Diagnostic ability of ganglion cell complex thickness to detect glaucoma in high myopia eyes by Fourier domain optical coherence tomography

AIM：To evaluate the ability of macular ganglion cell complex（GCC） thickness using Fourier domain optical coherence tomography（FD-OCT） to detect glaucoma in highly myopic eyes.METHODS：Cross-sectional study.A total of 114 participants,consecutively were enrolled.Macular GCC thickness and peripapillary retinal nerve fiber layer（RNFL） thickness were obtained with RTVue FD-OCT.Receiver operating characteristics curves were constructed for each measurement parameter,and areas under the curves（AUCs） were compared.RESULTS：Both the average GCC and average RNFL thickness showed negative correlations with axial length（rGCC=-0.404,P=0.001;rRNFL=-0.561,P〈0.001）.The largest AUCs from GCC,and RNFL parameters were 0.968 [global loss volume（GLV）],and 0.855（average RNFL）,respectively.GLV was significantly better for detecting high myopic glaucoma than average RNFL（P〈0.001）.CONCLUSION：Macular GCC thickness has higher diagnostic power than peripapillary RNFL thickness to discriminate glaucoma patients from non-glaucoma subjects in high myopia.

Retinal ganglion cell complex changes using spectral domain optical coherence tomography in diabetic patients without retinopathy

AIM：To assess the ganglion cell complex（GCC）thickness in diabetic eyes without retinopathy. METHODS：Two groups included 45 diabetic eyes without retinopathy and 21 non diabetic eyes. All subjects underwent full medical and ophthalmological history,full ophthalmological examination,measuring GCC thickness and central foveal thickness（CFT）using the RTVue~？ spectral domainoptical coherence tomography（SD-OCT）,and HbA1C level.RESULTS：GCC focal loss volume（FLV%）was significantly more in diabetic eyes（22.2% below normal）than normal eyes（P=0.024）. No statistically significant difference was found between the diabetic group and the control group regarding GCC global loss volume（GLV%）（P=0.160）. CFT was positively correlated to the average,superior and inferior GCC（P=0.001,0.000 and 0.001 respectively）and negatively correlated to GLV% and FLV%（P=0.002 and0.031 respectively）in diabetic eyes. C/D ratio in diabetic eyes was negatively correlated to average,superior and inferior GCC（P=0.015,0.007 and 0.017 respectively）. The FLV% was negatively correlated to the refraction and level of Hb A1c（P=0.019 and 0.013 respectively）and positively correlated to the best corrected visual acuity（BCVA）in log MAR in diabetic group（P=0.004）.CONCLUSION：Significant GCC thinning in diabetes predates retinal vasculopathy,which is mainly focal rather than diffuse. It has no preference to either the superior or inferior halves of the macula. Increase of myopic error is significantly accompanied with increased focal GCC loss. GCC loss is accompanied with increased C/D ratio in diabetic eyes.

Macular ganglion cell complex injury in different stages of anterior ischemic optic neuropathy

BACKGROUND Anterior ischemic optic neuropathy(AION)is a group of ophthalmic diseases in which the optic nerve is injured causing blindness.However,the pathogenesis,clinical manifestations,and clinical treatments of AION are yet elusive.Only a few related experimental or clinical reports are available on the disease.In this study,spectral domain optical coherence tomography(SD-OCT)was used to examine the morphology of thickness swelling and atrophic changes of macular ganglion cell complex(mGCC)in the different stages of AION that were then compared with the visual fields.Thus,the clinical value of mGCC examination was alleged to be similar to that of the visual field.AIM To explore the mGCC injury at different stages in AION and the clinical significance.METHODS Cases with AION were analyzed in a retrospective study.SD-OCT was used to analyze the correlation between mGCC and peripapillary retinal nerve fiber layer thicknesses at different stages of AION and the changes in the corresponding stages of visual fields.RESULTS A total of 21 cases(28 eyes)presented AION.The onset time of AION was defined as early stage(within 3 wk of onset),middle stage(from 3 wk to 2 mo),and late stage(disease span>2 mo).In the early stage,the mGCC thickness of SD-OCT was within the normal high limit,and the perioptic nerve fibers thickness was more than the normal.The changes in the visual field in early stage were not consistent with the swelling changes in mGCC and peri-disc nerve fibers.In addition,atrophy and thinning appeared in mGCC,and the perioptic nerve fibers were swollen.However,the thickness was lower in the middle period than that in the early stage.The change in visual field was consistent with that of mGCC in this period.In the late stage,mGCC shrank and thinned,and the thickness of the nerve fibers around the optic disc in the corresponding region shrank and thinned.CONCLUSION The changes in mGCC thickness in patients with AION showed early,middle,and late stages of development by SD-OCT.Although the early stage visual field changes of AION were not consistent with the swelling changes of mGCC,the horizontal delimitation or annular atrophy of mGCC was consistent with that in the middle and late stage of the disease.The atrophy of peripheral nerve fibers was later than that of the mGCC atrophy.

