蝶鞍区肿瘤视交叉压迫患者伽玛刀治疗前后黄斑区神经节细胞-内丛状层厚度与视野检查结果分析

摘要

目的 观察分析蝶鞍区肿瘤视交叉压迫患者伽玛刀治疗前后黄斑区神经节细胞-内丛状层(GCIPL)厚度与视野检查结果的相关性.方法 前瞻性临床研究.接受伽玛刀治疗的蝶鞍区肿瘤视交叉压迫患者37例72只眼纳入研究.根据治疗前视野缺损情况以及治疗后视野变化情况,将患者分为治疗前后视野均无缺损组(1组)、治疗后视野缺损改善组(2组)、治疗后视野缺损无改善或加重组(3组),分别为7例13只眼、17例34只眼、13例25只眼.治疗前及治疗后6个月采用Cirrus高分辨率光相干断层扫描仪和Humphrey视野分析仪测量患眼GCIPL厚度总平均值,颞上方、上方、鼻上方、鼻下方、下方及颞下方GCIPL厚度值和对应区域内的视野平均缺损(MD)值.治疗前2、3组患眼MD值比较,差异无统计学意义(t=1.471,P=0.084);GCIPL厚度总平均值以及6个象限GCIPL厚度值比较,差异均有统计学意义(P＜0.05).Logistic回归模型分析GCIPL厚度值与治疗后视野改善的相关性.结果 治疗后6个月,1、2、3组患眼MD值分别为(-2.96±0.75)、(-10.24±1.31)、(-20.2±5.88)dB.2、3组患眼MD值比较,差异有统计学意义(t=6.974,P=0.000).与治疗前比较,1组患眼GCIPL厚度总平均值及6个象限GCIPL厚度差异均无统计学意义(t=0.882、0.621、1.220、1.258、1.261、1.219、0.639,P=0.395、0.552、0.254、0.262、0.260、0.281、0.548);2组患眼GCIPL厚度平均值、鼻上方及鼻下方GCIPL厚度值增加,差异有统计学意义(t=2.438、4.630、4.457,P=0.035、0.001、0.001);3组患眼GCIPL厚度总平均值、鼻上方及鼻下方GCIPL厚度值下降,差异有统计学意义(t=-2.387、-4.603、-4.975,P=0.041、0.002、0.001).Logistic回归分析发现,治疗前存在视野缺损的患者,GCIPL厚度总平均值越大,治疗后视野缺损改善的比例越高[比值比(OR) =2.871,P=0.000].鼻上方(OR=5.374)、鼻下方(OR=4.693)GCIPL厚度值与治疗后视野检查结果改善呈曲线相关(P=0.000、0.000);颞上方(OR=1.058)、上方(OR=1.101)、下方(OR=1.074)、颞下方(OR=1.056)GCIPL厚度值与治疗后视野改善无相关(P=0.183、0.08、0.162、0.186).结论 蝶鞍区肿瘤视交叉压迫患者伽玛刀治疗前GCIPL总平均厚度越厚,治疗后视野缺损改善程度越高.鼻上方、鼻下方GCIPL厚度与治疗后视野缺损改善密切相关.%Objective To observe the correlation between the thickness of foveal ganglion cell-inner plexiform layer (GCIPL) and visual field mean defect before and after gamma knife treatment in patients of sellar region tumors with optic chiasmal compression.Methods This was a prospective case series.72 eyes of 37 consecutive patients suffering from optic chiasmal compression of sellar region tumors treated with gamma knife were enrolled in the study.According to the change of visual field before and after gamma knife treatment,the patients were divided into three groups.There were 13 eyes of 7 patients in group 1 with no vision defect pre-and post-treated,34 eyes of 17 patients in group 2 with improvement of visual field defect after treatment,25 eyes of 13 patients in groups 3 with no improvement or reorganization of visual field defect after treatment.Overall average thickness of GCIPL,and of the superotemporal,superior,superonasal,inferonasal,inferior,and inferotemporal retina were measured with the Cirrus high-definition spectral domain optical coherence tomography,and mean deviation (MD) with the Humphrey field analyzer before and 6 months after treatment.There was no significant difference in MD values between group 2 and 3 pre-treated (t =1.471,P =0.084).There was significant difference between all the groups in total average value of GCIPL thickness and the 6 quadrant GCIPL thickness values pre-treated (P ＜ 0.05).Logistic regression model was applied to analysis of the correlation between GCIPL thickness and the improvement of visual field after treatment.Results The MD values of the group 1,2 and 3 were (-2.96 ±0.75),(-10.24 ± 1.31),(-20.2 ± 5.88) dB at 6 months after treatment.There was significant difference between group 2 and 3 of MD value after treatment (t=6.974,P=0.000).In group 1,there was no significant difference in mean GCIPL thickness and the 6 quadrant GCIPL thickness values between pre-and post-treated(t=0.882,P =0.395).The mean thickness of GCIPL,superonasal and inferonasal GCIPL was increased than pre-treated in group 2,and the difference was statistically significant(t=2.438,4.630,4.457;P =0.035,0.001,0.001).The mean thickness of GCIPL,superonasal and inferonasal GCIPL was decreased than pre-treated in group 3,and the difference was statistically significant (t =-2.387,-4.603,-4.975;P =0.041,0.002,0.001).Logistic regression analysis showed that the greater of the value of average GCIPL thickness of patients with visual field defect pre-treated,the higher of the proportion of patients with improvement of visual field defect post-treated [odds ratio (OR)=2.871,P =0.000].There was a significant correlation between the value of superonasal or inferonasal GCIPL and the improvement of the visual field post-treated (OR =5.374,4.693;P =0.000,0.000).There was no significant correlation between the value of superotemporal or upper or lower or inferotemporal GCIPL and the improvement of the visual field post-treated (OR=1.058,1.101,1.074,1.056;P=0.183,0.080,0.162,0.186).Conclusions In patients with optic chiasmal compression of sellar region tumor,the greater of the average GCIPL thickness pre-treated,the higher of the proportion of patients with improvement of visual field defect post-treated.There was a significant correlation between superonasal or inferonasal value of the GCIPL thickness and the improvement of visual field defect post-treated.