Values of macular ganglion cell-inner plexiform layer and 10-2 visual field measurements in detecting and evaluating glaucoma

AIM:To assess the performance of macular ganglion cell-inner plexiform layer thickness(mGCIPLT)and 10-2 visual field(VF)parameters in detecting early glaucoma and evaluating the severity of advanced glaucoma.METHODS:Totally 127 eyes from 89 participants(36 eyes of 19 healthy participants,45 eyes of 31 early glaucoma patients and 46 eyes of 39 advanced glaucoma patients)were included.The relationships between the optical coherence tomography(OCT)-derived parameters and VF sensitivity were determined.Patients with early glaucoma were divided into eyes with or without central 10°of the VF damages(CVFDs),and the diagnostic performances of OCT-derived parameters were assessed.RESULTS:In early glaucoma,the mGCIPLT was significantly correlated with 10-2 VF pattern standard deviation(PSD;with average mGCIPLT:β=-0.046,95%CI,-0.067 to-0.024,P<0.001).In advanced glaucoma,the mGCIPLT was related to the 24-2 VF mean deviation(MD;with average mGCIPLT:β=0.397,95%CI,0.199 to 0.595,P<0.001),10-2 VF MD(with average mGCIPLT:β=0.762,95%CI,0.485 to 1.038,P<0.001)and 24-2 VF PSD(with average mGCIPLT:β=0.244,95%CI,0.124 to 0.364,P<0.001).Except for the minimum and superotemporal mGCIPLT,the decrease of mGCIPLT in early glaucomatous eyes with CVFDs was more severe than that of early glaucomatous eyes without CVFDs.The area under the curve(AUC)of the average mGCIPLT(AUC=0.949,95%CI,0.868 to 0.982)was greater than that of the average circumpapillary retinal nerve fiber layer thickness(cpRNFLT;AUC=0.827,95%CI,0.674 to 0.918)and rim area(AUC=0.799,95%CI,0.610 to 0.907)in early glaucomatous eyes with CVFDs versus normal eyes.CONCLUSION:The 10-2 VF and mGCIPLT parameters are complementary to 24-2 VF,cpRNFLT and ONH parameters,especially in detecting early glaucoma with CVFDs and evaluating the severity of advanced glaucoma in group level.

Comparisons of ganglion cell-inner plexiform layer loss patterns and its diagnostic performance between normal tension glaucoma and primary open angle glaucoma: a detailed, severity-based study

AIM: To evaluate the patterns of macular ganglion cell-inner plexiform layer(GCIPL) loss in normal tension glaucoma(NTG) and primary open angle glaucoma(POAG) in a detailed, disease severity-matched way;and to assess the diagnostic capabilities of GCIPL thickness parameters in discriminating NTG or POAG from normal subjects.METHODS: A total of 157 eyes of 157 subjects, including 57 normal eyes, 51 eyes with POAG and 49 eyes with NTG were enrolled and strictly matched in age, refraction, and disease severity between POAG and NTG groups. The average, minimum, superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal GCIPL thickness, and the average, superior, temporal, inferior, and nasal retinal nerve fiber layer(RNFL) thickness were obtained by Cirrus optical coherence tomography(OCT). The diagnostic capabilities of OCT parameters were assessed by area under receiver operating characteristic(AUROC) curves. RESULTS: Among all the OCT thickness parameters, no statistical significant difference between NTG group and POAG group was found(all P>0.05). In discriminating NTG or POAG from normal subjects, the average and inferior RNFL thickness, and the minimum GCIPL thickness had better diagnostic capabilities. There was no significant difference in AUROC curve between the best GCIPL thickness parameter(minimum GCIPL) and the best RNFL thickness parameter in discriminating NTG(inferior RNFL;P=0.076) and indiscriminating POAG(average RNFL;P=0.913) from normal eyes.CONCLUSION: Localized GCIPL loss, especially in the inferior and inferotemporal sectors, is more common in NTG than in POAG. Among all the GCIPL thickness parameters, the minimum GCIPL thickness has the best diagnostic performance in differentiating NTG or POAG from normal subjects, which is comparable to that of the average and inferior RNFL thickness.

Retinal nerve fiber layer and ganglion cell-inner plexiform layer thickness in children with obesity

AIM：To evaluate retinal nerve fiber layer（RNFL）thickness analysis of peripapillary optic nerve head（PONH） and macula as well as ganglion cell-inner plexiform layer（GCIPL） thickness in obese children.· METHODS：Eighty-five children with obesity and 30 controls were included in the study.The thicknesses of the PONH and macula of each subject＇s right eye were measured by high-resolution spectral-domain optic coherence tomography（OCT）.· RESULTS：The RNFL thicknesses of central macular and PONH were similar between the groups（all P 〉0.05）.The GCIPL thickness was also similar between the groups.However,the RNFL thickness of temporal outer macula were 261.7±13.7 and 268.9±14.3 μm for the obesity and the control group,respectively（P =0.034）.· CONCLUSION：Obesity may cause a reduction in temporal outer macular RNFL thickness.