Comparison of peripapillary and macular choroidal thickness and ganglion cell complex thickness in glaucomatous and healthy eyes

AIM: To assess choroidal thickness(CT) and its association with ganglion cell-inner plexiform layer thickness(GCIPLT) and retinal nerve fiber layer thickness(RNFLT) in open angle glaucoma(OAG) comparing with preperimetric glaucoma(PPG) and normal eyes.METHODS: Totally 55 eyes of OAG, 40 eyes of PPG, and 40 eyes of age-matched normal eyes were studied. Peripapillary CT(PCT), macular CT(MCT), RNFLT, and GCIPLT were evaluated. Relationship between the CT with RNFLT and GCIPLT were studied. The correlation between CT and confounding variables as gender, age, intraocular pressure, and visual field mean deviation were analyzed. RESULTS: Mean PCT were 113.6±39.1 μm in OAG, 116.3±42.7 μm in PPG, and 148.9±41.7 μm in normal eyes. PCT and MCT was thinner in OAG compared to healthy eyes. There was a significant correlation for PCT and mean RNFLT in 1, 2, 6, and 7 clock hours of OAG eyes. The difference in PCT remained after adjusting for axial length, age, and disc area(P=0.003). No significant correlation was shown between MCT and mean GCIPLT in all eyes.CONCLUSION: PCT is thinner in OAG and PPG compared with healthy eyes. The correlation of RNFLT and PCT found in OAG and PPG is not revealed in normal eyes.

Detection of macular ganglion cell complex loss and correlation with choroidal thickness in chronic and recurrent central serous chorioretinopathy

AIM:To investigate the association of ganglion cell complex thickness(GCCt),global loss volume percentage(GLV%),and focal loss volume percentage(FLV%)with structural and functional findings among patients with chronic central serous chorioretinopathy(CCSC)and recurrent central serous chorioretinopathy(RCSC)by optical coherence tomography(OCT).METHODS:Among 29 patients with monocular affected central serous chorioretinopathy(CSC),15 had CCSC,and 14 had RCSC.The GCCt,FLV%,GLV%,and subfoveal choroidal thickness(SFCT)and sublesional choroidal thickness(SLCT)values were determined using OCT,and the association of these characteristics with neural structure parameters,choroidal morphology,features and functional alterations were estimated for the CCSC and RCSC patients.RESULTS:In CCSC,the affected eyes had significantly lower GCCt values than the fellow eyes in the macular regions(all P<0.05),with the highest GCCt observed in the inferior area.A significant association was found between the GCCt in different regions and the change in best corrected visual acuity(BCVA;r=-0.696;-0.695;-0.694,P<0.05)in CCSC patients.A statistically significant moderate negative correlation indicated that long-term CCSC was associated with greater differences in the GCCt in different regions between affected and fellow eyes(r=-0.562;r=-0.556;r=0.525,P<0.05).Additionally,observation of thickened SFCT was associated with a worse FLV%(r=0.599;r=0.546,P<0.05)in both groups.Similarly,thickened SLCT was associated with FLV%in RCSC patients(r=0.544,P<0.05).CONCLUSION:The distribution and GCCt are associated with the duration and visual outcomes of CCSC,whereas there is no correlation among RCSC patients.FLV%may be instrumental in differentiating the various outer choroidal vessels(pachyvessels)in long-term CSC.These results suggest that neural structure parameters may aid in estimating and predicting the recovery of altered morphology and function in CCSC and RCSC patients.

Macular Perfusion Changes and Ganglion Cell Complex Loss in Patients with Silicone Oil-related Visual Loss

Objective The aim of this study was to investigate macular perfusion changes and ganglion cell complex(GCC)loss in patients with unexplained visual loss following vitrectomy and silicone oil(SO)tamponade,and to evaluate the correlation between retinal blood flow and GCC loss using optical coherence tomography angiography(OCTA)and optical coherence tomography(OCT).Methods This retrospective study included seven eyes(seven patients)with unexpected visual loss after vitrectomy and SO tamponade.OCTA was used to evaluate the alterations in retinal vessel density(VD)in the superficial capillary plexus(SCP),deep capillary plexus(DCP),and radial peripapillary capillary plexus(RPCP).OCT was used to measure the thickness of GCC and retinal nerve fiber layer(RNFL).Medical records of patients were reviewed.Results Quantitative analysis of OCTA images revealed a significant reduction in SCP VD in the affected eyes compared with the controls(all sections P<0.05).No difference was found in GCC thickness,but FLV(focal loss volume)and GLV(global loss volume)were significantly higher in the affected eyes(both P<0.001).SCP VD was inversely correlated with FLV and GLV.Conclusions Silicone oil-related severe visual loss was associated with superficial retinal microvasculature damage and ganglion cell apoptosis.

