原发性闭角型青光眼的不同分期频域OCT相关参数差异的研究

Study on the Difference of Spectral-Domain Optic Coherence Tomography in Different Stages of Primary Angle-Closure Glaucoma

摘要: 目的：通过频域OCT (spectral-domain optic coherence tomography, SD-OCT)的测量，比较早、中、晚期原发性闭角型青光眼(primary angle-closure glaucoma, PACG)中黄斑神经节细胞层(ganglion cell layer, GCIPL)厚度、视网膜神经纤维层(retinal nerve fiber layer, RNFL)厚度和视盘相关参数(ONH parameters)的差异。方法：回顾性研究了36例PACG眼的SD-OCT的检查结果。所有PACG眼分为早期[−6 dB < 视野平均偏差(visual field mean deviation, VF-MD)]，中期[−12 dB ≤ VF-MD ≤ −6 dB]和晚期[VF-MD < −12 dB]，均测量了平均GCIPL厚度、最小GCIPL厚度以及鼻上、上方、颞上、颞下、下方、鼻下GCIPL厚度；平均RNFL厚度以及上方、下方、颞侧和鼻侧RNFL厚度；盘沿面积、视盘面积、平均杯盘比、垂直杯盘比和杯容积等参数，并比较各组间参数。结果：早期与中期PACG眼相比，黄斑GCIPL厚度和视网膜RNFL厚度之间均无差异(p > 0.05)。晚期与中期PACG眼相比，上方和颞上黄斑GCIPL厚度明显变薄(p = 0.019, 0.049)，下方RNFL厚度明显变薄(p = 0.011)。早期与晚期PACG眼的黄斑GCIPL厚度和视网膜RNFL厚度之间均存在差异(p < 0.05)。早期与中期PACG眼的盘沿面积、平均杯盘比、垂直杯盘比和杯容积之间均无差异(p > 0.05)。晚期与中期PACG眼相比，平均杯盘比、垂直杯盘比和杯容积明显增高(p < 0.05)。早期与晚期PACG眼的盘沿面积、平均杯盘比、垂直杯盘比和杯容积之间均存在差异(p < 0.05)。结论：PACG的眼底损害在中期、晚期进展明显，尤其上方和颞上黄斑GCIPL厚度明显变薄，下方RNFL厚度明显变薄，与RNFL和黄斑GCIPL厚度相比，视盘参数存在差异。

Abstract: Purpose: To compare the macular ganglion cell layer (GCIPL) thickness and retinal nerve fiber layer (RNFL) thickness measured by spectral-domain optical coherence tomography (SD-OCT) in eyes with early, moderate and severe primary angle-closure glaucoma (PACG). Methods: In this retrospective study, 36 eyes with PACG were included. They all underwent the spectral-domain optical coherence tomography (SD-OCT). The subjects with PACG were further classified as the early [−6 dB < visual field mean deviation (VF-MD)], moderate [−12 dB ≤ VF-MD ≤ −6 dB], or severe [VF-MD < −12 dB] PACG. The average, minimum, and sectoral (superonasal, superior, superotemporal, inferotemporal, inferior, inferonasal) parameters were used to determine the macular GCIPL thickness. The average, superior, inferior, temporal, and nasal quadrant thicknesses were included in the analysis with regard to the peripapillary RNFL thickness measurements. Individual parameters in the ONH measurements included rim area, disc area, average cup to disc ratio, vertical cup to disc ratio, and cup volume. Results: The macular GCIPL and the RNFL thickness in eyes with early PACG and those in eyes with moderate PACG were not substantially different (all p > 0.05). The GCIPL was significantly thinner in the severe PACG eyes compared with the moderate PACG eyes at the superior and superotemporal macular locations (p = 0.019, 0.049). The RNFL was significantly thinner in the severe PACG eyes compared with the moderate PACG eyes at the inferior optic disc locations (p = 0.011). There were significant differences between the macular GCIPL and RNFL thickness in the eyes with early PACG and those in the eyes with severe PACG (all p < 0.05). There was no significant difference in the rim area, average cup to disc ratio, vertical cup to disc ratio, and cup volume between the early and moderate PACG eyes (all p > 0.05). When compared to the moderate PACG eyes, the average cup to disc ratio, vertical cup to disc ratio, and cup volume in the severe PACG eyes were substantially different (all p < 0.05). There were significant differences in the rim area, average cup to disc ratio, vertical cup to disc ratio, and cup volume between the early and severe PACG eyes (all p < 0.05). Conclusions: The fundus damage of PACG progressed significantly in the moderate and severe stages, especially the thickness of GCIPL in the superior and superotemporal macular locations was significantly thinner, and the thickness of RNFL in the inferior locations was significantly thinner. Compared with the thickness of RNFL and macular GCIPL, the optic disc parameters were different.