Different damage patterns of retinal nerve fiber layer and ganglion cell-inner plexiform layer between early glaucoma and non-glaucomatous optic neuropathy

AIM:To compare the damage pattern of the peripapillary retinal nerve fiber layer(pRNFL)and the macular ganglion cell-inner plexiform layer(mGCIPL)between early glaucomatous and non-glaucomatous optic neuropathy(EGON and NGON).METHODS:It is a cross-sectional study.Thirty-eight healthy controls,74 EGONs and 70 NGONs with comparable average pRNFL loss were included.The NGON group included 23 eyes of optic neuritis(ON),13 eyes of hereditary optic neuropathy(HON),19 eyes of toxic optic neuropathy(TON)and 15 eyes of compressive neuropathy(CON).The sectoral pRNFL and mGCIPL thickness obtained by high definition optical coherence tomography were analyzed.RESULTS:Compared to normal controls,the pRNFL thickness in all quadrants showed a decrease in both EGON and NGON group(P<0.001),but the average pRNFL thickness of EGON group was not different to that of NGON group(P=0.94).The inferior and superior pRNFL was thinner in EGON group compared to NGON group(P<0.001).The temporal pRNFL was thinner in NGON group compared to EGON group(P<0.001).No statistically significant difference was found in nasal pRNFL between EGON and NGON.While the nasal pRNFL was thinner in CON than other three types of NGON(P=0.01),no statistically significant difference was found in other three quadrantal pRNFL among the four types of NGON(P>0.05).The mGCIPL of EGON and NGON group were thinner than control group(P<0.001).In EGON group the severest sites of mGCIPL reduction was located at inferotemporal and inferior sectors.While,compared to EGON group,the average mGCIPL of NGON groupwere significantly thinner,especially in superonasal and inferonasal sectors(P<0.001).CONCLUSION:The damage pattern of pRNFL and mGCIPL caused by glaucoma is distinct from other NGON such as ON,TON,HON and CON,and this characteristic damage pattern is helpful in differentiating early glaucoma from other NGON.

Correlation between macular ganglion cell-inner plexiform layer thickness and visual acuity after resolution of the macular edema secondary to central retinal vein occlusion

AIM： To examine the thickness of the ganglion cell-inner plexiform layer（GCIPL） in eyes with resolved macular edema（ME） in non-ischemic central retinal vein occlusion（CRVO）, applying spectral-domain optical coherence tomography（SD-OCT）, and its relationship with visual acuity.METHODS： The retrospective observational case-control study included 30 eyes of non-ischemic CRVO patients with resolved ME（ME eyes） after treatment, and 30 eyes of non-ischemic CRVO patients without ME（non-ME eyes）. The macular GCIPL thickness, peripapillary retinal nerve fiber layer（p RNFL） thickness and central macular thickness（CMT） were measured on a SD-OCT scan. Linear regression analyses were performed to determine the correlation between the thickness of each and the visual acuity（VA）.RESULTS： No significant difference in average GCIPL thickness, mean pR NFL thickness and CMT were observed between ME group and non-ME group（P=0.296, 0.183, 0.846）. But, minimum GCIPL thickness was reduced in ME eyes compared with non-ME eyes（P=0.022）. Final VA significantly correlated with the minimum GCIPL thickness in ME eyes（r=-0.482, P=0.007）, whereas no correlation was found with average GCIPL thickness, average pR NFL thickness and mean CMT.CONCLUSION： Minimum GCIPL thickness is reduced in ME eyes compared with non-ME eyes, and correlated with the VA in non-ischemic CRVO. These results propose that inner retinal damage occurring in patients with ME secondary to non-ischemic CRVO may lead to permanent visual defect after treatment.

