光相干断层扫描测量视网膜神经节细胞复合体在青光眼中的研究进展  

Research progress of measurement of retinal ganglion cell complex using optical coherence tomography in glaucoma

作　　者：厉君[1] 段宣初[2] Li Jun,Duan Xuanchu(1.Aier Ophthalmology Hospital, Changsha 410015 ;2.Department of Ophthalmology, the Second Hospital of Central South University, Changsha 410001)

机构地区：[1]长沙爱尔眼科医院,410015 [2]中南大学湘雅第二医院眼科,长沙410001

出　　处：《中华实验眼科杂志》2018年第4期299-304,共6页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目（81370913、81670859）

摘　　要：青光眼主要影响视网膜神经节细胞层的轴突和细胞体。光相干断层扫描（OCT）是一种非接触性、扫描速度快、分辨率高的影像学检查方法，可以定量测量视网膜神经节细胞复合体（GCC）厚度或神经节细胞层和内丛状层（GCIPL）的厚度。GCC包括神经纤维层、神经节细胞层及内丛状层，GCIPL则只包括神经节细胞层和内丛状层2层。TD-OCT只能测量黄斑区全层厚度，而事实上视网膜一些层面在青光眼进展中未被累及，导致了其诊断特异性及敏感性下降。目前用于测量GCC和GCIPL的OCT为谱域OCT（SD—OCT），它比传统的时域OCT（TD—OCT）获得更快的扫描速度，能扫描更多位置，并形成黄斑区3D图像。细化黄斑视网膜分层，对视网膜内层进行定性测量，有助于提高检测青光眼损害的敏感度及特异度。目前常用的仪器有美国光视RTVue-100OCT、德国蔡司CirrusHD—OCT和日本拓普康Topcon3DOCT，3种测量方法各有优势。OCT测量GCC厚度可能受到年龄、性别、眼轴长度、种族及信号强度等因素的影响。近年来，许多研究表明GCC或GCIPL与视野变化具有较好的一致性，能够很好地用于青光眼的早期诊断和定期随访。今后的研究应当致力于建立不同年龄、不同种族人群GCC和GCIPL厚度参数的正常数据库及对青光眼GCC和GCIPL厚度参数变化进行大量的临床试验以及随访研究，以提高更早期诊断能力。Glaucoma mainly affects the axon and cell body of retinal ganglion cells （RGCs）. Optical coherence tomography （OCT） is a kind of imaging machine with noncontact,high scanning speed and high resolution, can be used for quantitative measurement of retinal ganglion cell complex （GCC） thickness or ganglion cell-inner layer （GCIPL） thickness. GCC includes nerve fiber layer, ganglion cell layer and inner cluster layer, GCIPL only includes ganglion cell layer and inner cluster layer time domain OCT （TD-OCT） can only measure the total thickness of the macular region,in fact,some levels are not involved in the progress of glaucoma, which leads to a decrease in specificity and sensitivity. At present, spectral domain OCT （SD-OCT） is used for measuring GCC and GCIPL. It gains faster scanning speed than traditional TD-OCT, and can scan more locations and form 3D images in macular region. Therefore, it is helpful to improve the sensitivity and specificity of detecting the damage of glaucoma by refining the stratification of the maeular retina and making the qualitative measurement of the inner layer of retina. Three scanning modes and methods are commonly used, RTVue-100 OCT, Cirrus HD-OCT,3D OCT,and the three methods have their own advantages. Measurement of the thickness of GCC by OCT may be influenced by factors such as age, sex, axial length, race and signal intensity. In recent years, many studies have indicated that GCC or GCIPL has a good consistency with the visual field, and can be used in early diagnose and regular follow-up of glaucoma. The future research should be devoted to normal database establishment of GCC and GCIPL thickness parameters with different age and different ethnic and clinical trials and follow-up study should be performed to explore the change rules of those paremeters.

关 键 词：光相干断层扫描 视网膜神经节细胞复合体 视野 青光眼 

分 类 号：R775[医药卫生—眼科]