背景 青光眼以视网膜神经节细胞( RGCs)丢失为主要的病理特征,频域光学相干断层扫描(SD-OCT)可以检测黄斑区视网膜神经节细胞复合体(GCC)厚度. 目的 探讨黄斑区视网膜GCC厚度在原发性开角型青光眼(POAG)人群的分布特征. 方法 采用系列病例对照研究设计.利用SD-OCT( RTVue100)和时域OCT(TD-OCT)技术分别检测POAG患者101例101眼和年龄、屈光度相匹配的正常对照者41例41眼视网膜的黄斑区整体平均GCC厚度(GCC-Avg)、上方平均GCC厚度(GCC-Sup)和下方平均GCC厚度(GCC-Inf)及对应区域视盘旁视网膜神经纤维层(RNFL)厚度,按照POAG的程度分为视野损害前POAG组、早期POAG组、进展期POAG组和晚期POAG组,比较各POAG组与正常对照组间上述3个GCC参数的差异,分析GCC厚度和RNFL厚度的相关性以及青光眼患者视野平均缺损值(MD)与GCC厚度的相关性. 结果 视野损害前POAG组、早期POAG组GCC-Avg、GCC-Sup和GCC-Inf值均明显低于正常对照组,差异均有统计学意义( GCC-Avg:t=5.411、10.247,P＜0.01:GCC-Sup:t=6.171、9.484,P＜0.01; GCC-Inf:t=5.281、8.592,P＜0.01).进展期POAG组GCC-Avg、GCC-Sup和GCC-Inf值均明显低于早期POAG组,差异均有统计学意义(GCC-Avg:t =4.246,P＜0.01;GCC-Sup:t=2.419,P=0.019;GCC-Inf:t=4.636,P＜0.01),而晚期POAG组GCC-Avg、GCC-Sup和GCC-Inf值均明显低于进展期POAG组,差异均有统计学意义(GCC-Avg:t=2.095,P=0.040;GCC-Sup:t=2.756,P＜0.01;GCC-Inf:t=2.018,P=0.040).GCC-Sup、GCC-Inf和GCC-Avg值与对应区域平均RNFL厚度值均呈高度正相关(r=0.802、0.825、0.856,P＜0.01),青光眼患者的视野MD值与GCC-Avg值呈正相关( r=0.601,P＜0.01). 结论 SD-OCT能够定量测量并区分青光眼患者与正常人群的黄斑区GCC厚度,GCC厚度随青光眼病情的进展而逐渐变薄,并与RNFL和视野的损害有较好的相关性.%Background Glaucoma is primarily characterized by the damage of retinal ganglion cells.The macular ganglion cell complex (GCC)thickness can be quantitatively measured using spectral domain optical coherence tomography(SD-OCT). Objective This clinical study was to explore the macular GCC thickness change in primary open-angle glaucoma (POAG) patient with SD-OCT. Methods A serial case-controlled study was designed.A total 101 eyes of 101 POAG patients and 41 normal eyes of 41 age- and refract power-matched normal subjects were cnrolled in the study.POAG patients were assigned to normal perimetry POAG group,early stage POAG group,advanced POAG group and late stage POAG group.Average macular GCC thickness(GCC-Avg),superior GCC thickness(GCC-Sup) and inferior GCC thickness (GCC-Inf)of subjects were measured by SD-OCT and compared among POAG patients and normal controls.Peripapillary retinal nerve fiber layer(RNFL) thickness was measured with time domain OCT(TD-OCT).The correlation between GCC thickness with RNFL thickness or mean deviation(MD) of perimetry were evaluated and analyzed.Informed consent was obtained from each patient prior to entering this study.Results GCC-Avg thickness,GCC-Sup thickness and GCC-Inf thickness were significantly decreased in the normalperimetry POAG group and early stage POAG group compared with the normal control group (GCC-Avg:t =5.411,10.247,P ＜ 0.01 ; GCC-Sup:t =6.171,9.484,P＜ 0.01 ; GCC-Inf:t =5.281,8.592,P ＜ 0.01 ).Also,GCC-Avg thickness,GCC-Sup thickness and GCC-Inf thickness were significantly decreased in the advanced POAG group compared with the early stage POAG group ( GCC-Avg:t =4.246,P＜0.01 ; GCC-Sup:t - 2.419,P - 0.019 ; GCC-Inf:t =4.636,P＜0.01 ),and GCC-Avg thickness,GCC-Sup thickness and GCC-Inf thickness were significantly decreased in the late stage POAG group compared with the advanced POAG group (GCC-Avg:t=2.095,P=0.040;GCC-Sup:t=2.756,P＜0.01:GCC-Inf:t =2.018,P =0.040 ).The positive correlations were seen between GCC-Avg thickness,GCC-Sup thickness,GCC-Inf thickness and RNFL-Avg thickness,RNFL-Sup thickness,RNFL-Inf thickness respectively( r =0.802,0.825,0.856,P ＜ 0.01 ).MD value of perimetry was positive correlated with GCC-Avg thickness in POAG patients ( r =0.601,P ＜ 0.01 ). Conclusions SD-OCT can quantitatively measure and differentiate the GCC thickness in POAG patients.The GCC thickness gradually decreases with the development of POAG.There exist a well correlation between visual field defect and RNFL thinning.
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