Retinal ganglion cell-inner plexiform and nerve fiber layers in neuromyelitis optica

AIM： To determine the thickness of the retinal ganglion cell-inner plexiform layer（GCIPL） and the retinal nerve fiber layer（RNFL） in patients with neuromyelitis optica（NMO）.METHODS： We conducted a cross-sectional study that included 30 NMO patients with a total of 60 eyes. Based on the presence or absence of optic neuritis（ON）, subjects were divided into either the NMO-ON group（30 eyes） or the NMO-ON contra group（10 eyes）. A detailed ophthalmologic examination was performed for each group; subsequently, the GCIPL and the RNFL were measured using highdefinition optical coherence tomography（OCT）. RESULTS： In the NMO-ON group, the mean GCIPL thickness was 69.28±21.12 μm, the minimum GCIPL thickness was 66.02±10.02 μm, and the RNFL thickness were 109.33±11.23, 110.47±3.10, 64.92±12.71 and 71.21±50.22 μm in the superior, inferior, temporal and nasal quadrants, respectively. In the NMO-ON contra group, the mean GCIPL thickness was 85.12±17.09 μm, the minimum GCIPL thickness was 25.39±25.1 μm, and the RNFL thicknesses were 148.33±23.22, 126.36±23.45, 82.21±22.30 and 83.36±31.28 μm in the superior, inferior, temporal and nasal quadrants, respectively. In the control group, the mean GCIPL thickness was 86.98±22.37 μm, the minimum GCIPL thickness was 85.28±10.75 μm, and the RNFL thicknesses were 150.22±22.73, 154.79±60.23, 82.33±7.01 and 85.62±13.81 μm in the superior, inferior, temporal and nasal quadrants, respectively. The GCIPL and RNFL were thinner in the NMO-ON contra group than in the control group（P〈0.05）; additionally, the RNFL was thinner in the inferior quadrant in the NMO-ON group than in the control group（P〈0.05）. Significant correlations were observed between the GCIPL and RNFL thickness measurements as well as between thickness measurements and the two visual field parameters of mean deviation（MD） and corrected pattern standard deviation（PSD） in the NMO-ON group（P〈0.05）. CONCLUSION： The thickness of the GCIPL and RNFL, as measured using OCT, may indicate optic nerve damage in patients with NMO.

Anti-vascular endothelial growth factor drugs combined with laser photocoagulation maintain retinal ganglion cell integrity in patients with diabetic macular edema: study protocol for a prospective, non-randomized, controlled clinical trial

The integrity of retinal ganglion cells is tightly associated with diabetic macular degeneration that leads to damage and death of retinal ganglion cells,affecting vision.The major clinical treatments for diabetic macular edema are anti-vascular endothelial growth factor drugs and laser photocoagulation.However,although the macular thickness can be normalized with each of these two therapies used alone,the vision does not improve in many patients.This might result from the incomplete recovery of retinal ganglion cell injury.Therefore,a prospective,non-randomized,controlled clinical trial was designed to investigate the effect of anti-vascular endothelial growth factor drugs combined with laser photocoagulation on the integrity of retinal ganglion cells in patients with diabetic macular edema and its relationship with vision recovery.In this trial,150 patients with diabetic macular edema will be equally divided into three groups according to therapeutic methods,followed by treatment with anti-vascular endothelial growth factor drugs,laser photocoagulation therapy,and their combination.All patients will be followed up for 12 months.The primary outcome measure is retinal ganglion cell-inner plexiform layer thickness at 12 months after treatment.The secondary outcome measures include retinal ganglion cell-inner plexiform layer thickness before and 1,3,6,and 9 months after treatment,retinal nerve fiber layer thickness,best-corrected visual acuity,macular area thickness,and choroidal thickness before and 1,3,6,9,and 12 months after treatment.Safety measure is the incidence of adverse events at 1,3,6,9,and 12 months after treatment.The study protocol hopes to validate the better efficacy and safety of the combined treatment in patients with diabetic macula compared with the other two monotherapies alone during the 12-month follow-up period.The trial is designed to focus on clarifying the time-effect relationship between imaging measures related to the integrity of retinal ganglion cells and best-corrected visual acuity.The trial protocol was approved by the Medical Ethics Committee of the Affiliated Hospital of Beihua University with approval No.(2023)(26)on April 25,2023,and was registered with the Chinese Clinical Trial Registry(registration number:ChiCTR2300072478,June 14,2023,protocol version:2.0).

Discriminating performance of macular ganglion cellinner plexiform layer thicknesses at different stages of glaucoma

