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.

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.

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.

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.

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).

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.

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。

频域光学相干断层扫描检测原发性开角型青光眼视盘及黄斑参数的影响因素分析

目的利用频域光学相干断层扫描(SD-OCT)检测健康对照和早中期原发性开角型青光眼(POAG)患者的视盘及黄斑参数,分析其相关影响因素。方法选择2015年9月至2018年8月在我科就诊的早中期POAG患者40例(40眼),其中20~39岁者20例、60~79岁者20例;纳入同期在我科就诊的40名(40眼)健康对照,其中20~39岁者20名、60~79岁者20名。受试者均接受全面的眼科检查,并利用SD-OCT测量所有受试者视盘周围视网膜神经纤维层(pRNFL)厚度、黄斑区平均神经节细胞层联合内丛状层(GCL-IPL)厚度、黄斑区最薄GCL-IPL厚度和黄斑区平均整体厚度。结果健康对照组和早中期POAG组黄斑区平均GCL-IPL厚度及最薄GCL-IPL厚度均随年龄增长而变薄,差异均有统计学意义(P<0.05,P<0.01);两组黄斑区平均整体厚度随着年龄的增长均无明显变化。在健康对照组,年龄因素对pRNFL厚度影响不大,20~39岁者与60~79岁者pRNFL厚度差异无统计学意义(P>0.05)。在早中期POAG组,20~39岁者和60~79岁者pRNFL平均厚度、上方厚度、下方厚度和颞侧厚度与健康对照组同年龄者相比均变薄,且60~79岁者上述pRNFL厚度与20~39岁者相比更薄,差异均有统计学意义(P<0.01);早中期POAG组pRNFL鼻侧厚度在20~39岁者与60~79岁者之间差异无统计学意义(P>0.05),与健康对照组同年龄者相比差异亦无统计学意义(P>0.05)。结论 SD-OCT测量的pRNFL厚度与POAG有关,可作为早期诊断POAG的检测指标。

无黄斑病变近视患者黄斑区视网膜结构与视功能改变的相关性

目的研究不同近视程度的无黄斑病变患者黄斑区视网膜厚度(retinal thickness,RT)、视网膜神经节细胞和内丛状层(ganglion cell and inner plexiform layer,GCIPL)厚度及微视野改变规律,并分析结构与功能改变之间的相关性。方法收集2018年6至12月就诊于我院的100例(199眼)无黄斑病变的不同程度近视患者资料,记录患者性别、年龄、等效球镜度数、眼轴长度。HD-OCT测量RT及GCIPL厚度;采用MAIA微视野计检测视网膜黄斑区10°范围平均光敏感度(MS)。根据屈光度不同分为A组(-1.0^-3.0 D)、B组(>-3.0^-6.0 D)、C组(>-6.0 D),比较各组所有测量参数的差异。分析患者屈光度与微视野计测量参数的相关性,相同解剖位置的黄斑区RT、GCIPL厚度与MS相关性。结果黄斑区4个方位RT 3组间差异均有统计学意义(均为P<0.05),中心方位组间差异无统计学意义(P>0.05);黄斑区4个方位视网膜GCIPL厚度3组间差异均有统计学意义(均为P<0.05)。黄斑区总体MS,4个方位MS 3组间差异均有统计学意义(均为P<0.05),中心方位视网膜MS 3组间差异无统计学意义(P=0.060)。所有参数在3组间两两比较结果均显示A组与B组、C组间差异均有统计学意义(均为P<0.05),但B组、C组间差异均无统计学意义(均为P>0.05)。总体视网膜MS及4个方位视网膜MS与屈光度均呈显著正相关(均为P<0.05),中心方位视网膜MS与屈光度无相关性(P>0.05)。黄斑区RT与视网膜GCIPL厚度4个方位均呈正相关(均为P<0.05),两者上、下方位2个参数与视网膜MS均呈正相关(均为P<0.05),余方位均无相关性(均为P>0.05)。结论无黄斑病变近视患者即使最佳矫正视力≥1.0,也会有一定程度的黄斑区结构及功能改变,二者具有一定相关性。临床中可采用OCT和微视野二者相结合进行近视患者黄斑区结构与功能改变的监测。

