OCT参数对原发性开角型青光眼性视神经损伤的诊断价值

Value of OCT in the diagnosis of primary open angle glaucoma optic nerve injury

目的:探究频域光学相干断层成像技术(OCT)对原发性开角型青光眼性视神经损伤的诊断价值。方法:选择2018-01/2020-03我院收治的80例80眼原发性开角型青光眼患者及100例100眼健康受试者作为研究对象,将原发性开角型青光眼患者分为早期组、中期组及晚期组,采用OCT测定各组患者上方、下方、鼻侧、颞侧视乳头旁视网膜神经纤维层(pRNFL)厚度值及上方、下方黄斑区视网膜神经节细胞复合体(mGCC)厚度值,比较各组受试者OCT参数之间差异,采用Spearman相关性分析OCT参数与视野缺损程度的相关性,绘制受试者特征工作曲线(ROC)计算OCT参数诊断原发性开角型青光眼的价值。结果:入组患者早期组24例、中期组39例、晚期组17例,各组患者pRNFL、mGCC参数均有差异(P<0.05),晚期组青光眼患者上方、下方、鼻侧pRNFL、平均pRNFL及上方、下方、平均mGCC显著低于早期组、中期组,中期组患者各指标显著低于早期组(P<0.05)。Spearman相关性分析示,pRNFL、mGCC参数与原发性开角型青光眼严重程度呈负相关关系(P<0.05)。ROC曲线显示,上方pRNFL、下方pRNFL、鼻侧pRNFL、颞侧pRNFL、平均pRNFL诊断原发性开角型青光眼视神经损伤的曲线下面积为0.693、0.846、0.676、0.579、0.844,上方mGCC、下方mGCC及平均mGCC诊断原发性开角型青光眼视神经损伤的曲线下面积分别为0.542、0.677、0.676;平均pRNFL联合平均mGCC诊断原发性开角型青光眼视神经损伤的曲线下面积为0.883。结论:OCT测定pRNFL、mGCC参数与开角型青光眼视神经损伤程度密切相关,两者有较高的诊断价值,临床可将其用于诊断及病情评估。

AIM:To explore the value of frequency threshold optical coherence tomography(OCT)in the diagnosis of primary open angle glaucoma optic nerve injury.METHODS:Eighty patients with early primary glaucoma who were admitted to the hospital between January 2018 and March 2020 and 100 healthy subjects were selected as the study subjects.Patients with primary open angle glaucoma were divided into early group,middle group and late group.OCT was used to measure the thicknesses of upper,lower,nasal,bitemporal peri-papillary retinal nerve fiber layer(pRNFL)and upper and lower macular ganglion cell complex(mGCC)in each group.The mean deviation(MD)of visual field was determined through perimetry.The OCT parameters and perimetry parameters were compared among groups.Spearman correlation analysis was performed to analyze the correlation between OCT parameters and visual field defects,and the receiver operating characteristic(ROC)curve was used to calculate the value of OCT parameters in diagnosing primary open angle glaucoma.RESULTS:There were 24 cases,39 cases and 17 cases in the early group,middle group and late group,respectively.There were statistically significant differences in pRNFL and mGCC among 3 groups(P<0.05).The upper,lower,average pRNEL and the upper,lower,and average mGCC of patients in the early group of a third-class hospital were significantly lower than those of the control group,and the parameters of pRNFL and mGCC in each position of the mid-stage and late group were significantly lower than those of the control group.The upper,lower,nasal pRNFL,average pRNFL,upper,lower and average mGCC of the late group of glaucoma patients were significantly lower than those of the early group and the middle group.The indicators of the middle group were significantly lower than those of the early group(P<0.05).Spearman correlation analysis showed that pRNFL and mGCC parameters were negatively correlated with glaucoma severity(P<0.05)ROC curve analysis showed that the areas under the curves of the upper,lower,nasal,bitamporal and average pRNFL for diagnosis of primary open angle glaucoma optic nerve injury were 0.693,0.846,0.676,0.579 and 0.844,respectively.The areas under the curves of upper,lower and average mGCC for diagnosis of primary open angle glaucoma optic nerve injury were 0.542,0.677 and 0.676 respectively.The area under the curve of average pRNFL combined with average mGCC for the diagnosis of primary open angle glaucoma optic nerve injury was 0.883.CONCLUSION:The pRNFL and mGCC measured by OCT are closely related to the degree of primary open angle glaucoma optic nerve injury.Both have high diagnostic value for glaucoma and can be used clinically for diagnosis and condition assessment.