AIM: To determine the discriminating performance of the macular ganglion cell-inner plexiform layer(GCIPL) parameters between all the consecutive stages of glaucoma(from healthy to moderate-to-severe glaucoma), and to compare it with the discriminating performances of the peripapillary retinal nerve fiber layer(RNFL) parameters and optic nerve head(ONH) parameters.METHODS: Totally 147 eyes(40 healthy, 40 glaucoma suspects, 40 early glaucoma, and 27 moderate-to-severe glaucoma) of 133 subjects were included. Optical coherence tomography(OCT) was obtained using Cirrus HD-OCT 5000. The diagnostic performances of GC-IPL, RNFL, and ONH parameters were evaluated by determining the area under the curve(AUC) of the receiver operating characteristics. RESULTS: All GC-IPL parameters discriminated glaucoma suspect patients from subjects with healthy eyes and moderate-to-severe glaucoma from early glaucoma patients(P<0.017, for all). Also, minimum, inferotemporal and inferonasal GC-IPL parameters discriminated early glaucoma patients from glaucoma suspects, whereas no RNFL or ONH parameter could discriminate between the two. The best parameters to discriminate glaucoma suspects from subjects with healthy eyes were superonasal GC-IPL, superior RNFL and average c/d ratio(AUC=0.746, 0.810 and 0.746, respectively). Discriminating performances of all the parameters for early glaucoma vs glaucoma suspect comparison were lower than that of the other consecutive group comparisons, with the bestGC-IPL parameters being minimum and inferotemporal(AUC=0.669 and 0.662, respectively). Moreover, minimum GC-IPL, average RNFL, and rim area(AUC=0.900, 0.858, 0.768, respectively) were the best parameters for discriminating moderate-to-severe glaucoma patients from early glaucoma patients.CONCLUSION: GC-IPL parameters can discriminate glaucoma suspect patients from subjects with healthy eyes, and also all the consecutive stages of glaucoma from each other(from glaucoma suspect to moderate-tosevere glaucoma). Further, the discriminating performance of GC-IPL thicknesses is comparable to that.

0.01%阿托品滴眼液对不同程度近视儿童黄斑微循环的影响

目的:研究0.01%阿托品滴眼液对不同程度近视儿童黄斑血流密度及视网膜厚度的影响。方法:前瞻性自身对照研究。64例(112眼)首次诊断为屈光不正(近视)的患者在使用0.01%阿托品滴眼液治疗前及用药6个月后进行眼科检查,包括裸眼远视力(uncorrecte d distance visual acuity,UCVA)、眼轴(axial length,AL)、等效球镜度数(spherical equivalent,SE)、裂隙灯检查及使用光学相干断层扫描(optical coherence tomography,OCT)常规模式测量黄斑神经节细胞-内丛状层厚度(macular ganglion cell-inner plexiform layer thicknes,mGCIPL)。使用光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)测量黄斑区血管密度、中心凹无血管区面积等。比较用药前后各项指标的变化。结果:3组近视患者AL均较用药前显著增长(P<0.01),但低、中度近视用药前后差值明显小于高度近视组;3组近视患者SE均较用药前增长,但低度近视组用药前后差异无统计学意义(P>0.05),中度、高度近视组差异均具有统计学意义(P<0.01);3组近视患者眼压(intraocular pressure,IOP)较用药前无明显变化(P>0.05)。用药6个月后,中心圆黄斑血管密度(central circle macular vessel density,cCVD)增加在低度、中度近视组中均有统计学差异(P<0.01),在高度近视组中差异无统计学意义(P>0.05)。3个近视组用药前后外圆黄斑血管密度(outer circle macular vessel density,oCVD)、内圆黄斑血管密度(inner circle macular vessel density,iCVD)、全圆黄斑血管密度(whole circle macular vessel density,wCVD)无明显改变(P>0.05);mGCIPL增加在低度近视组中有统计学差异(P<0.01),在中度、高度近视组中均无统计学差异(P>0.05)。3个近视组黄斑中心凹无血管区(foveal avascular zone,FAZ)面积在用药前后无明显改变(P>0.05)。3个近视组中cCVD和AL、SE之间均无相关性(P>0.01),低度近视组中c CVD与m GCIPL呈低度相关(r=0.442,P<0.05),中度、高度近视组中cCVD与mGCIPL均无相关性(P>0.01)。结论:0.01%阿托品滴眼液可以明显降低低度近视患儿AL增长及屈光度增长速度,增加低、中度近视患儿黄斑中心圆血管密度,增加低度近视患儿m GCIPL厚度。

Effect of infusion pressure during cataract surgery on ganglion cells measured using isolated-check visual evoked potential

AIM： To detect the relationship between infusion pressure and postoperative ganglion cells function.METHODS： This prospective observational cohort study included sixty-one eyes that underwent uncomplicated cataract surgery. Patients were divided into two groups according to infusion time（IT） recorded using surgery equipment [Group A： IT〉IT_（mean）（27 eyes）; Group B： IT

Structural measurements and vessel density of spectraldomain optic coherence tomography in early,moderate,and severe primary angle-closure glaucoma