Cirrus HD OCT测量近视人群的青光眼诊断参数对比研究

目的采用Cirrus HD OCT测量近视人群的青光眼诊断参数差异性及近视人群的特征。方法选取2016年1月至2017年8月,就诊于我院的18~35岁不同近视程度的患者共95例(190只眼)。记录患者性别、年龄,采集其眼轴、医学验光屈光度(等效球镜)、视盘周围视网膜神经纤维层厚度(cpRNFL)包括平均、上下方,颞鼻侧5个参数、黄斑部神经节细胞和内丛状层(GCIPL)厚度包括平均、最小、上下方、鼻颞侧6个参数。根据屈光度分为A组(-0.25~3.0D);B组(-3.25^-6.0D);C组(>-6.0D),采用单因素方差分析进行所有参数的组间比较。采用Pear-son相关性分析不同屈光度与眼轴、GCIPL厚度、cpRNFL厚度的相关性及GCIPL厚度与cpRNFL厚度之间相关性。结果各组的性别及年龄无统计学差异。但各组间平均屈光度差异有统计学意义(F=521.963,P=0.000),眼轴和屈光度之间呈显著负相关(相关系数-0.706,P=0.000)。根据屈光度分组,所有参数各组之间均有显著差异(F=3.396~16.305,P<0.05)。cpRNFL厚度除颞侧外均与屈光度呈负相关(相关系数-0.316^-0.212,P<0.05),GCLIP厚度各参数均与屈光度呈负相关(相关系数-0.205^-0.384,P<0.05)。两种参数之间除颞侧外,其余参数均具呈正相关性(相关系数0.222~0.559),GCIPL与cpRNFL厚度在近视人群中均随屈光度发生一定的改变。结论近视眼cpRNFL厚度上下方及鼻侧象限均随屈光度增大逐渐变薄,颞侧变厚。GCIPL厚度各参数均随屈光度增大逐渐变薄,二者具有很好的一致性。近视人群采用此两种方法评估青光眼损害时,均需要考虑近视程度对参数的影响。

SD—OCT黄斑区GCIPLT测量在青光眼诊断中的应用研究

目的探讨黄斑区神经节细胞-内丛状层厚度（ganglioncell-innerplexiformlayerthickness，GCIPLT）在不同阶段青光眼诊断中的应用价值，了解与视功能的关系。方法采用前瞻性系列病例对照研究设计。在同一天内，使用频阈光学相干断层扫描（spectral domain optical coherencetomography，SD-OCT）对入选的63例青光眼患者（青光眼组）及年龄、性别、屈光均匹配的42名正常对照者（正常对照组）分别行视盘及黄斑区扫描，检测黄斑区平均GCIPLT（mGCIPL）、最小GCIPLT（minGCIPLT），上方、颞上、颞下、下方、鼻下、鼻上共6个不同方位的GCIPLT及视盘周围视网膜神经纤维层厚度（retinal nerve fiber layer thickness，RNFLT）。根据青光眼患者的视野损害程度将其进一步分为早期组、中期组及晚期组，分析GCIPLT与RNFLT参数的相关性及其随病情进展的普遍变化规律。同时通过受试者工作特征曲线下面积（area under receiver operating characteristic curve，AROC）分析GCIPLT与RNFLT参数诊断能力大小，通过Pearson相关分析GCIPLT、RNFLT、视野平均缺损值（mean deviation，MD）的相关性。结果青光眼组与正常对照组相比，黄斑GCIPLT各参数值均明显降低（P〈0．01），青光眼早期、中期及晚期组间minGCIPLT、颞下及下方GCIPLT差异均有统计学意义（P〈0．05），随着青光眼程度的加重，各参数均明显降低，差异有统计学意义（P〈0．01）。早期组GCIPLT参数中minGCIPLT具有最大的AROC，为0．819，RNFLT参数中下方RNFLT具有最大的AROC，为0．902，两者比较差异无统计学意义（P〉0．05）。mGCIPLT与视野MD相关系数为0．795，平均RNFLT（mRNFLT）与视野的相关性为0．852，两者差异无统计学意义（P〉0．05）。结论黄斑区GCIPLT参数和RNFLT参数一样，两者具有相似的诊断能力，且与RNFLT参数及视野各指数高度相关。

