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  

Correlations between the thickness of foveal ganglion cell-inner plexiform layer and visual field defect in patients of sellar region tumors with optic chiasmal compression before and after gamma knife treatment

作　　者：李满[1] 陈晓明[2] 李妮[2] 牟章兵[1] 王冬梅[1] 徐斌[1] 

机构地区：[1]中航工业三六三医院眼科,成都610041 [2]四川大学华西医院眼科,成都610041

出　　处：《中华眼底病杂志》2016年第6期633-636,共4页Chinese Journal of Ocular Fundus Diseases

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

关 键 词：视交叉/损伤 视网膜神经节细胞 视野 体层摄影术 光学相干 

分 类 号：R739.41[医药卫生—肿瘤] R771.3[医药卫生—临床医学]