剥脱性青光眼视盘视网膜神经纤维层厚度与视野缺损的相关性

Correlation between the Peripapillary Retinal Nerve Fiber Thickness and Visual Field Mean Defect in Pseudoexfoliation Glaucoma

目的:探讨不同时期剥脱性青光眼(PXG)患者视盘视网膜神经纤维层(RNFL)厚度与视野缺损的相关性。方法:病例对照研究。连续性选取2013年1月至2018年1月在石家庄市第一医院青光眼科住院治疗的PXG患者97例(97眼),并将其分为早期PXG组28例,中期PXG组27例,晚期PXG组42例。另选择与PXG组匹配的正常志愿者32例(32眼)作为正常对照组。所有纳入对象均采用SD-OCT对视盘各区RNFL厚度进行扫描,采用单因素方差分析比较4组受检者视盘各区RNFL厚度差异,采用Pearson相关分析对视盘RNFL厚度与视野平均缺损相关性进行分析。结果:正常对照组及早、中、晚期PXG组平均视盘RNFL厚度分别为(104±11)μm,(92±14)μm,(82±12)μm,(54±18)μm。4组受检者鼻侧、鼻上方、颞上方、颞侧、颞下方、鼻下方及平均RNFL厚度总体差异均具有统计学意义(F=24.38、36.40、47.84、8.70、95.46、54.75、82.28,均P<0.001)。进一步两两比较发现,正常对照组与早期PXG组颞上方、颞下方、鼻下方及平均视盘RNFL厚度差异有统计学意义(均P<0.05);正常对照组与中期PXG组鼻侧、鼻上方、颞上方、颞下方、鼻下方及平均RNFL厚度差异有统计学意义(均P<0.05);正常对照组与晚期PXG组各区RNFL厚度差异均有统计学意义(均P<0.001)。中、晚期PXG组视盘平均RNFL厚度与视野平均缺损呈正相关(r=0.404,P=0.037;r=0.582,P<0.001)。结论:中、晚期PXG眼视盘平均RNFL厚度与视野缺损呈正相关,SD-OCT监测视盘RNFL厚度变化可以作为PXG诊断分期和随访的重要参考指标。

Objective:To discuss the correlation between the peripapillary retinal nerve fiber layer (RNFL) thickness and the visual field mean defect in different periods of pseudoexfoliation glaucoma (PXG).Methods: This was a clinical case control study.In the study,samples were selected consecutively from patients who were hospitalized in the Glaucoma Department of the First Hospital of Shijiazhuang from January 2013 to January 2018.The PXG group included 97 eyes of 97 patients who were divided into an early PXG group (28 eyes),a medium PXG group (27 eyes),and a late PXG group (42 eyes).The normal control group consisted of 32 eyes of 32 people who were matched for age,gender and refractive error.All subjects underwent spectral domain optical coherence tomography (SD-OCT) scans to measure peripapillary RNFL thickness in every quadrant.The SD-OCT and the visual field measurements among the different groups were compared using analysis of variance,and the correlation between the average RNFL thickness and visual field defects were analyzed with a Pearson correlation.Results:The average RNFL thickness in the normal control group,and the early,medium and late PXG groups was 104±11 μm,92±14 μm,82±12 μm,and 54±18 μm,respectively.The difference between the 4 groups in nasal,nasal superior,temporal superior,temporal,temporal inferior,nasal inferior quadrants and the average RNFL thickness were all statistically significant (F=24.38,36.40,47.84,8.70,95.46,54.75,82.28,all P<0.001).The differences between the normal control group and the early PXG group in the temporal superior,temporal inferior, and nasal inferior quadrants and the average RNFL thickness were statistically significant (all P<0.05). The differences between the normal control group and the medium PXG group in the nasal,nasal superior, temporal superior,temporal inferior,and nasal inferior quadrants and the average RNFL thickness were statistically significant (all P<0.05).The differences in RNFL thickness between the normal control group and the late PXG group in every quadrant were statistically significant (P<0.001).The average RNFL thickness was positively correlated with visual field mean differences in the medium PXG group and the late PXG group (r=0.404,P=0.037;r=0.582,P<0.001).Conclusions:The average peripapillary RNFL thickness is positively correlated with visual field mean differences in the medium and late PXG eyes.The changes of peripapillary RNFL thickness can be monitered by SD-OCT,which can be used as an important reference index for the status and follow-up of PXG.