Systematic review of macular ganglion cell complex analysis using spectral domain optical coherence tomography for glaucoma assessment

AIM: To review the use of spectral domain optical coherence tomography(SD-OCT) for macular retinal ganglion cells(RGC) and ganglion cell complex(GCC) measurement in glaucoma assessment, specifically for early detection and detection of disease progression. METHODS: A systematic review was performed by searching Pub Med, Medline, and Web of Science for articles published in English through July 2014 describing the various macular SD-OCT scanning strategies developed for glaucoma assessment. The review focused on papers evaluating the use of macular RGC/GCC SDOCT to detect early glaucoma and its progression. The search included keywords corresponding to the index test(macular ganglion cell/RGC/GCC/Spectral domain OCT), the target condition(glaucoma), and diagnostic performance. The RGC/GCC SD-OCT scanning strategies used to assess glaucoma of most commonly used SD-OCT instruments were described and compared. These included the Cirrus high definition-OCT(Carl Zeiss Meditec, Inc., Dublin, CA, United States), RTVue(Optovue, Inc., Fremont, CA, United States), Spectralis(Heidelberg Engineering, Heidelberg, Germany) and the 3D OCT 2000(Topcon Corporation, Tokyo, Japan). Studies focusing on the ability of RGC/GCC SD-OCT to detect early glaucomatous damage and on the correlation between glaucomatous progression and RGC/GCC measurement by SD-OCT were reviewed.RESULTS: According to the literature, macular RGC/GCC SD-OCT has high diagnostic power of preperimetric glaucoma, reliable discrimination ability to differentiate between healthy eyes and glaucomatous eyes, with good correlation with visual filed damage. The current data suggests that it may serve as a sensitive detection tool for glaucomatous structural progression even with mild functional progression as the rate of change of RGC/GCC thickness was found to be significantly higher in progressing than in stable eyes. Glaucoma assessment with RGC/GCC SD-OCT was comparable with and sometimes better than circumpapillary retinal nerve fiber layer thickness measurement.CONCLUSION: An increasing body of evidence supports using macular RGC/GCC thickness as an indicator for early glaucoma. This might be a useful tool for monitoring disease progression.

Evaluation of peripapillary retinal nerve fiber layer, macula and ganglion cell thickness in amblyopia using spectral optical coherence tomography

AIM:To investigate peripapillary retinal nerve fiber layer (RNFL), macula and ganglion cell layer thicknesses (GCC) in amblyopic eyes with spectral domain optical coherence tomography (SD-OCT). METHODS:Thirty six patients with a history of unilateral amblyopia and thirty two children who had emmetropia without amblyopia were included in this study. In this institutional study, 36 eyes of 36 patients with amblyopia (AE), 36 fellow eyes without amblyopia (FE), and 32 eyes of 32 normal subjects (NE) were included. RNFL, GCC and macular thickness measurements were performed with RS-3000 OCT Retina Scan (Nidek Inc CA. USA). RESULTS:The mean global thicknesses of the RNFL were 113.22 ±21.47, 111.57 ±18.25, 109.96 ±11.31μm in the AE, FE, and NE, respectively. There was no statistically significant difference for mean global RNFL thickness among the eyes (P =0.13). The mean thicknesses of the macula were 258.25±18.31, 258.75±19.54, 248.62±10.57μm in the AE, FE and NE, respectively. There was no statistically significant difference for thickness of macula among the eyes (P =0.06). The GCC was investigated into two parts:superior and inferior. The mean thicknesses of superior GCC were 102.57 ±13.32, 103.32 ±10.64, 100.52 ± 5.88μm in the AE, FE, and NE, respectively. The mean thicknesses of inferior GCC were 103.82 ±12.60, 107.82 ± 12.33, 105.86±10.79μm in the AE, FE and NE, respectively. There was no statistically significant difference for thickness of superior and inferior GCC between the eyes (P =0.63, P =0.46). ·CONCLUSION:The macular thicknesses of AE and FE were greater than the NE, although it was not statistically significant. Amblyopia does not seem to have a profound effect on the RNFL, macula and GCC.

Neurodegeneration and choroidal vascular features on OCT in the progression to advanced age-related macular degeneration

AIM:To quantify and compare longitudinal thickness changes of the ganglion cell complex(GCC)and the choroid in patients with different patterns of age-related macular degeneration(AMD)progression.METHODS:Retrospective cohort analysis of anonymized data from participants aged 50y or more and diagnosed with early/intermediate AMD in at least one eye(with no evidence of advanced AMD).A total of 64 participants were included from the Instituto de Retina de Lisboa(IRL)study(IPL/2022/MetAllAMD_ESTeSL)and divided into 4 groups according to the Rotterdam classification for AMD.Spectral domain optical coherence tomography(SD-OCT)was used to assess and quantify GCC and choroid thickness at two time points(first visit vs last visit)with a minimum interval of 3y.RESULTS:In the GCC inner ring,a thinner thickness(P=0.001)was observed in the atrophic AMD group(51.3±21.4μm)compared to the early AMD(84.3±11.5μm),intermediate AMD(77.6±16.1μm)and neovascular AMD(88.9±16.3μm)groups.Choroidal thickness quantification showed a generalized reduction in the central circle(P=0.002)and inner ring(P=0.001).Slight reductions in retinal thickness were more accentuated in the inner ring in the atrophic AMD(-13%;P<0.01).CONCLUSION:The variation of the analyzed structures could be an indicator of risk of progression with neurodegenerative(GCC)or vascular(choroid)pattern in the intermediate and atrophic AMD.The quantification of both structures can provide important information about the risk of disease progression in the early and intermediate stages but also for the evolution pattern into late stages(atrophic or neovascular).

