光学相干断层成像在监测青光眼视神经病变进展中作用  

The clinical role of optical coherence tomography in monitoring glaucomatous optic neuropathy progression

作　　者：方圆[1] 杜泠泠 潘英姿[1] 李梅[1] 乔荣华[1] 才瑜[1] 

机构地区：[1]北京大学第一医院眼科,北京市100034

出　　处：《中国实用眼科杂志》2015年第11期1215-1220,共6页Chinese Journal of Practical Ophthalmology

基　　金：首都医学发展科研基金（2007-2007）

摘　　要：目的评价光学相干断层成像（OCT）在原发性开角型青光眼（POAG）患者的随访中监测青光眼视神经病变进展的作用，探索能较好地反映青光眼视神经损害进展的参数。方法回顾性临床病例研究。对2006年2月至2010年2月在北京大学第一医院眼科就诊的57例POAG患者（57只眼）4年中OCT和视野的数据结果进行分析，按照患者最终一次随访时间减去基础测量值，得出各参数的变化值。对视野参数变化值和OCT各参数变化值做相关性分析。视野MD值下降≥2dB的患者分入视野进展组，分析视野进展组和无进展组之间OCT参数变化值的差异，绘制ROC曲线并计算其曲线下面积（AROC）。结果所有受试者随访时间最长4年，平均随访年数（2．8±1．086）年，视野中度异常组与MD下降值相关性有统计学意义的OCT参数为I的神经纤维层（RNFL）厚度（r=0．446，P=0．043），与PSD下降值相关性有统计学意义的OCT参数为8点（r=-0．664，P=0．001），I（r=-0．554,P=0．009）及Inf（r=-0．491，P=0．024）的RNFL厚度，轻度与重度异常组MD及PSD下降值与OCT参数变化值均无统计学意义的相关性。视野进展组和无进展组之间12点的RNFL厚度及盘沿面积变化值差异有统计学意义（t=2．194，P=0．032；t=2．081，P=0．042），AROC分别为0．663，0．689。结论OCT下方RNFL厚度参数（I、Inf、8点位）变化值与视野参数变化值相关性较好，下方RNFL厚度参数可能在监测青光眼视神经病变进展中意义较大。Objective To evaluate the ability of optical coherence tomography （OCT） retinal nerve fiber layer （RNFL）, optic nerve head, and macular parameters to detect progressive structural damage in glaucoma. Methods Retrospective evaluated 57 subjects （57 eyes） of POAG patients. Im- ages were obtained every 12±3 months with the Stratus OCT along with Humphrey visual field （VF） testing. The correlation between the change of VF measurements and OCT measurements were analyzed. VF progression was defined as reproducible drop of at least 2dB of mean deviation （MD） from baseline visit. Analyze the difference of OCT measurements between the progression group and the non-progression group. Results The longest follow-up time was 4 years, with a mean follow-up of 2.8±1.1 years. OCT parameters which were significantly correlated with MD reduction were Inferi- or RNFL thickness measurements （I： r =0.446, P =0.043）. 8 o＇clock （r =-0.664, P =0.001）,Inferior （r =-0.554, P =0.009） and lnf （r =-0.491, P =0.024） RNFL thickness measurements of OCT were sig- nificantly correlated with PSD reduction in moderate group. There were no significant correlation between OCT parameters and VF reduction in mild and severe groups. The reduction of 12 o＇ clock RNFL thickness measurements and rim area were significantly different between VF progression group and non-progression group （t =2.194, P =0.032; t =2.081, P =0.042）. OCT parameters with rel- atively AROC were 0.663, 0.689. Conclusions The change of inferior RNFL thickness parameters （I, 8, Inf） is correlated with the change of VF measurements in moderate VF damage group. Inferi- or RNFL thickness parameters might be more important in discriminating eyes with progressive glau- comatous optic nerve damage and eyes remain stable.

关 键 词：光学相干断层成像(OCT) 原发性开角型青光眼(POAG) 进展 视野 

分 类 号：R775.2[医药卫生—眼科]