剥脱性青光眼黄斑厚度与视野平均缺损相关性分析

Correlation analysis between macular thickness and visual field mean defect in pseudoexfoliation glaucoma

目的比较早中期、晚期剥脱性青光眼(PXG)患者及正常人黄斑厚度的差异,探讨黄斑厚度与视野平均缺损(MD)的相关性。方法采用系列病例观察研究方法,纳入2013年5月至2018年5月在石家庄市第一医院治疗的早中期PXG患者33例33眼作为早中期PXG组,晚期PXG患者24例24眼作为晚期PXG组。同期纳入性别、年龄及屈光度匹配的健康志愿者34人34眼作为正常对照组。所有受检者均采用频域光相干断层扫描(SD-OCT)测量并比较3个组患者黄斑各区厚度及体积差异,对黄斑厚度与视野MD的相关性进行分析。结果正常对照组、早中期PXG组和晚期PXG组平均黄斑厚度分别为(305±15)、(297±15)和(287±17)μm;平均黄斑体积分别为(0.94±0.05)、(0.91±0.05)和(0.89±0.05)μm^3。3个组鼻内环、上内环、颞内环、下内环、上外环和颞外环、下外环区的黄斑厚度及体积总体比较,差异均有统计学意义(F厚度=4.226、9.335、12.133、10.115、11.298、8.243、12.142,均P<0.05;F体积=3.812、9.152、12.774、8.889、11.284、7.937、11.652,均P<0.05),早中期PXG组上内环、颞内环、下内环、上外环和颞外环区黄斑厚度均较正常对照组减小,差异均有统计学意义(均P<0.05);晚期PXG组下内环、颞内环区黄斑厚度均较早中期PXG减小,差异均有统计学意义(均P<0.05);晚期PXG组内、外环各区黄斑厚度均较正常对照组减小,差异均有统计学意义(均P<0.05)。正常对照组与早中期PXG组黄斑各区厚度与视野MD均无相关性(均P>0.05),晚期PXG组鼻内环、上内环、颞内环区黄斑厚度与视野MD均呈正相关(r=0.527、0.544、0.417,均P<0.05)。结论SD-OCT可定量分析黄斑厚度变化,联合视野检查可作为PXG诊断分期和随访的重要参考指标。

Objective To compare and analyze differences in macular thickness and to discuss the correlation between macular thickness and visual field mean defect (MD) in early and moderate, late pseudoexfoliation glaucoma (PXG) patients and normal control subjects. Methods A series of cases-observation study was adopted.Thirty-three early and moderate PXG patients (33 eyes) and 24 late PXG patients (24 eyes) were collected in the First Hospital of Shijiazhuang from May 2013 to May 2018.Meanwhile, 34 age, gender and dioper-matched healthy subjects (34 eyes) were included as normal control group.Spectral domain optical coherence tomography (SD-OCT) was used to measure macular thickness and volume in every quadrant.The correlation between the macular thickness and visual field MD were analyzed.This study followed the Helsinki declaration and was approved by the ethics committee of the First Hospital of Shijiazhuang.Written informed consent was obtained from each subject prior to any medical examination. Results The average macular thickness in normal control group, early and moderate PXG group and late PXG group were (305±15),(297±15) and (287±17)μm, respectively;the average macular volume were (0.94±0.05),(0.91±0.05) and (0.89±0.05)μm^3, respectively.The macular thickness and volume differences between the 3 groups were statistically significant in nasal inner macula, superior inner macula, temporal inner macula, inferior inner macula, superior outer macula, temporal outer macula, inferior outer macula quadrants (Fthickness=4.226, 9.335, 12.133, 10.115, 11.298, 8.243, 12.142;all at P<0.05.Fvolume=3.812, 9.152, 12.774, 8.889, 11.284, 7.937, 11.652;all at P<0.05). The macular thickness of early and moderate PXG group in superior inner macula, temporal inner macula, inferior inner macula, superior outer macula and temporal outer macula quadrants were statistically thinner than those in the normal control group (all at P<0.05);the macular thickness of late PXG group in inferior inner macula, temporal inner macula, superior outer macula and inferior outer macula quadrants were statistically thinner than those in the early and moderate PXG group (all at P<0.05);the macular thickness of late PXG group in inner and outer rings were statistically thinner than those in the normal control group (all at P<0.05). The macular thickness was not correlated with visual field MD in normal control group and the early and moderate PXG group in every quadrants (all at P>0.05), but it was positively correlated with visual field MD in the late PXG group in nasal inner macula, superior outer macula and temporal inner macula quadrants (r=0.527, 0.544, 0.417;all at P<0.05). Conclusions SD-OCT can quantify the macular thickness, and can be used an important reference index for the staging and follow-up of PXG combined with perimetry.