青光眼对不同区域视网膜神经纤维层厚度与光反射信号的影响研究

Study on the Impacts of Glaucoma on the Thickness and Light Reflectivity of Retinal Nerve Fiber Layer in Different Regions

摘要: 目的：利用光相干断层扫描(OCT)研究不同区域视网膜神经纤维层(RNFL)厚度与光反射信号值在青光眼中的变化情况。方法：病例对照研究。纳入49名健康受试者的49只眼及47名青光眼患者的47只眼进行以视盘为中心的三维OCT扫描。在半径为1.7 mm、1.95 mm和2.2 mm的3个分析环下，导出视盘周围环形截面图像，然后通过Image J软件进行分析。对比两组间不同半径，分析环下不同象限RNFL厚度及光反射信号的改变。结果：青光眼组RNFL在不同分析半径不同象限下的厚度值及光反射信号值基本较对照组低(p < 0.05，独立t检验)，其中在下方象限中两组厚度差别最大；在颞侧象限中光反射信号值差别最大。大部分区域RNFL厚度与视野MD呈中至高度正相关(p < 0.01)，与PSD呈低至中度负相关(p < 0.05)；所有区域RNFL光反射信号值与视野MD呈中度正相关(p均 < 0.01)，与PSD呈低至中度负相关(p均 < 0.05)。结论：不同区域的RNFL光反射信号值在一定程度上体现了青光眼的RNFL损伤程度及区域性改变，可以作为青光眼诊断的辅助诊断指标之一。

Abstract: Objective: To investigate the changes in the thickness of the retinal nerve fiber layer (RNFL) and light reflectivity in different regions in eyes with glaucoma using optical coherence tomography (OCT). Methods: A case-control study was conducted, including 49 eyes from 49 healthy subjects and 47 eyes from 47 glaucoma patients for three-dimensional OCT scans centered on the optic disc. Circular peripapillary sections were extracted at radii of 1.7 mm, 1.95 mm, and 2.2 mm and then analyzed using Image J software. The changes in RNFL thickness and light reflectivity in different quadrants under different radii of analysis rings were compared between the two groups. Results: The thickness and light reflectivity of the RNFL in the glaucoma group were generally lower than those in the control group at different analysis radii and in different quadrants (p < 0.05, independent t-test), with the greatest difference in thickness in the inferior quadrant and the greatest difference in light reflectivity in the temporal quadrant. The RNFL thickness in most areas showed a moderate to high positive correlation with visual field mean deviation (MD) (p < 0.01) and a low to moderate negative correlation with pattern standard deviation (PSD) (p < 0.05); the light reflectivity of the RNFL in all areas showed a moderate positive correlation with visual field MD (p < 0.01) and a low to moderate negative correlation with PSD (p < 0.05). Conclusion: The light reflectivity of the RNFL in different regions reflects the degree and regional changes of RNFL damage in glaucoma to some extent and can be used as one of the auxiliary diagnostic indicators for glaucoma diagnosis.