AIM:To compare the macular ganglion cell-inner plexiform layer(GCIPL)thickness,retinal nerve fiber layer(RNFL)thickness,optic nerve head(ONH)parameters,and retinal vessel density(VD)measured by spectral-domain optical coherence tomography(SD-OCT)and analyze the correlations between them in the early,moderate,severe primary angle-closure glaucoma(PACG)and normal eyes.METHODS:Totally 70 PACG eyes and 20 normal eyes were recruited for this retrospective analysis.PACG eyes were further separated into early,moderate,or severe PACG eyes using the Enhanced Glaucoma Staging System(GSS2).The GCIPL thickness,RNFL thickness,ONH parameters,and retinal VD were measured by SD-OCT,differences among the groups and correlations within the same group were calculated.RESULTS:The inferior and superotemporal sectors of the GCIPL thickness,rim area of ONH,average and inferior sector of the retinal VD were significantly reduced(all P<0.05)in the early PACG eyes compared to the normal and the optic disc area,cup to disc ratio(C/D),and cup volume were significantly higher(all P<0.05);but the RNFL was not significant changes in early and moderate PACG.In severe group,the GCIPL and RNFL thickness were obvious thinning with retinal VD were decreasing as well as C/D and cup volume increasing than other three groups(all P<0.01).In the early PACG subgroup,there were significant positive correlations between retinal VD and GCIPL thickness(except superonasal and inferonasal sectors,r=0.573 to 0.641,all P<0.05),superior sectors of RNFL thickness(r=0.055,P=0.049).More obvious significant positive correlations were existed in moderate PACG eyes between retinal VD and superior sectors of RNFL thickness(r=0.650,P=0.022),and temporal sectors of RNFL thickness(r=0.740,P=0.006).In the severe PACG eyes,neither GCIPL nor RNFL thickness was associated with retinal VD.CONCLUSION:The ONH damage and retinal VD loss appears earlier than RNFL thickness loss in PACG eyes.As the PACG disease progressed from the early to the moderate stage,the correlations between the retinal VD and RNFL thickness increases.

光学相干断层扫描对2型糖尿病患者视网膜神经变性的早期评估价值

目的采用光学相干断层扫描(OCT)检测无糖尿病性视网膜病变(DR)的2型糖尿病(T2DM)患者在糖尿病视网膜神经变性(DRN)早期的视网膜神经厚度变化。方法采用横断面研究,选取2022年1—10月医院收治的32例无DR的T2DM患者(共32眼)作为试验组,以年龄、性别匹配的32名健康者(32眼)作为对照组。将黄斑区分为9个区域(中央区、上方内环区、颞侧内环区、下方内环区、鼻侧内环区、上方外环区、颞侧外环区、下方外环区和鼻侧外环区),采用OCT检测以上区域的黄斑视网膜神经纤维层(mRNFL)、神经节细胞层(GCL)、内丛状层(IPL)、视网膜厚度,并进行比较;将视盘分为4个区域(上方、下方、鼻侧、颞侧),采用OCT检测视盘视网膜神经纤维层(pRNFL)厚度,以及全周pRNFL平均厚度,并对两组各指标比较。结果黄斑区9个区域中,试验组下方外环区、鼻侧外环区mRNFL厚度低于对照组,中央区、上方内环区、颞侧内环区、下方内环区、鼻侧内环区的GCL厚度低于对照组,上方内环区、颞侧内环区、下方内环区、鼻侧内环区的IPL厚度低于对照组,差异均有统计学意义(P<0.05);两组黄斑区9个区域的视网膜厚度比较,差异均无统计学意义(P>0.05)。视盘4个区域中,试验组视盘上方、下方、鼻侧的pRNFL厚度均低于对照组,差异有统计学意义(P<0.05);两组颞侧pRNFL厚度及全周pRNFL平均厚度比较,差异均无统计学意义(P>0.05)。结论DRN早期患者存在mRNFL、GCL、IPL、pRNFL区域性变薄现象,说明在出现临床血管变化之前已经发生DRN,GCL、IPL内环对DRN的预测价值最高。

