原发性开角型青光眼与原发性慢性闭角型青光眼活体筛板厚度和筛板前表面深度的比较

摘要

目的 观察原发性开角型青光眼(POAG)与原发性慢性闭角型青光眼(CPACG)患者筛板厚度(LCT)和筛板前表面深度(ALCSD).方法 临床确诊的POAG患者73例73只眼(POAG组)、CPACG患者64例64只眼(CPACG组)以及正常人40名40只眼(正常对照组)纳入研究.3组受检者之间性别构成比(x2=2.07)、年龄(F=0.38)比较,差异均无统计学意义(P＞0.05);受检眼之间眼压、眼轴长度、视网膜神经纤维层(RNFL)厚度值及平均视野缺损值比较,差异有统计学意义(F=15.67、21.15、44.40、27.99,P＜0.05).采用频域光相干断层扫描增强深部成像技术,以20°扫描角度对视盘中央行放射状扫描,每只受检眼获得6条高分辨率的筛板B扫描图像,分别测量6幅图像中央、旁中央LCT和ALCSD,以6幅图像中央、旁中央LCT和ALCSD平均值记为平均LCT(MLCT)、ALCSD(MALCSD);比较青光眼与正常受检眼以及POAG与CPACG患眼之间MLCT及MALCSD的差异.结果 正常对照组、POAG组、CPACG组受检眼MLCT值分别为(211.48±12.07)、(145.43±34.33)、(156.79±33.66) μm.POAG组、CPACG组受检眼与对照组受检眼MLCT值之间比较,差异有统计学意义(t=-11.76、-9.88,P＜0.01);POAG组受检眼与CPACG组受检眼MLCT值之间比较,差异有统计学意义(t=-1.96,P=0.03).3组受检眼MALCSD值分别为(390.73±84.40)、(558.51±176.66)、(539.39±177.30) μm.POAG组、CPACG组受检眼与正常对照组受检眼MALCSD值之间比较,差异有统计学意义(t=5.65、4.96,P＜0.01);POAG组受检眼与CPACG组受检眼MALCSD值之间比较,差异无统计学意义(t=0.63,P=0.49).结论 POAG、CPACG患眼较正常眼LCT薄,ALCSD加深;相同视野缺损和RNFL损害情况下,POAG患眼较CPACG患眼的LCT更薄.%Objective To compare the lamina cribrosa parameters between primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) eyes.Methods A total of 73 POAG eyes (73 subjects),64 CPACG eyes (64 subjects),and 40 normal control eyes (40 subjects) with matched ages were included in this cross-sectional observational study.No significant difference was found in sex (x2 =2.07) and age (F=0.38) among three groups (P＞0.05).The intraocular pressure,average retinal nerve fiber layer (RNFL) thickness and average visual field defect were not significantly different between POAG and CPACG patients (F=15.67,21.15,44.40,27.99;P＜0.05).All subjects underwent spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI).The optic nerve head was scanned radially at the angle of 20;six high resolution B-scan images were obtained from each eye.The center and para-center lamina cribrosa thickness (LCT) and anterior lamina cribrosa surface depth (ALCSD) were measured in each image.The mean LCT and ALCSD were recorded as the average of the LCT and ALCSD of the 6 images and compared among POAG,CPACG and normal control eyes.Results The average LCT of normal control eyes were (211.48±12.07) μm,while those of the POAG eyes were (145.43±34.33) μm,CPACG eyes were (156.79±33.66) μm.The mean LCT of the POAG and CPACG eyes were thinner than those of the control eyes (t=-11.76,-9.88;P＜0.01).All LCT of the POAG eyes were significantly thinner than those of the CPACG eyes (t=-1.96,P=0.03).The average ALCSD of normal control eyes were (390.73±84.40) μm,while those of the POAG eyes were (558.51± 176.66) μm,CPACG eyes were (539.39± 177.30) μm,respectively.The average ALCSD of the POAG and CPACG eyes were deeper than those of the control eyes (t=5.65,4.96;P＜0.01).But no significantly different ALCSD was shown between POAG and CPACG eyes (t =0.63,P =0.49).Conclusions POAG and CPACG eyes have thinner LCT and deeper ALCSD than normal eyes.POAG eyes have thinner LCT than CPACG eyes when their visual field defect and damage of RNFL were in the same degree.