MP-3 microperimeter in early primary open angle glaucoma with a new pattern

AIM:To investigate macular microperimetry in patients with early primary open angle glaucoma(POAG)using a new custom-made pattern,and analyze the characteristics of macular sensitivity.METHODS:This case-control study included 38 patients with POAG,who were divided into pre-perimetric glaucoma(18 eyes of 18 patients),early-stage(20 eyes of 20 patients),and control(20 eyes of 20 patients)groups.All subjects underwent standard 24-2 humphrey visual field test.An MP-3 microperimeter with a new custom-made pattern(28 testing points distributed in four quadrants,covering the central 10°of the retina)was used to evaluate macular sensitivity.Ganglion cell complex(GCC)thicknesses were examined using an RS-3000 Advance OCT system.The features of structure and function were analysed per quadrant.RESULTS:The pre-perimetric glaucoma group had significantly lower inferior hemifield macular sensitivity compared to controls(P<0.05).The early-stage POAG group had significantly lower average,inferior hemifield,inferonasal,and inferotemporal mean sensitivities compared to the pre-perimetric glaucoma group(P<0.05),and lower macular sensitivity in all sectors compared to controls(P<0.05).Regarding GCC thickness,all sectors in the early-stage POAG group became thinner compared to those in controls(P<0.05);whereas all sectors in the early-stage POAG group,except the superonasal quadrant,became thinner compared to those in the pre-perimetric glaucoma group(P<0.05).Macular sensitivity and GCC thickness were significantly associated in each sector.The inferotemporal quadrant had the highest correlation coefficients(0.840).The structure-function relationship for the inferonasal and inferotemporal sectors was stronger compared to the corresponding superior sectors.CONCLUSION:Microperimetry reveals variations in macular sensitivity in patients with early glaucoma earlier than conventional perimetry,particularly in pre-perimetric glaucoma cases in which it might be undetectable by conventional methods.The new custom-made pattern may improve the accuracy of microperimetry by enhancing point arrangement and reducing fatigue effects.Macular sensitivity measured by MP-3 with this pattern shows statistically significant structural and functional associations with the thicknesses of the GCC.

广域SS-OCTA下早期糖尿病性视网膜病黄斑区的改变

目的基于广域扫频光学相干断层扫描血管成像(SS-OCTA)观察早期糖尿病性视网膜病变(DR)黄斑视网膜微循环的改变及神经节细胞内丛状层(GC-IPL)结构的变化及其相关性。方法于2023年07月至2023年08月在安徽理工大学第一附属医院眼科共招募105例105眼DR患者,分为无DR组(NDR)53眼和轻至中度非增殖性DR组(NPDR)52眼两组,53例健康受试者作为对照组。采用SS-OCTA以黄斑为中心的12mm×12mm扫描成像并自动定量测算黄斑不同分区的浅层血管复合体(SVC)、深层血管复合体(DVC)的血管密度(VD)、灌注面积(PA),SVC的小血管密度(SVD)以及神经节细胞内从状层(GC-IPL)厚度,并进行相关性分析。结果与对照组相比,NDR组DVC中只有鼻侧象限PA差异有统计学意义(P=0.035);NPDR组除了SVC中VD的上、颞侧象限、PA的上象限、DVC中VD的鼻侧象限差异没有统计学意义(P=0.443、P=0.302、P=0.644、P=0.129),其余均有统计学意义(P<0.05)。与NDR组相比,NPDR组的SVC、DVC中平均VD、总PA以及各象限的和SVC中SVD平均以及各象限的差异均有统计学意义(P<0.05)。与对照组、NDR组相比,NPDR组鼻侧象限GC-IPL的差异均有统计学意义(P=0.020、P=0.003);与对照组相比,NDR组GC-IPL中的差异以及各象限无统计学意义(P=1.000)。在Spearman相关分析中,鼻侧象限GC-IPL与SVC中平均VD、总PA、SVD呈正相关性(r=0.438,P<0.001;r=0.417,P<0.001;r=0.439,P<0.001),中等相关;与DVC中平均VD、总PA呈正相关性(r=0.247,P=0.002;r=0.360,P<0.001),弱相关。结论随着DR进展,广域SS-OCTA可观察到视网膜微循环先代偿性增加后下降。浅层小血管的密度可作为临床前糖尿病视网膜病变早期客观检测影像学标志。早期DR视网膜微循环的改变和视网膜神经改变存在相关性。

