甲状腺相关眼病导致的压迫性视神经病变患者cpRNFL及黄斑区GCIPL厚度变化与视力损害和预后视力的关系  

Correlation of visual impairment and visual prognosis with circumpapillary retinal nerve fiber layer and macular ganglion cell-inner plexiform layer thickness in patients with compressive optic neuropathy caused by thyroid associated ophthalmology

作　　者：许瑾 王婧[1] 张珂[1] 王丽丽[1] 朱豫[1] XU Jin;WANG Jing;ZHANG Ke;WANG Lili;ZHU Yu(Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan Province,China)

机构地区：[1]郑州大学第一附属医院眼科,河南省郑州市450052

出　　处：《眼科新进展》2022年第4期310-313,共4页Recent Advances in Ophthalmology

摘　　要：目的分析甲状腺相关眼病(TAO)导致的压迫性视神经病变(CON)患者视盘周围神经纤维层(cpRNFL)及黄斑区节细胞-内丛状层(GCIPL)厚度变化与视力损害和预后视力的关系。方法选取2018年1月至2020年7月郑州大学第一附属医院眼科治疗组门诊和病房收治的有完整临床资料的TAO-CON患者94例146眼。根据患者最佳矫正视力(BCVA)情况,将患者分为轻度(>0.3~1.0)、中度(>0.1~0.3)和重度(无光感~0.1)视力损害组。另选取性别、年龄相匹配,病程相近的TAO无CON患者19例28眼为TAO-NCON组;选取性别、年龄相匹配的49名(49眼)正常人作为正常对照组。采用OCT检测所有受试者cpRNFL、黄斑区GCIPL及内界膜-视网膜色素上皮层(ILM-RPE)厚度。随访规范治疗的TAO-CON患者,检测预后BCVA(logMAR)。比较各组患者cpRNFL、GCIPL及ILM-RPE厚度差异,分析预后BCVA与cpRNFL、GCIPL厚度的关系。结果轻、中、重度视力损害组以及TAO-NCON组患者的cpRNFL厚度,均高于正常对照组(均为P<0.05);中、重度视力损害组患者的cpRNFL厚度均高于轻度视力损害组和TAO-NCON组,差异均有统计学意义(均为P<0.05)。中、重度视力损害组患者的GCIPL厚度均显著低于轻度视力损害组、TAO-NCON组及正常对照组(均为P<0.05);且重度视力损害组患者的GCIPL厚度低于中度视力损害组,差异有统计学意义(P<0.05)。各组间ILM-RPE厚度差异无统计学意义(P>0.05)。轻度视力损害组患者多能恢复较好视力,中、重度视力损害组患者视力恢复至0.5以上者在50%以上。TAO-CON患者预后BCVA(logMAR)与黄斑区GCIPL厚度呈显著负相关(r=-0.928,P=0.008),与cpRNFL厚度无相关性(r=0.095,P=0.571)。结论TAO-CON患者视力损害越重,cpRNFL增厚越多、GCIPL变薄越明显;TAO-CON患者GCIPL厚度与预后视力密切相关。Objective To analyze the correlation of visual impairment and visual prognosis with circumpapillary retinal nerve fiber layer(cpRNFL)and macular ganglion cell-inner plexiform layer(GCIPL)thickness in patients with compressive optic neuropathy(CON)caused by thyroid associated ophthalmology(TAO).Methods A total of 94 TAO-CON patients(146 eyes)with complete clinical data,diagnosed and treated at the outpatient and inpatient of our treatment group in Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University from January 2018 to July 2020,were enrolled.According to the best corrected visual acuity(BCVA)of patients,they were divided into the mild(>0.3-1.0),moderate(>0.1-0.3)and severe(no light perception-0.1)visual impairment groups.Another 19 non-CON TAO patients(28 eyes)with comparable age,gender and duration were selected into the TAO-NCON group.And 49 normal individuals(49 eyes)with comparable age and gender were selected into the normal control group.Optical coherence tomography(OCT)was applied to detect cpRNFL,macular GCIPL and inner limiting membrane-retinal pigment epithelium(ILM-RPE)thickness in all patients.The prognostic BCVA(logMAR)of TAO-CON patients who received regular treatment were followed up.The differences in cpRNFL,GCIPL and ILM-RPE thickness among these groups were compared respectively.The correlation of prognostic BCVA with cpRNFL and GCIPL thickness was analyzed.Results The average cpRNFL thickness in the mild,moderate and severe visual impairment groups and the TAO-NCON group was signi-ficantly higher than that in the normal control group(all P<0.05).The average cpRNFL thickness in the moderate and severe visual impairment groups was significantly higher than that in the mild visual impairment group and the TAO-NCON group(all P<0.05).The average GCIPL thickness in the moderate and severe visual impairment groups was significantly lower than that in the mild visual impairment group,the TAO-NCON group and the normal control group(all P<0.05).And the average GCIPL thicknes

关 键 词：甲状腺相关眼病 压迫性视神经病变 视盘周围神经纤维层 黄斑区节细胞-内丛状层 视力 

分 类 号：R774[医药卫生—眼科]