单侧湿性年龄相关性黄斑变性患者患眼黄斑区GCIPL厚度变化及其与血清IL-8水平的关系

目的 探讨单侧湿性年龄相关性黄斑变性(wetAMD)患者患眼黄斑区神经节细胞-内丛状层(GCIPL)厚度变化及其与血清白细胞介素(IL)-8水平的关系。方法 选取单侧wetAMD患者(wetAMD组)120例,根据荧光素眼底血管造影和吲哚菁绿血管造影检查结果将其分为单侧典型脉络膜新生血管(tCNV)组(45例)以及单侧息肉样脉络膜血管病变(PCV)组(75例)。另选取门诊健康体检眼科检查正常者75例(75眼)作为正常对照组。收集3组受试者的一般资料,并检测研究眼GCIPL厚度参数和血清IL-8水平,比较3组间上述指标的差异。分析GCIPL厚度与血清IL-8水平和wetAMD的关系及其诊断价值。结果 wetAMD组的吸烟比例、伴糖尿病比例以及血清IL-8水平高于对照组,而wetAMD组GCIPL厚度的各测量值均小于正常对照组(均P<0.05)。tCNV组的年龄、吸烟比例、伴糖尿病比例以及血清IL-8水平高于PCV组,而tCNV组GCIPL厚度的各测量值均小于PCV组(均P<0.05)。wetAMD患者患眼GCIPL厚度的各测量值均与血清IL-8水平呈显著负相关(均P<0.05)。多因素Logistic回归分析结果显示,吸烟、糖尿病、平均GCIPL厚度值降低和血清IL-8水平升高是wetAMD发病的危险因素;糖尿病、平均GCIPL厚度值降低和血清IL-8水平升高是wetAMD患者发生tCNV的危险因素(均P<0.05)。平均GCIPL厚度诊断wetAMD的受试者工作特征曲线下面积(AUC)为0.775(95%CI:0.710~0.832),当临界值取75.60μm时,敏感度为63.33%,特异度为81.33%。平均GCIPL厚度诊断tCNV的AUC为0.765(95%CI:0.678~0.837),当临界值取70.20μm时,敏感度为64.44%,特异度为82.62%。结论 wetAMD患者患眼GCIPL厚度值异常降低,且与血清IL-8水平升高有关,其对诊断wetAMD和tCNV具有一定辅助价值。

采用频域OCT观察糖尿病患者早期黄斑区视网膜结构的变化

目的探讨糖尿病患者黄斑区视网膜结构变化的频域OCT(Cirrus HD-OCT)特征,将其测量参数与正常人群的测量结果进行比较。方法回顾性分析了由Cirrus HDOCT测量的糖尿病患者黄斑区视网膜的结构参数。将糖尿病患眼分为了存在糖尿病视网膜病变(diabetic retinopathy,DR)组和不存在DR组(NDR组),纳入与糖尿病患者年龄和性别分布相匹配的健康对照者(对照组),并对三组的黄斑区神经纤维层和神经节细胞-内丛状层(ganglion cell-inner plexiform layer,GCIPL)厚度等参数进行比较。结果本研究纳入了42例(42眼)2型糖尿病患者(DR组26眼,NDR组16眼),以及30例健康对照者(30眼;对照组)。DR组的GCIPL为(77.2±8.7)μm,NDR组为(79.4±11.3)μm,均小于对照组的(83.2±7.6)μm(均为P<0.05)。DR组的最小GCIPL为(65.4±9.3)μm,NDR组为(69.7±7.6)μm,均小于对照组的(76.2±9.2)μm(均为P<0.05)。黄斑区各个扇形区域GCIPL厚度中,DR组的上方、鼻侧和下方区域,以及NDR组的鼻下和下方区域明显变薄,与对照组相比差异均有统计学意义(均为P<0.05)。DR组和NDR组之间的GCIPL厚度相近,差异均无统计学意义(均为P>0.05)。DR组、NDR组和对照组的黄斑区神经纤维层厚度相近,差异均无统计学意义(均为P>0.05)。结论糖尿病患者在DR出现之前就已经出现了GCIPL的变薄,频域OCT可被用于监测糖尿病患者早期出现的视网膜神经退行性改变。

不同分期糖尿病视网膜病变患者黄斑区结构和微血管改变定量分析

目的:通过光相干断层扫描(OCT)和光相干断层扫描血管造影(OCTA)检查,观察不同分期糖尿病视网膜病变(DR)患者黄斑区神经节细胞-内丛状层(GCIPL)厚度及各象限视网膜浅层毛细血管密度特征并作定量分析。方法:回顾性病例对照研究。选取2019-12/2020-05我院确诊DR患者33例54眼,并根据眼底情况分为无糖尿病视网膜病变(NDR)组6例8眼、非增殖型糖尿病视网膜病变(NPDR)组18例28眼和增殖型糖尿病视网膜病变(PDR)组9例18眼。选取同期与患者年龄相匹配的健康志愿者18例26眼作为对照组。观察并定量分析不同分期DR患者黄斑区GCIPL厚度及各象限视网膜浅层毛细血管线性密度(VD)和血管灌注密度(PD)。结果:DR组患者黄斑区各象限视网膜浅层毛细血管VD、PD及GCIPL厚度最小值均小于对照组(P<0.05)。不同分期DR患者黄斑区GCIPL厚度最小值及各象限视网膜浅层毛细血管VD组间比较均有差异(P<0.05),下方视网膜浅层毛细血管VD对DR的诊断价值最高(AUC=0.807、最佳诊断界限值为18.60mm^(-1)、灵敏度为0.923、特异度为0.648)。DR患者黄斑区GCIPL厚度最小值与各象限视网膜浅层毛细血管VD均呈正相关(r=0.342、0.480、0.384、0.342,均P<0.05)。结论:OCT结合OCTA检查为早期评估及定期随访DR的进展提供了可重复、可定量的检测方法和监测指标。