阻塞性睡眠呼吸暂停综合征患者黄斑区GCIPL厚度的观察研究

目的:研究阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者的黄斑区神经节细胞层和内丛状层(macular ganglion cell-inner plexiform layer,GCIPL)厚度是否发生改变,为OSAS患者预防眼部并发症提供依据。方法:选取重庆市急救医疗中心及市人民医院的124例确诊OSAS者为观察组,67例正常人为对照组,均取右眼作为研究对象,运用光学相干断层扫描仪(optical coherence tomography,OCT)测量2组患者黄斑区平均GCIPL厚度、最小GCIPL厚度及黄斑区各区GCIPL厚度。结果:观察组平均GCIPL厚度、最小GCIPL厚度及各区GCIPL厚度均小于对照组,2组黄斑区平均GCIPL厚度、最小GCIPL厚度、上方GCIPL厚度、鼻上方GCIPL厚度、鼻下方GCIPL厚度、下方GCIPL厚度、颞下方GCIPL厚度、颞上方GCIPL厚度差异均具有统计学意义(t=3.335,P=0.001;t=2.491,P=0.014;t=2.822,P=0.005;t=2.567,P=0.011;t=3.046,P=0.003;t=3.279,P=0.001;t=3.432,P=0.001;t=3.086,P=0.002)。结论:OSAS患者黄斑区平均GCIPL厚度、最小GCIPL厚度及各区GCIPL厚度均较对照组变薄。OSAS患者在出现相应眼科临床症状前,其黄斑区GCIPL层变薄,与早期开角型青光眼黄斑区改变类似,OSAS患者缺氧和对血流灌注的影响可能是黄斑部视网膜神经节细胞丢失的高危因素。

Evaluation of spectral domain optical coherence tomography parameters in discriminating preperimetric glaucoma from high myopia

AIM: To evaluate the diagnostic ability of macular ganglion cell-inner plexiform layer(GCIPL) thickness o b t a i n e d b y s p e c t r a l-d o m a i n o p t i c a l c o h e r e n c e tomography(SD-OCT) in discriminating non-highly myopic eyes with preperimetric glaucoma(PPG) from highly myopic healthy eyes. METHODS: A total of 254 eyes, including 76 normal controls(NC), 116 eyes with high myopia(HM) and 62 non-highly myopic eyes with PPG were enrolled. The diagnostic ability of OCT parameters was accessed by the areas under the receiver operating characteristic(AUROC) curve in two distinguishing groups: PPG eyes with nonglaucomatous eyes including NC and HM(Group 1), and PPG eyes with HM eyes(Group 2). Differences in diagnostic performance between GCIPL and RNFL parameters were evaluated. RESULTS: The minimum(AUROC curve of 0.782), inferotemporal(0.758) and inferior(0.705) GCIPL thickness were the top three GCIPL parameters in discriminating PPG from non-glaucomatous eyes, all of which had statistically significant lower diagnostic ability than average RNFL thickness(0.847). In discriminating PPG from HM, the best GCIPL parameter was minimum(0.689), statistically significant lower in diagnostic ability than average RNFL thickness(0.789) and three other RNFL thickness parameters of temporal and inferotemporal clock-hour sectors. CONCLUSION: The minimum GCIPL thickness is the best GCIPL parameter to detect non-highly myopic PPG from highly myopic eyes, whose diagnostic ability is inferiorto that of average RNFL thickness and RNFL thickness of several temporal and inferotemporal clock-hour sectors. The average RNFL thickness is recommended for discriminating PPG from highly myopic healthy eyes in current clinical practice in a Chinese population.