3D-OCT对早期原发性青光眼黄斑区视网膜神经节细胞复合体及神经纤维层结构变化的评估

背景 视网膜神经纤维层（RNFL）变薄被认为是能够检测到的青光眼最早期的改变,3D-OCT对黄斑区神经节细胞复合体（mGCC）厚度的检测使得检测黄斑区节细胞的改变成为可能,为更早发现和诊断青光眼提供思路. 目的 利用3D-OCT检查系统检测早期原发性青光眼mGCC厚度及视盘周围RNFL厚度的变化,评估早期原发性青光眼视神经损害的解剖基础. 方法 对2010年12月至2012年12月在中日友好医院眼科就诊的一眼为中晚期而对侧眼为早期的原发性青光眼的10例患者采集的3D-OCT扫描图像进行回顾性分析.所有患者均符合1987年中国青光眼学组推荐的诊断标准,临床检查资料完整.患者均接受常规眼科检查和眼底3D-OCT检查,分别采用3D-macular模式、3D-macular Wide模式和3D-disc模式对原发性青光眼黄斑区、后极部和视盘进行扫描,利用检查系统自带软件对黄斑6 mm×6 mm区域的扫描结果进行分析,由黄斑中心凹向外各方向等距离分成100个小格区,每个格区面积为0.6 mm×0.6 mm,按照mGCC的变薄程度由重到轻依次以红色、黄色和灰色标记,以每个小格中的数字与其正常值比较得到与颜色匹配的、mGCC变薄程度发生的概率值（依次为P＜1％、P＜5％、P≥5％）表示.然后分析视盘旁RNFL厚度和不同部位的厚度曲线改变,并评估视盘生理凹陷的改变. 结果 10例患者患早期青光眼的眼和对侧眼视细胞层和双极细胞层厚度均未发生改变,而患中晚期青光眼的一侧眼视盘周围RNFL厚度概率图呈红色,即视盘周围RNFL层厚度明显变薄,mGCC厚度概率和黄斑区RNFL厚度概率图呈红色,即mGCC和黄斑区RNFL层厚度明显变薄;而患早期青光眼的一侧眼视野均正常,mGCC厚度概率图和黄斑区RNFL区呈黄色,即mGCC和黄斑区RNFL厚度轻微变薄;视盘周围RNFL厚度概率图呈绿色或黄色,即视盘周围RNFL厚度正常或轻微变薄.结论 原发性青光眼mGCC层厚度变薄早于视盘周围RNFL的变薄,提示青光眼视神经结构的损害始于RGCs的细胞体并早于轴突的损伤或丢失.

神经节细胞复合体厚度检测在原发性开角型青光眼中的诊断价值

背景青光眼以损害视网膜神经节细胞（RGCs）继而出现视野缺损为特征，高分辨率频域OCT（SD-OCT）可以准确可靠地定量分析黄斑区视网膜神经节细胞复合体（GCC）厚度。目的探讨黄斑区GCC厚度对原发性开角型青光眼（POAG）的诊断意义。方法采用前瞻性诊断试验研究设计。于2015年11月至2016年4月在北京同仁医院连续纳入POAG患者70例和30名健康志愿者，应用RTVue SD—OCT对70例POAG患者和30名正常对照者进行黄斑区GCC厚度和视盘周围视网膜神经纤维层（RNFL）厚度检测，并行Humphrey视野检查，均纳入受检者的右眼进行统计。根据视野检查的平均缺损（MD）值将POAG分为早期、进展期和晚期，对各组受检眼平均GCC、上方GCC和下方GCC、平均RNFL、上方RNFL、下方RNFL、局部丢失体积（FLV）和整体丢失体积（GLV）进行比较；评估POAG患者GCC厚度、RNFL厚度与视野MD值的关系，采用曲线下面积（AUC）和受试者工作特征ROC曲线评价GCC厚度和RNFL厚度对POAG的诊断效率。结果与正常对照组比较，早期POAG组、进展期POAG组和晚期POAG组的平均GCC、上方GCC、下方GCC、平均RNFL、上方RNFL和下方RNFL均明显降低，FLV和GLV均明显升高，各组间总体比较差异均有统计学意义（均P〈0．001）；与早期POAG组比较，进展期POAG组和晚期POAG组受检眼平均GCC值和平均RNFL厚度值均明显下降，GLV值明显增加，差异均有统计学意义（均P〈0.05）；晚期POAG组受检眼上方RNFL厚度值明显低于早期POAG组，差异有统计学意义（P=0．003）；晚期POAG组受检眼上方GCC值明显低于早期POAG组和进展期POAG组，差异均有统计学意义（均P〈0.001）；与早期POAG组比较，进展期POAG组和晚期POAG组受检眼下方GCC和下方RNFL厚度值明显下降，FLV明显增加，差异均有统计学意义（均P≤0．01）。POAG患者平均GCC、上方GCC和下方GCC、平均RNFL、上方RNFL和下方RNFL与MD值均呈线性正相关（r=0．624、0．583、0．601、0．571、0．447、0．537，均P〈0.001）；POAG患者平均GCC与平均RNFL、上方GCC与上方RNFL以及下方GCC与下方RNFL均呈线性正相关（r=0．648、0．630、0．602，均P〈0.001）。平均GCC、上方GCC、下方GCC、FLV、GLV、平均RNFL、上方RNFL和下方RNFL的AUC值分别为0．965、0．924、0．979、0．985、0．980、0．990、0．979和0．992（均P〈0．001）。GCC参数中FLV与下方RNFL的AUC值比较，差异无统计学意义（P〉0．05）。结论POAG患者下方GCC厚度更容易受到损伤，GCC参数中FLV和GLV是诊断POAG的敏感指标，GCC厚度可以作为诊断和判断POAG病情进展的有效指标。