HD-OCT测量黄斑区神经节细胞层-内丛状层厚度对开角型青光眼诊断的意义

目的:评估利用高分辨率相干光断层扫描(Cirrus-HD OCT)测量黄斑区神经节细胞层-内丛状层(GCIPL)厚度参数对早期和中晚期青光眼的诊断意义。方法:本研究共纳入20例健康个体,26例早期青光眼患者,29例中晚期青光眼患者。对所有纳入个体均测量黄斑区GCIPL厚度参数,视盘(ONH)区参数以及视盘周围神经纤维层(RNFL)厚度参数。最后将所有数据利用SPSS 17.0统计学软件进行分析,分别计算各参数诊断早期和中晚期青光眼的AUC值,以比较和评价各参数的诊断意义。结果:对于早期青光眼组,AUC值最高的为RNFL平均值(0.871)和7∶00位值(0.896),GCIPL各参数也表现出较高的AUC值,其中GCIPL平均值和最小值相应的AUC值分别为0.847和0.812。对于中晚期青光眼组,AUC值最高为盘沿面积(0.992),其次为RNFL平均值(0.991),而GCIPL各参数中平均值与最小值的AUC值分别为0.967和0.983。对于早期青光眼诊断,灵敏度最高的指标为RNFL平均值(76.9%),而特异度最高的指标为GCIPL平均值(93.5%)。结论:GCIPL作为诊断青光眼的新指标在诊断早期和中晚期青光眼时,具有与RNFL相似的诊断意义。对于早期青光眼,诊断时应重点观察RNFL平均值,而在筛查时应重点观察GCIPL的平均值。

近视程度与黄斑部神经节细胞-内丛状层(GCIPL)厚度的相关性研究

目的分析视网膜黄斑区神经节细胞-内丛状层(ganglion cell and inner plexiform layer,GCIPL)厚度与不同近视人群眼轴及屈光度的相关性,以期为合并近视青光眼人群GCIPL厚度分析提供指导。方法选取2015年10月至2016年9月在我院就诊的18~36岁的不同程度近视患者95例(190眼)。记录所有患者性别、年龄、眼轴、医学验光屈光度(等效球镜)、GCIPL的厚度,包括平均、最小、上方、下方、颞上、颞下、鼻上、鼻下共8个参数。根据屈光度分为A组(-0.25^-3.00 D)、B组(-3.25^-6.00 D)、C组(>-6.00 D)。根据眼轴长度分为A1组(22~24 mm)、B1组(>24~26 mm)、C1组(>26 mm),进行所有参数的比较。各组的性别及年龄差异均无统计学意义(均为P>0.05)。但各组平均屈光度和眼轴长度差异均有统计学意义(F=523.963,P=0.000;F=57.452,P=0.000)。采用SPSS 20.0软件单因素方差分析3组间GCLIP厚度参数的差异及Pearson相关性分析不同屈光度、眼轴长度与GCIPL厚度的相关性。结果眼轴长度和屈光度之间呈显著负相关(r=-0.707,P=0.000)。不同屈光度分组8个厚度参数之间差异均有统计学意义(F=3.231~16.500,均为P<0.05)。不同眼轴长度分组8个厚度参数之间差异均有统计学意义(F=5.234~19.999,均为P<0.05)。GCIPL厚度与屈光度均呈负相关(r=-0.419^-0.153,均为P<0.05),与眼轴长度均呈负相关(r=-0.407^-0.241,均为P<0.05),随着屈光度增大及眼轴增长,GCLIP厚度逐渐变薄。结论近视人群随着屈光度和眼轴的增长,GCLIP厚度也逐渐变薄。采用GCLIP厚度评估合并近视青光眼人群时要考虑眼轴长度的影响。

