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.

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.

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.

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.

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.

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.

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.

不同程度近视患者视网膜神经纤维层厚度和神经节细胞复合体参数的变化

目的:比较低度、中度和高度近视非青光眼受试者通过光谱域光学相干断层扫描技术(SD-OCT)测量的视网膜神经纤维层(RNFL)和黄斑神经节细胞复合体(GCC)参数的变化。方法:选择2019-12/2022-11期间在我院就诊的近视受试者400例400眼参与本研究,根据受试者近视程度分为:低度近视组(142例142眼,35.5%)、中度近视组(139例139眼,34.8%)和高度近视组(119例119眼,29.8%)。测量RNFL厚度,包括均值、上方、下方、鼻侧、颞侧RNFL厚度。测量GCC参数,包括均值、上方、颞上方、下方、颞下方、鼻上方、鼻下方。评估OCT测量的RNFL厚度、GCC参数均值与眼轴长度之间的相关性。结果:低度近视组和中度近视组的上方、下方、鼻侧、平均RNFL厚度明显高于高度近视组,颞侧RNFL厚度明显低于高度近视组(均P<0.05);低度近视组和中度近视组的上方、颞上方、下方、颞下方、鼻上方、鼻下方、平均GCC厚度明显高于高度近视组(均P<0.05);在中度近视组中,RNFL和GCC厚度均值与眼轴长度均呈负相关(r=-0.387、-0.309,均P<0.05)。在高度近视组中,RNFL和GCC厚度均值与眼轴长度均呈负相关(r=-0.499、-0.503,均P<0.01)。结论:高度近视受试者的RNFL和GCC厚度往往比低度和中度近视受试者更薄。

糖尿病患者黄斑神经节细胞复合体、视盘周围视网膜神经纤维层厚度水平与视网膜病变的相关性分析

目的分析糖尿病(diabetes mellitus,DM)患者黄斑神经节细胞复合体(ganglion cell complex,GCC)、视盘周围视网膜神经纤维层(retinal nerve fiber layer,RNFL)的厚度水平与视网膜病变(diabetic retinopathy,DR)的关系。方法选择2020年2月至2022年3月首都医科大学宣武医院收治的DM患者110例145眼作为研究对象,按照是否发生DR分为DR组(51例,69眼)和非DR组(59例,76眼),依据DR不同严重程度分期将DR组分为非增殖性DR组(NPDR组,38例,47眼)和增殖性DR组(PDR组,13例,22眼)。两组患者均进行光学相干断层扫描血管成像技术(optical coherence tomography angiography,OCTA)检查,比较不同分组DM患者黄斑部GCC和视盘周围RNFL厚度变化及与DR分期的关系。结果DR组GCC总体厚度(total GCC thickness,tGCC)、GCC上方厚度(superior GCC thickness,sGCC)和GCC下方厚度(inferior GCC thickness,iGCC)均低于非DR组(P<0.05);PDR组tGCC、sGCC和iGCC均低于轻中度NPDR组(mNPDR)和重度NPDR组(sNPDR),且sNPDR组tGCC、sGCC和iGCC均低于mNPDR(P<0.05);NPDR组视盘周围RNFL上方和下方以及平均厚度均低于非DR组和PDR组(P<0.05),PDR组视盘周围RNFL各部位厚度均高于非DR组和NPDR组(P<0.05);sNPDR组视盘周围上方、下方、颞侧、鼻侧及平均厚度均低于mNPDR组(P<0.05),PDR轻中度组和重度组视盘周围各部位RNFL厚度均高于mNPDR组和sNPDR组,且PDR重度组各部位RNFL厚度均高于轻中度组(P<0.05);Spearman相关性分析结果显示,DR患者黄斑tGCC、sGCC和iGCC厚度与DR严重程度呈负相关(r分别为-0.485、-0.496、-0.501,P<0.05),DR患者视盘周围各部位RNFL厚度与NPDR分期呈负相关(r分别为-0.519、-0.527、-0.498、-0.507、-0.511,P<0.05),与PDR严重程度呈正相关(r分别为0.531、0.514、0.501、0.512、0.499,P<0.05)。结论DR患者早期已经出现视网膜神经的损伤,黄斑GCC厚度随着DR进展明显下降;NPDR患者视盘周围RNFL厚度呈现下降趋势,随着DR进展至PDR,视盘周围RNFL厚度有所增加,黄斑GCC和视盘周围RNFL厚度的动态变化能够为糖尿病患者视网膜神经结构的损伤和DR的进展提供依据。