频域-OCT观测原发性闭角型青光眼患者视盘形态、视网膜神经纤维层及神经节细胞复合体的临床意义

目的应用频域-OCT观测原发性闭角型青光眼(primary angle closed glaucoma,PACG)患者视盘形态、视网膜神经纤维层(retinal nerve fiber layer,RNFL)及黄斑区神经节细胞复合体(ganglion cell complex,GCC),分析其与视野平均缺损(mean deviation,MD)的相关性。方法选取35例60眼PACG患者,根据视野损害程度分为早期及中晚期2组,与33例正常人进行频域-OCT对比检查。测量视盘形态学参数、整体平均RNFL厚度(RNFL-Avg)、上方平均RNFL厚度(RNFL-Sup)、下方平均RNFL厚度(RNFL-Inf)、整体平均GCC的厚度(GCC-Avg)、上方平均GCC厚度(GCC-Sup)、下方平均GCC厚度(GCC-Inf),并分析青光眼患者组视野MD与RNFL、GCC的相关性。结果视盘各形态学参数在各期PACG组与正常对照组间的差异具有统计学意义(视盘面积F=14.29、P=0.000;视杯面积F=11.31、P=0.000;盘沿面积F=6.27、P=0.002;盘沿容积F=10.41、P=0.000;视神经盘容积F=3.53、P=0.034;视杯容积F=10.99、P=0.000;杯盘比F=8.64、P=0.000;杯盘纵比F=3.14、P=0.048;杯盘横比F=4.20、P=0.012)。其中视盘面积差异表现为两个PACG组均较正常对照组大,而两个PACG组间差异无统计学意义;其他各参数表现为:中晚期PACG组的视杯面积、视杯容积、杯盘比均比正常对照组显著增大;而盘沿面积、盘沿容积和视神经盘容积均比正常对照组显著减小。增大及缩小的程度与正常对照组比较,差异均具有统计学意义,变化符合PACG神经损害的特点;而早期PACG组在上述参数中与正常对照组之间的差异均无统计学意义(均为P>0.05)。对RNFL及GCC的分析中,PACG组与正常对照组间的差异具有统计学意义(RNFL-Avg F=9.79、P=0.000;RNFL-Sup F=6.48、P=0.002;RNFL-Inf F=7.54、P=0.001;GCC-Avg F=6.62、P=0.002;GCC-Sup F=5.69、P=0.005;GCC-Inf F=6.45、P=0.003)。组间两两比较发现:中晚期PACG组上述各参数与正常对照组的差异具有统计学意义(均为P<0.05);而早期PACG组各参数与正常对照组间的差异无统计学意义(均为P>0.05)。中晚期PACG组RNFL和GCC均与MD呈明显的正相关(r=0.689 5,P=0.001;r=0.527 1,P=0.010);早期PACG组RNFL及GCC与MD无相关性(r=-0.208 4、P=0.244;r=0.200 1、P=0.281)。结论频域-OCT是一种比较敏感的能够观察到视网膜结构改变的检查方法,但其对于早期青光眼的诊断仍具有局限性。

傅立叶光学相干断层扫描测量黄斑区节细胞复合体和视网膜神经纤维层的可重复性研究

目的采用傅立叶光学相干断层扫描(OCT)对正常眼压性青光眼(NTG)与原发性开角型青光眼(POAG)患者的黄斑区节细胞复合体(mGCC)和视网膜神经纤维层(RNFL)进行测量,评估其可重复性和诊断能力。方法以NTG患者(NTG组,n=15)、POAG患者(POAG组,n=15)和正常人(正常对照组,n=15)作为研究对象,采用傅立叶OCT测量各组RNFL厚度以及mGCC厚度及其整体丢失体积(GLV)和局部丢失体积(FLV),首先由检查者A测量,重复5次,间隔时间为4 h,检查者B于次日行相同检查。以检查者内和检查者间的类内相关系数(ICC)评估可重复性,受试者工作特征曲线下面积(AROC)分析诊断能力。结果三组mGCC和RNFL测量的ICC均>0.75。NTG组和POAG组的各项测量参数与正常对照组比较差异均有统计学意义(P<0.05);NTG组与POAG组RNFL厚度和FLV%比较差异无统计学意义(P>0.05),而mGCC厚度和GLV%比较差异有统计学意义(P<0.01,P<0.001);RNFL与mGCC参数间的AROC比较差异无统计学意义(P>0.05)。结论对于NTG和POAG患者,傅立叶OCT测量mGCC和RNFL的可重复性好,RNFL具有良好的诊断能力,mGCC可作为良好的补充诊断依据。

