺损值差异有统计学意义(P<0.001);两组受试者角膜厚度、舒张压、眼压、舒张期灌注压差异均无统计学意义(均为P>0.05);青光眼组受试者脉络膜厚度为(157.70±48.54)μm,正常组为(179.90±36.10)μm,差异有统计学意义(P<0.001)。对所有受试者脉络膜厚度与各因素进行单变量回归分析,结果提示脉络膜厚度与年龄、眼轴长度、是否青光眼均呈显著负相关(均为P<0.05)。在考虑年龄和眼轴长度等因素在内的多变量回归分析结果显示,当年龄和眼轴长度被矫正时,青光眼组与正常组之间的脉络膜厚度差异无统计学意义(P=0.216),是否青光眼与脉络膜厚度之间无相关性。结论脉络膜厚度与青光眼无明显相关性,年龄、眼轴长度与脉络膜厚度呈负相关,脉络膜厚度不能作为诊断POAG和病情评估的指标。

Objective To evaluate choroidal thickness（ CT） in healthy and primary openangle glaucoma（ PO AG） eyes using deep-range imaging optical coherence tomography（ D R I-O CT） and to analyze the relationship betw een choroidal thickness and glaucoma. Methods Totally 140 patients（ 216 eyes） with PO AG were selected as glaucoma group,and 67 patients（ 106 eyes） with normal eyes as normal group. The optical coherence tomography produced by Japanese company（ Topcon） was used to detect CT in both groups. The association betw een CT and potential confounding variables including age,axial length,central corneal thickness,systolic pressure,diastolic pressure,systolic perfusion pressure,diastolic perfusion pressure,intraocular pressure,and visual field defects were examined by using univariable and multivariable regression analyses. Results The age,axial length,systolic blood pressure and systolic blood pressure of the glaucoma group were all higher than those of the normal group（ all P〈0. 05）,and the subjects in the glaucoma group had more severe visual field damage,and the difference of visual field defect was statistically significant（ P 0. 001）. There was no significant difference in corneal thickness,diastolic blood pressure,intraocular pressure and diastolic perfusion pressure betw een the two groups（ all P〈0. 05）. The CT was（ 157. 70 ± 48. 54） μm in the glaucoma group,and（ 179. 9± 36. 1） μm in the normal group,respectively,and the difference was statistically significant（ P 0. 001）. U ninitiated regression analysis show ed that CT was negatively correlated with age,axial length and glaucoma（ all P〈0. 05）. Multivariate regression analysis show ed that there was no significant difference in CT betw een glaucoma group and normal group when the length of the age and the axis of the eye were corrected（ P = 0. 216）,and moreover,there was also no association betw een glaucoma severity and CT. Conclusion Glaucoma is not associated with CT measured using D R I-O CT; how ever,older age and longer axial length were associated with thinner CT,so CT cannot be used as a marker for diagnosing PO AG and assessing the condition of the disease.