应用 SD－O CT 纵向比较正常人群和青光眼进展及非进展人群的 RNFL 厚度

摘要

Abstract?AIM:To compare the loss of peripapillary retinal nerve fiber layer ( RNFL ) thickness measurements by spectral-domain optical coherence tomography ( SD -OCT ) in healthy individuals and glaucoma patients with or without progression.? METHODS: A total of 60 eyes, comprising 36 glaucomatous eyes with primary open angle glaucoma (POAG) and 24 healthy controls, were included in the study over a 2-year period.All eyes underwent at least 4 serial RNFL measurements performed by Cirrus OCT every half a year over a period of 2a.Visual field ( VF) testing was performed by using the Swedish interactive threshold algorithm( SITA) Standard 30-2 program of the Humphrey field analyzer within the same week as the optic disc/RNFL photography. By masked comparative analysis of VF test results and optic disc/RNFL photographs, the eyes were classified into non -progressive and progressive glaucoma cases. Longitudinal loss of RNFL thickness was compared.?RESULTS: The mean follow-up time was 2.1 ±0.3a. Seventeen from 36 subjects were identified as progressors. Mean rates of change in average RNFL thickness were significantly higher for progressors compared with nonprogressors (2.46μm/a vs.1.21μm/a;P <0.001 ). Inferior quadrant RNFL thickness were significantly correlated with MD reduction in glaucoma eyes with progression(r=0.423, P=0.03).? CONCLUSION: Longitudinal measurements of RNFL thickness using SD-OCT show a pronounced reduction in patients with progression compared with patients without progression.Inferior RNFL thickness parameters might be more important in discriminating eyes with progressive glaucomatous optic nerve damage.%目的：应用频域光学相干断层扫描（ spectral－domain optical coherence tomography ，SD－OCT）纵向比较正常人群、青光眼进展及非进展人群的视网膜神经纤维层（ retinal nerve fiber layer ，RNFL）厚度。方法：应用SD－OCT对36例POAG患者和24例正常人监测RNFL厚度。受试者行视盘OCT、眼底照相及视野检查，每6mo一次，随访2a，至少有4次可信的OCT检查结果。根据视野及眼底照相结果将POAG患者划分为进展组和非进展组。分析各组RNFL厚度变化差异，同视野参数变化值做相关性分析。结果：平均随访2．1±0．3 a。17例被确定为POAG进展组。POAG进展组平均RNFL厚度损失速率明显高于POAG非进展组（2．46μm／a vs 1．21μm／a，P＜0．001）。下方RNFL厚度变化同视野平均偏差（ mean deviation ，MD）变化相关性最佳（r＝0．423，P＝0．03）。结论：应用SD－OCT纵向监测RNFL厚度， POAG进展者RNFL厚度丢失速率明显增高，下方RNFL厚度参数变化可能在监测中意义较大。