方向光相干断层扫描观察正常人视网膜外核层厚度分布及其影响因素  

Applying directional optical coherence tomography to observe the thickness distribution of retinal outer nuclear layer and influencing factors in normal subjects

作　　者：石婕 张欣[1] 王霄娜[1] 赵琦[1] 游启生[1] 彭晓燕[1] Shi Jie;Zhang Xin;Wang Xiaona;Zhao Qi;You Qisheng;Peng Xiaoyan(Beijing Institute of Ophthalmology,Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Ophthalmology Visual Sciences Key Lab,Beijing 100005,China)

机构地区：[1]北京市眼科研究所北京同仁眼科中心首都医科大学附属北京同仁医院北京市眼科学与视觉科学重点实验室,100005

出　　处：《中华眼底病杂志》2020年第7期526-532,共7页Chinese Journal of Ocular Fundus Diseases

基　　金：首都卫生发展科研专项(2018-2-1081);研究所市财政改革与发展专项(2019005)。

摘　　要：目的应用方向OCT(D-OCT)观察并分析正常人视网膜外核层(ONL)厚度分布及随年龄、性别及解剖部位改变的变化规律。方法横断面观察性研究。2017年8月至2019年1月于北京同仁医院眼科就诊且经常规检查受检眼无异常者及健康志愿者纳入研究。应用Cirrus HD-OCT仪5线高清单线扫描模式对黄斑区进行水平、垂直扫描,所有受检眼瞳孔直径>6 mm。操作方法参考威斯康辛医学院机构审查委员会提供的D-OCT操作标准。探测光于距瞳孔中央约1.5~2.0 mm的颞侧、鼻侧、上方、下方入射,得到倾斜且清晰显示Henle纤维层(HFL)的图像。人工标记HFL上界、下界及外界膜。以黄斑中心凹为中点向外,水平和垂直径线上以150μm为间隔测量并记录多个位点ONL与HFL+ONL厚度。比较不同解剖部位、不同年龄及性别者ONL厚度。年龄对ONL的影响行单因素方差分析;性别对ONL的影响行独立样本t检验。结果共入组67名67只眼。其中,男性27名27只眼,女性40名40只眼。平均年龄为(39.97±16.98)岁;男性、女性平均年龄分别为(38.48±15.33)、(40.98±17.78)岁,差异无统计学意义(t=-0.582,P=0.562)。年龄<20、20~39、40~59、≥60岁者分别为11、22、22、12名,并据此分为A组、B组、C组、D组。按解剖部位,中心凹ONL厚度最厚,其后随离心率增大,厚度逐渐降低。水平扫描,鼻侧0.90 mm、颞侧0.75 mm处ONL/ONL+HFL值最低,分别为36.1%、38.3%。垂直扫描,下方0.75 mm、上方0.90 mm处ONL/ONL+HFL值最低,分别为36.2%、35.6%。A组、B组、C组、D组受试眼中心凹ONL厚度比较,差异无统计学意义(P>0.05);旁中心凹、中心凹周围区ONL厚度比较,差异有统计学意义(P<0.05)。男性受试眼ONL厚度较女性厚,旁中心凹及中心凹周围区差异有统计学意义(P<0.05)。结论正常人中心凹ONL厚度最厚,距中心凹越远,ONL越薄;随年龄增长,旁中心凹及中心凹周围区ONL厚度逐渐变薄;男性ONL厚度较女性厚Objective To observe the thickness distribution of retina outer nuclear layer(ONL)by directional optical coherence tomography(D-OCT),and analyze variation of ONL thickness with age,gender and anatomical location.Methods Cross sectional observational study.From August 2017 to January 2019,the patients were included who had no abnormal eyes in Beijing Tongren Hospital,and healthy volunteers were included in the study.Cirrus HD-OCT 5-line single line scanning mode was used to scan the macular area horizontally and vertically.The pupil diameter of all the tested eyes was more than 6 mm.The protocol was approved by The Medical College of Wisconsin Institutional Review Board.The detection light was incident on the temporal,nasal,upper and lower sides about 1.5 to 2.0 mm away from the pupil center to obtain an image that was oblique and clearly showed the Henle fiber layer(HFL).The upper and lower bounds of HFL and external limiting membrane(ELM)were manually labeled.The thickness of ONL and HFL+ONL were measured and recorded at 150μm intervals on the horizontal and vertical radial lines with the fovea as the midpoint.The thickness of ONL in different anatomic location,ages and genders were compared.The influence of age and gender on ONL were analyzed by one-way ANOVA and independent sample t test respectively.Results 67 eyes of 67 subjects were enrolled.Among them,the mean age of 27 males(27 eyes)and 40 females(40 eyes)was 38.48±15.33 and 40.98±17.78 years respectively without significantly statistical difference(t=-0.582,P=0.562).The total mean age was 39.97±16.98 years old.There were 11,22,22 and 12 patients aged less than 20,20-39,40-59 and over 60 years old respectively,according which they were divided into A,B,C and D groups.According to the anatomical location,the thickness of the ONL reached a maximum in the foveola,and then decreased as the eccentricity increased.Horizontally,ONL/ONL+HFL reached the minimum as 36.1%at 0.90 mm on the nasal side,while the minimum was 38.3%at 0.75 mm on the temporal side.Vert

关 键 词：体层摄影术 光学相干 正常人 外核层 Henle纤维层 

分 类 号：R774.1[医药卫生—眼科]