神经节细胞-视网膜内丛状层复合体厚度在早期青光眼的诊断价值

目的评估神经节细胞层-视网膜内丛状层厚度(GCIPL)及GCIPL联合神经纤维层厚度(RNFL)参数在诊断青光眼中的作用。方法选择青光眼患者48例(62只眼)及健康志愿者39例(62只眼),分别测试患者每只眼视乳头周边RNFL厚度及黄斑区GCIPL分布图。评估GCIPL、RNFL及GCIPL和RNFL联合参数的敏感性、特异性,阳性似然比(PLR)和阴性似然比(NLR),并判断各参数的诊断效能。结果 GCIPL参数中,下半区域GCIPL厚度有最好的诊断效能,(敏感度88.7%,特异度为98.4%;PLR,55.4;和NLR,0.169)。下四分之一扇区,是RNFL诊断效能最好的参数(灵敏度,90.3%;特异性98.4%;PLR,56.4;和NLR,0.10)。下方区域GCIPL厚度和下四分之一扇区RNFL层厚度的或逻辑的组合具有最佳诊断性能(敏感度96.8%,特异度为98.4%;PRL,60.5;和NLR,0.033),而第6或第7点钟方位RNFL层厚度与下半区域GCIPL层厚度的或逻辑组合拥有最佳的敏感度(敏感度100%,特异度为93.5%;PRL,15.4;和NLR,0)。结论下方区域GCIPL厚度与下四分之一扇区RNFL层厚度的或逻辑的组合具有最佳诊断性能,比单独的GCIPL,RNFL参数拥有更好的诊断性能,该联合参数的使用可以减少一部分早期青光眼的漏诊。

分离格栅视觉诱发电位联合HD-OCT对早期原发性开角型青光眼的诊断效能研究

目的应用分离格栅视觉诱发电位(IC-VEP)和高清度相干光层析成像术(HD-OCT)分析、评估早期原发性开角型青光眼(POAG)功能和结构变化,为POAG的早期诊断提供依据。方法收集2017年3月至2019年4月在我院就诊的POAG患者(观察组)31例(31只眼),平均年龄(43.11±5.34)岁(24~56岁);正常对照者(对照组)30例(30只眼),平均年龄(42.88±5.15)岁(27~59岁)。所有受试者均行视野、HD-OCT及IC-VEP检测,统计分析两组受试者基线资料,评估各参数的诊断效能。结果两组受试者的性别、年龄、最佳矫正视力、屈光度、中央角膜厚度均无统计学差异(P﹥0.05),视野平均缺损比较P﹤0.01。早期POAG患者IC-VEP及HD-OCT检查的敏感性和特异性分别为83.87%和90%,80.64%和86.67%,两者敏感性及特异性比较均P﹥0.05。IC-VEP检测早期POAG的ROC曲线下面积(AUCs)为0.901,和黄斑区不同部位节细胞内丛状层(GCIPL)的AUCs比较,均无统计学差异(P>0.05),两者的一致性检测率为65.57%。结论IC-VEP联合HD-OCT对早期POAG诊断的效能较高,快捷、简便,能够提高POAG早期诊断率,降低青光眼致盲率。

垂体瘤患者黄斑区GCIPL和视神经乳头周围RNFL厚度分析

目的分析垂体瘤患者黄斑区视网膜神经节细胞内丛状层(GCIPL)厚度和视神经乳头周围视网膜神经纤维层(pRNFL)厚度的改变情况,探讨GCIPL和pRNFL在垂体瘤引起的视交叉压迫检测中的敏感性和可靠性。方法收集2021年1—11月确诊为垂体瘤且未经治疗的患者36例(64眼),并以同年龄段正常人9例(18眼)作为对照组。所有受试者均进行黄斑区、视神经乳头光学相干断层(OCT)扫描和视野(VF)检查。采用SPSS 21.0对VF平均缺损(MD)值、模式标准差(PSD)值与GCIPL、pRNFL平均厚度进行Pearson相关性分析。结果Pearson相关性分析提示,VF异常组患者MD值与GCIPL平均厚度、最小厚度呈正相关(P<0.05),与pRNFL无相关性,而PSD值与GCIPL平均厚度呈负相关(P<0.05);VF正常+GCIPL变薄组,其MD值与GCIPL平均厚度呈负相关(P<0.05),与GCIP最小厚度及pRNFL平均厚度均无相关性;VF正常+GCIPL正常组,其MD、PSD值与GCIPL平均厚度、最小厚度及pRNFL平均厚度均无相关性。VF异常组、VF正常+GCIPL变薄组pRNFL平均厚度与GCIPL平均厚度呈正相关(P<0.05);VF正常+GCIPL正常组,pRNFL平均厚度与GCIPL平均厚度、最小厚度均无相关性。结论在垂体瘤视交叉压迫评估中,黄斑区GCIPL的敏感性、可靠性比VF和pRNFL高,能更早且更客观地反映垂体瘤对视路的压迫情况。