OCT测量黄斑区神经节细胞复合体厚度在高度近视眼中的应用进展

近视防控已经上升到我国国家战略层面,高度近视引起的视神经病变会损害视功能,但在临床上常常被忽视。OCT可以非侵入、高分辨率、快速以及可重复地定量视网膜各层厚度,是评估高度近视相关视神经病变的有力工具。由于高度近视常合并视盘和盘周的改变,视神经纤维层厚度的定量常出现误差。近年来,学者开始聚焦于黄斑区神经节细胞复合体(ganglion cell complex,GCC)厚度的研究,但其在高度近视眼中的变化规律尚不统一。该文针对近年来高度近视眼黄斑区GCC的测量规范、诊断价值、变化规律等进行综述,以期提高眼科医师对高度近视视神经病变的重视和研究水平。

颈内动脉狭窄及合并缺血性脑卒中患者视网膜微血管神经改变特征

目的对比单侧颈内动脉狭窄(ICAS)患者双眼视网膜厚度及血流密度(VD)、视网膜神经纤维层(RNFL)厚度及神经节细胞复合体(GCC)厚度,探讨颈内动脉狭窄及合并缺血性脑卒中患者视网膜微血管神经的变化特点。方法横断面研究。收集2019年12月至2021年12月在我院就诊的单侧ICAS≥70%(狭窄侧眼组)、对侧颈内动脉无狭窄或狭窄<50%(对侧眼组)的27例患者的临床资料。所有患者均行眼科常规及光学相干断层扫描血管成像(OCTA)检查。对比观察双眼视网膜厚度、VD、RNFL厚度及GCC厚度,并根据是否合并缺血性脑卒中进行亚组分析。结果ICAS≥70%的患者狭窄侧眼组黄斑区浅层、深层视网膜及黄斑中心凹无灌注区面积周围300μm环内的VD均较对侧眼组明显降低(均为P<0.05),狭窄侧眼组的视盘下颞区及颞下区VD均较对侧眼组明显降低(均为P<0.05)。合并缺血性脑卒中的ICAS患者狭窄侧眼组黄斑区视网膜浅层和深层VD、视盘下颞及颞下区VD、下半部GCC厚度均较对侧眼组显著降低(P<0.05)。不合并脑卒中的ICAS患者狭窄侧眼组与对侧眼组黄斑区及视盘的VD、RNFL厚度、GCC厚度差异均无统计学意义(均为P>0.05)。结论重度及以上ICAS的患者已经出现视网膜微循环障碍,且在合并有缺血性脑卒中的患者中表现更明显,并出现神经节细胞的损伤,提示ICAS合并视网膜微血管和神经节细胞的损伤有可能是缺血性脑卒中发生的危险因素。