OCT测量黄斑区神经节细胞复合体厚度在早期原发性开角型青光眼诊断中的作用

目的利用光学相干断层扫描技术(optical coherence tomography,OCT)比较正常人和早期原发性开角型青光眼(primary open-angle glaucoma,POAG)患者黄斑区神经节细胞复合体(ganglion cell complex,GCC)厚度的差异,评价其对早期POAG的诊断价值。方法选取早期POAG患者46例(46眼)为早期POAG组,正常人50人(50眼)为正常组,利用RT-Vue-100FD-OCT GCC程序记录2组黄斑区平均、上方及下方GCC厚度,分析2组黄斑区不同区域GCC厚度差异,确定OCT测量黄斑区GCC厚度值对早期POAG的最佳诊断指标。结果正常组黄斑区平均、上方及下方GCC厚度值分别为(104.76±5.96)μm、(104.89±6.73)μm、(104.61±6.37)μm,各区域厚度值间对比差异无统计学意义(P>0.05);早期POAG组黄斑区平均、上方及下方GCC厚度值分别为(88.81±7.50)μm、(89.04±8.84)μm、(89.07±7.92)μm,各区域GCC厚度值比较差异无统计学意义(P>0.05);早期POAG组黄斑区不同区域GCC厚度值较正常组明显变薄,2组间比较差异均有显著统计学意义(均为P<0.01)。正常人和早期POAG之间黄斑区平均、上方、下方GCC厚度的受试者工作特征曲线下面积分别为0.899、0.894、0.903。结论 OCT测量黄斑区GCC厚度可作为早期POAG的一种辅助诊断方法。

原发性慢性闭角型青光眼黄斑区结构损害的定量研究及相关分析

目的探讨慢性原发性闭角型青光眼(chronic primary angle-closure glaucoma,CPACG)患者黄斑区神经节细胞复合体(macular ganglion cell complex,m GCC)厚度变化及与视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度的相关性。方法采用RTVue100-2 OCT检测CPACG患者55例(55眼)早期、中期及晚期与正常人30例(30眼)平均、上方、下方m GCC厚度及平均、上方、下方RNFL厚度,比较组间各检测指标的差异,分析m GCC厚度与RNFL厚度的相关性。结果早期CPACG组、中期CPACG组、晚期CPACG组平均、上方、下方m GCC厚度值分别为(95.15±8.21)μm、(96.11±7.77)μm、(95.05±9.94)μm,(76.04±8.58)μm、(83.04±8.72)μm、(74.17±9.71)μm,(64.40±10.13)μm、(68.83±13.26)μm、(63.34±12.61)μm。早期CPACG组、中期CPACG组、晚期CPACG组各RNFL及m GCC厚度值均较正常对照组降低,差异均有统计学意义(均为P<0.05);随着青光眼病情的进展,RNFL厚度及m GCC厚度逐渐变薄,中期CPACG组各RNFL及m GCC厚度值均较早期CPACG组降低,差异均有统计学意义(均为P<0.05),晚期CPACG组各RNFL及m GCC厚度值均较中期CPACG组降低,差异均有统计学意义(均为P<0.05)。CPACG患者平均m GCC厚度和平均RNFL厚度、上方m GCC厚度和上方RNFL厚度、下方m GCC厚度和下方RNFL厚度均呈高度正相关(r=0.987、0.976、0.971,均为P=0.000)。结论频域OCT检测的CPACG患者的m GCC厚度随青光眼病情的进展逐渐变薄,与RNFL厚度有良好的相关性。

频域光相干断层扫描在原发性青光眼诊断中的应用研究进展

光相干断层扫描（OCT）具有非接触性、可重复性好、获取眼部图像快等优点，随着OCT图像分辨率和扫描速度的不断提高，以及从时域OCT（TD-OCT）到频域OCT（SD-OCT）的发展，使其在眼科领域的应用越来越广泛。在原发性青光眼的诊断中，OCT从对视野出现损害的中晚期青光眼的诊断已经发展到可以对视野损害前的青光眼进行诊断，尤其是在原发性开角型青光眼（POAG）病程进展的随访检查中起到重要作用。近年来，通过检测视网膜神经纤维层（RNFL）厚度、视盘结构参数以及对黄斑区视网膜神经节细胞复合体（mGCC）厚度进行测量，SD-OCT对青光眼的检测和诊断作出了巨大的贡献。本文对SD-OCT检测以上参数在原发性青光眼诊断中的应用研究进展进行综述。

