SD-OCT测量APACG大发作后GCIPLT、RNFLT的变化

摘要

OBJECTIVE To measure the thickness of ganglion cell-inner plexiform layer thickness (GCIPLT) and retinal nerve fiber layer thickness (RNFLT) changes after attack of primary acute angle-closure glaucoma (APACG) by spectral domain optical coherence tomography (SD-OCT) and explore the parts of the retinal damage caused by high intraocular pressure.METHODS From July 2015 to May 2016,20 eyes of 20 consecutive patients with attack of APACG in the department of ophthalmology in Affiliated Hospital of Zunyi Medical College were enrolled.Within 2 days of transparent cornea after attack as well as 15 days,3 months,6 months after intraoeular pressure maintained in normal range owing to intervention,the minimum ganglion cell-inner plexiform layer thickness (minGCIPLT),mean ganglion cell-inner plexiform layer thickness (mGCIPLT) and mean retinal nerve fiber layer thickness (mRNFLT) were measured by SD-OCT.RESULTS There was no significant difference of minGCIPLT and mGCIPLT between affected eye and contralateral normal eye within 2 days of transparent cornea after attack and 15 days after treatment (P>0.05) while mRNFLT became thicker than the contralateral eye (P＜0.05).However,3 months and 6 months after treatment,minGCIPLT,mGCIPLT and mRNFLT of related eyes became thinner than their control eyes (P＜0.05).CONCLUSIONS The retinal ganglion cells (RGCs) damage caused by acute high intraocular pressure was antidromic,which meant edema of retinal nerve fiber layer arose first and RGCs apoptosis followed.%目的 通过频域光学相干断层扫描(SD-OCT)测量急性原发性闭角型青光眼(APACG)大发作患者双眼黄斑区视网膜神经节细胞层和内丛状层厚度(GCIPLT)、视网膜视神经纤维层厚度(RNFLT)的变化,探讨高眼压导致视网膜损害的部位.方法 2015年7月-2016年5月在我科治疗的APACG单眼发作患者20例(20只眼),分别于大发作缓解角膜透明2d内和治疗后眼压维持在正常范围的15d、3个月、6个月时,用SD-OCT测量急性大发作眼和对侧眼的黄斑区视网膜神经节细胞层和内丛状层最小厚度(minGCIPLT)、视网膜神经节细胞层和内丛状层平均厚度(mGCIPLT)和视网膜神经纤维层平均厚度(mRNFLT).结果 大发作眼缓解角膜透明2d内及治疗后15d时,minGCIPLT和mGCIPLT与对侧眼比较无改变(P＞0.05),mRNFLT较对侧眼增厚(P＜0.05);治疗后3个月和6个月mRNFLT、minGCIPLT和mGCIPLT与对侧眼比较变薄(P＜0.05).结论 急性眼压增高所致的视网膜神经节细胞(RGCs)损伤是逆向进行的,即先导致视神经纤维水肿,后引起RGCs凋亡.