mGCC和pRNFL厚度及视野对新生血管性青光眼的诊断价值

目的:分析黄斑区节细胞复合体(mGCC)和视乳头周围视网膜神经纤维层(pRNFL)厚度及视野对新生血管性青光眼(NVG)的诊断价值。方法:回顾性研究。收集2018-01/2021-10本院收治的NVG患者92例100眼,按病理分期分为新生血管性青光眼前期患者31例32眼、开角型青光眼期患者31例36眼及闭角型青光眼期患者30例32眼。选择同期于我院接受健康体检者50例100眼者作为对照组。采用Pearson相关性分析mGCC、pRNFL厚度与MD的相关性,以受试者工作特征(ROC)曲线研究各指标诊断效能。结果:新生血管性青光眼前期、开角型青光眼期和闭角型青光眼期mGCC-平均(a)、mGCC-上方(s)、mGCC-下方(i)厚度均低于对照组(均P<0.001),新生血管性青光眼前期、开角型青光眼期mGCC-a、mGCC-s、mGCC-i均高于闭角型青光眼期(均P<0.001),新生血管性青光眼前期mGCC-a、mGCC-s、mGCC-i均高于开角型青光眼期(均P<0.001)。新生血管性青光眼前期、开角型青光眼期和闭角型青光眼期pRNFL-a、pRNFL-颞侧(t)、pRNFL-s、pRNFL-鼻侧(n)、pRNFL-i厚度均高于对照组,MD高于对照组(均P<0.001);新生血管性青光眼前期、开角型青光眼期pRNFL-a、pRNFL-t、pRNFL-s、pRNFL-n、pRNFL-i均高于闭角型青光眼期,MD高于闭角型青光眼期(均P<0.001),新生血管性青光眼前期pRNFL-a、pRNFL-t、pRNFL-s、pRNFL-n、pRNFL-i均高于开角型青光眼期,MD高于开角型青光眼期(均P<0.001)。mGCC-a、mGCC-s、mGCC-i和pRNFL-a、pRNFL-t、pRNFL-s、pRNFL-n、pRNFL-i与MD呈负相关性(均P<0.001)。mGCC、pRNFL厚度及MD联合诊断NVG的效能最高(敏感度为79.00%,特异度为87.00,AUC=0.973,95%CI=0.956~0.990,P<0.05)。结论:NVG患者mGCC、pRNFL厚度与MD呈负相关关系,mGCC、pRNFL厚度及MD对NVG有一定的诊断价值,且以联合检测的诊断效能最高。

黄斑区节细胞复合体 视乳头周围视网膜神经纤维层厚度和视野平均缺损在新生血管性青光眼临床分期 疗效及预后中的价值分析

目的分析黄斑区节细胞复合体(mGCC)、视乳头周围视网膜神经纤维层(pRNFL)厚度和视野平均缺损(MD)在新生血管性青光眼(NVG)临床分期、疗效及预后中的价值。方法选取80例NVG患者(80眼)作为研究对象,依据临床分期不同将其分为虹膜红变组(24例24眼)、开角型青光眼组(30例30眼)和闭角型青光眼组(26例26眼);同期选取40名健康体检者(80眼)作为对照组;所有对象均接受光学相干断层扫描技术(OCT)检查,并收集mGCC、pRNFL厚度和MD,对比各组mGCC、pRNFL厚度和MD差异;NVG患者治疗方案相同,根据术后疗效将NVG患者分为有效组(56例)和无效组(24例),对比2组mGCC、pRNFL厚度和MD差异,绘制受试者工作曲线(ROC)分析疗效预测价值;根据术后6个月虹膜及前房角新生血管复发情况将NVG患者分为复发组(8例)和健康组(48名),对比2组mGCC、pRNFL厚度和MD差异,绘制ROC曲线分析预后预测价值。结果NVG各组和对照组mGCC-a、pRNFL-a厚度和MD比较,差异均有统计学意义(P<0.05),其中mGCC-a、pRNFL-a厚度在对照组、虹膜红变组、开角型青光眼组和闭角型青光眼组依次降低,而NVG各组MD均高于对照组,但在虹膜红变组、开角型青光眼组和闭角型青光眼组依次降低。NVG患者中有效组患者mGCC-a、pRNFL-a厚度高于无效组,但MD低于无效组,差异均有统计学意义(P<0.05)。与正常组比较,复发组mGCC-a、pRNFL-a厚度降低,MD升高,差异均有统计学意义(P<0.05)。绘制ROC曲线分析发现,mGCC-a、pRNFL-a厚度和MD均可预测NVG患者疗效和预后,三者联合效果更佳。结论mGCC-a、pRNFL-a厚度和MD在NVG在一定程度上可预测患者疗效和预后,具有一定临床推广价值。

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。