OCT对多发性硬化与视神经脊髓炎谱系疾病患者视功能损伤的评价

目的:利用光学相干断层扫描(OCT)检测复发缓解型多发性硬化(RRMS)与视神经脊髓炎谱系疾病(NMOSD)患者的视乳头周围视网膜神经纤维层(pRNFL)和黄斑区神经节细胞复合体(GCC)厚度,探讨疾病所致的视神经及轴突损伤情况。方法:回顾性病例对照分析。收集2014-08/2016-01首都医科大学附属北京天坛医院收治的RRMS患者60例、NMOSD-AQP4抗体阳性患者48例、NMOSD-AQP4抗体阴性患者35例及正常对照健康人群60例,通过OCT检测pRNFL(包括平均和上方、下方、鼻侧、颞侧四个象限)和GCC(包括平均和上方、下方两个象限)的厚度,采用单因素方差分析或秩和检验进行比较分析。结果:RRMS、NMOSD-AQP4抗体阳性及NMOSD-AQP4抗体阴性组pRNFL(平均和四个象限)及GCC厚度(平均和上方、下方)均较正常对照组减少,差异有统计学意义(P<0.01),其中NMOSD-AQP4抗体阳性组的pRNFL及GCC厚度最薄。组间pRNFL厚度比较:NMOSD-AQP4抗体阳性组与RRMS组相比,四个象限pRNFL厚度均明显变薄,差异有统计学意义(P<0.01);NMOSD-AQP4抗体阳性组与NMOSD-AQP4抗体阴性组相比,下方、鼻侧、颞侧象限pRNFL均更薄,差异有统计学意义(P<0.05),上方pRNFL厚度无统计学差异(P>0.05);NMOSD-AQP4抗体阴性组和RRMS组相比,上方pRNFL厚度更薄,差异有统计学意义(P<0.05),下方、鼻侧、颞侧象限pRNFL厚度上无统计学差异(P>0.05)。组间GCC厚度比较:NMOSDAQP4抗体阳性组上方、下方象限GCC厚度比RRMS组和NMOSD-AQP4抗体阴性组变薄明显,差异有统计学意义(P<0.05),NMOSD-AQP4抗体阴性组和RRMS组相比,上方GCC厚度更薄,差异有统计学意义(P<0.01),下方GCC厚度无统计学差异(P>0.05)。结论:NMOSD-AQP4抗体阳性患者的轴突损伤最明显,RRMS患者损伤最轻,而NMOSD-AQP4抗体阴性患者介于二者之间,且与RRMS更为相似。

无视网膜病变的糖尿病患者视网膜神经与血管损害及其相关性分析

目的探究无糖尿病视网膜病变(NDR)的糖尿病患者视网膜神经与血管损害,并分析其相关性。方法纳入无视网膜病变的2型糖尿病患者66眼为NDR组,健康者62眼为对照组。使用免散瞳、全视野闪光ERG记录仪(RETeval)记录16 Td·s(6.0 mm瞳孔直径时,1 cd·s·m-2=28.3 Td·s)和32 Td·s光刺激时两组的潜伏期及振幅。采用光学相干断层扫描血管成像(OCTA)检测黄斑区浅层毛细血管丛(SCP)、深层毛细血管丛(DCP)的血管密度及黄斑中心凹无血管区周围300μm的毛细血管密度(FD300)、神经节细胞复合体(GCC)层厚度、视网膜神经纤维层(RNFL)厚度。分析NDR组患眼视网膜结构与功能的改变,并分析其与糖尿病病程和糖化血红蛋白(HbAlc)水平的相关性。结果NDR组在旁中心凹区和中心凹周围区的SCP的血管密度分别为(49.97±4.45)%、(48.12±4.01)%,均低于对照组的(52.47±4.31)%(P=0.002)、(50.42±3.73)%(P=0.001);NDR组在旁中心凹区和中心凹周围区的DCP的血管密度分别为(52.70±4.51)%、(48.62±6.39)%,均低于对照组的(55.99±4.09)%(P<0.001)、(52.71±6.56)%(P=0.001)。但两组间GCC层厚度无明显差异(P=0.661)。NDR组RNFL厚度为(109.85±11.50)μm,较对照组(115.06±10.61)μm显著降低(P=0.009);NDR组视盘周围血管密度为(50.27±4.10)%,较对照组(52.48±2.73)%显著降低(P<0.001)。ERG检测结果显示,在16 Td·s和32 Td·s光刺激时与对照组相比,NDR组潜伏期均延长和振幅均下降(均为P<0.01)。多元线性回归分析结果显示,16 Td·s和32 Td·s光刺激ERG的潜伏期延长均与HbAlc升高显著相关(β=0.350,P<0.001;β=0.328,P<0.001),与旁中心凹区SCP血管密度下降也显著相关(β=-0.266,P=0.013;β=-0.253,P=0.005),而与GCC层厚度均不相关(均为P>0.05)。结论在出现临床可见的视网膜病变之前,糖尿病患者的视网膜就已经开始出现结构和功能的损伤。NDR患者早期视功能改变可能与微血管异常有关,ERG潜伏期延长与血糖控制不良相关。