SD-OCT评估孔源性视网膜脱离硅油填充术后黄斑区微结构的改变

目的:应用频域光学相干断层成像(SD-OCT)评估孔源性视网膜脱离(RRD)硅油填充术后黄斑区微结构的改变。方法:选取2019-11/2021-07就诊于沧州爱尔眼科医院行玻璃体切除联合硅油填充术的RRD患者27例27眼纳入观察组,另选取健康志愿者30例30眼纳入对照组。观察患者手术前后最佳矫正视力(BCVA),并使用SD-OCT量化评估术后黄斑区微结构的改变情况。结果:观察组术后1wk, 3mo BCVA(LogMAR)(0.61±0.23、0.69±0.34)较术前(1.43±0.77)均改善(均P<0.01)。观察组术后3mo黄斑区立方体体积、立方体平均厚度较术后1wk, 1mo及对照组均降低(均P<0.05)。观察组术后1wk, 1、3mo平均神经节细胞-内丛状层(GCIPL)厚度、GCIPL最小厚度、平均黄斑区视网膜神经纤维层(mRNFL)厚度、mRNFL最小厚度均无差异,但较对照组均降低(均P<0.01)。术后随访观察组发生视网膜下积液(SRF)9眼,SRF有逐渐吸收的趋势,但其中1眼继发黄斑裂孔;椭圆体带中断3眼,有逐渐修复趋势;黄斑区视网膜下重水残留2眼;黄斑水肿2眼。结论:SD-OCT可以很好地显示RRD硅油填充术后黄斑区微结构及形态改变,对RRD术前及术后随访评估具有重要的临床价值。

ICL植入术后黄斑区节细胞-内丛状层及视网膜厚度的变化

目的:应用OCT观察ICL植入术后黄斑区节细胞-内丛状层及中央区视网膜厚度的改变,明确ICL植入术对于眼后节的影响。方法:前瞻性研究。最终纳入行ICL植入术患者26例41眼,平均年龄28.19±6.48岁。所有受试者均行眼轴长度(AL)、裸眼视力(UCVA)、综合验光、最佳矫正视力(BCVA)、眼压(IOP)及OCT检查。观察术前及术后的中央区视网膜厚度(CRT)和节细胞-内丛状层厚度(GCT),以及UCVA、BCVA和IOP的变化。结果:ICL植入术后UCVA和BCVA较术前均有提高(P<0.05),而眼压无变化。术前,术后1wk,1、3mo CRT分别为273.20±25.48、274.07±27.64、277.85±25.49、275.99±24.68μm,而GCT分别为85.31±5.19、88.95±6.87、87.73±4.23、87.45±4.59μm(均P<0.05),其中CRT在术后1mo较术前有增加(P<0.01),GCT在术后1wk,1、3mo均比术前有增加(P<0.05)。GCT在术后1wk的变化与AL呈正相关(r s=0.529,P=0.001)。结论:ICL植入术具有良好的有效性及一定的安全性,但术后也会发生一定的黄斑区改变,需给予一定的重视。

Ethambutol-induced optic neuropathy with rare bilateral asymmetry onset:A case report

BACKGROUND Ethambutol-induced optic neuropathy(EON)most commonly manifests as bilateral symmetrical loss of vision and often cause serious and irreversible visual impairment because of the lack of early detection and effective treatment.We followed a case of EON with rare binocular asymmetric clinical manifestations and observed the changes of visual function and retinal structure after drug withdrawal,so as to further understand the clinical characteristics of this disease.CASE SUMMARY A 54-year-old man complained of gradual visual decline in the left eye.The patient presented with best-corrected visual acuity of 20/20 in the right eye and 20/50 in the left eye.Color vision examination revealed difficulty in reading green color plates in the left eye.The visual field manifested as concentric contraction in the left eye.After nearly a month of drug withdrawal,the right eye had a similar decline in visual function.At the last visit,19 mo after drug withdrawal,the visual function significantly recovered in both eyes.During follow-up optical coherence tomography(OCT)examination,both eyes manifested the thickness of the retinal nerve fiber layer from mild thickening to thinning and finally temporal atrophy,and the ganglion cell-inner plexiform layer showed significant thinning.The difference was that a reversible structural disorder in the outer retina of the nasal macula was detected in the left eye by macular high-definition OCT.CONCLUSION Nephropathy and high blood pressure,which damage the retinal microcirculation,may cause damage to the outer layer of the retina.Ethambutol may influence photoreceptor as well as retinal ganglion cells.