频域OCT测量高度近视黄斑区视网膜神经节细胞复合体厚度及视盘周围视网膜神经纤维层厚度

目的：分析高度近视患者黄斑区视网膜神经节细胞复合体（GCC）厚度与视盘周围视网膜神经纤维层（RNFL）厚度的特征。方法：横断面研究。应用RTVue SD-OCT对2015 年11 月至2016 年7 月期间在北京同仁医院眼科就诊的46例（46眼）高度近视患者和31例（31眼）正常对照者进行黄斑区GCC厚度和视盘周围RNFL厚度检测,按照眼轴长度（AL）将高度近视患者分为A组（26 例,26 mm≤AL＜28 mm）、B组（12 例,28 mm≤AL＜30 mm）和C组（8 例,AL≥30 mm）。高度近视组和正常对照组的均数比较采用独立样本t 检验,多组均数间的比较采用非参数Kruskal-Wallis H 检验。高度近视组GCC厚度、RNFL厚度与AL的相关关系采用Pearson相关分析。结果：高度近视患者平均、上方、下方GCC厚度和平均、上方、下方、鼻侧RNFL厚度较正常对照组低（H =20.38、15.65、21.69、31.27、20.10、20.78、11.08,P ＜0.001）,GCC局部丢失体积（FLV）和整体丢失体积（GLV）均较正常对照组大,差异均有统计学意义（H =20.02、27.24,均P ＜0.001）。高度近视患者平均、上方、下方GCC厚度和平均、上方、下方、颞侧RNFL厚度与AL均呈负相关（r=-0.462、-0.422、-0.462、-0.511、-0.502、-0.295、-0.408,均P ＜0.05）,与屈光度均呈正相关（r=0.479、0.469、0.444、0.604、0.535、0.413、0.528,均P ＜0.05）;FLV、GLV与AL均呈正相关（r=0.643、0.590,均P ＜0.001）,与屈光度均呈负相关（r=-0.666、-0.594,均P ＜0.001）。高度近视组RNFL厚度的变化率大于GCC厚度的变化率,差异有统计学意义（P ＜0.001）。结论：高度近视患者黄斑区GCC厚度降低,与AL呈负相关,与屈光度呈正相关。GCC厚度的变化率小于RNFL厚度的变化率。     

不同程度近视患者视网膜神经纤维层厚度和神经节细胞复合体参数的变化

目的:比较低度、中度和高度近视非青光眼受试者通过光谱域光学相干断层扫描技术(SD-OCT)测量的视网膜神经纤维层(RNFL)和黄斑神经节细胞复合体(GCC)参数的变化。方法:选择2019-12/2022-11期间在我院就诊的近视受试者400例400眼参与本研究,根据受试者近视程度分为：低度近视组(142例142眼,35.5%)、中度近视组(139例139眼,34.8%)和高度近视组(119例119眼,29.8%)。测量RNFL厚度,包括均值、上方、下方、鼻侧、颞侧RNFL厚度。测量GCC参数,包括均值、上方、颞上方、下方、颞下方、鼻上方、鼻下方。评估OCT测量的RNFL厚度、GCC参数均值与眼轴长度之间的相关性。结果:低度近视组和中度近视组的上方、下方、鼻侧、平均RNFL厚度明显高于高度近视组,颞侧RNFL厚度明显低于高度近视组(均P<0.05);低度近视组和中度近视组的上方、颞上方、下方、颞下方、鼻上方、鼻下方、平均GCC厚度明显高于高度近视组(均P<0.05);在中度近视组中,RNFL和GCC厚度均值与眼轴长度均呈负相关(r=-0.387、-0.309,均P<0....     

神经节细胞复合体厚度检测在原发性开角型青光眼中的诊断价值

背景 青光眼以损害视网膜神经节细胞(RGCs)继而出现视野缺损为特征,高分辨率频域OCT(SD-OCT)可以准确可靠地定量分析黄斑区视网膜神经节细胞复合体(GCC)厚度. 目的 探讨黄斑区GCC厚度对原发性开角型青光眼(POAG)的诊断意义.方法 采用前瞻性诊断试验研究设计.于2015年11月至2016年4月在北京同仁医院连续纳入POAG患者70例和30名健康志愿者,应用RTVue SD-OCT对70例POAG患者和30名正常对照者进行黄斑区GCC厚度和视盘周围视网膜神经纤维层(RNFL)厚度检测,并行Humphrey视野检查,均纳入受检者的右眼进行统计.根据视野检查的平均缺损(MD)值将POAG分为早期、进展期和晚期,对各组受检眼平均GCC、上方GCC和下方GCC、平均RNFL、上方RNFL、下方RNFL、局部丢失体积(FLV)和整体丢失体积(GLV)进行比较;评估POAG患者GCC厚度、RNFL厚度与视野MD值的关系,采用曲线下面积(AUC)和受试者工作特征ROC曲线评价GCC厚度和RNFL厚度对POAG的诊断效率. 结果 与正常对照组比较,早期POAG组、进展期POAG组和晚期POAG组的平均GCC、上方GCC、下方GCC、平均RNFL、上方RNFL和下方RNFL均明显降低,FLV和GLV均明显升高,各组间总体比较差异均有统计学意义(均P＜0.001);与早期POAG组比较,进展期POAG组和晚期POAG组受检眼平均GCC值和平均RNFL厚度值均明显下降,GLV值明显增加,差异均有统计学意义(均P＜0.05);晚期POAG组受检眼上方RNFL厚度值明显低于早期POAG组,差异有统计学意义(P=0.003);晚期POAG组受检眼上方GCC值明显低于早期POAG组和进展期POAG组,差异均有统计学意义(均P＜0.001);与早期POAG组比较,进展期POAG组和晚期POAG组受检眼下方GCC和下方RNFL厚度值明显下降,FLV明显增加,差异均有统计学意义(均P≤0.01).POAG患者平均GCC、上方GCC和下方GCC、平均RNFL、上方RNFL和下方RNFL与MD值均呈线性正相关(r=0.624、0.583、0.601、0.571、0.447、0.537,均P＜0.001);POAG患者平均GCC与平均RNFL、上方GCC与上方RNFL以及下方GCC与下方RNFL均呈线性正相关(r=0.648、0.630、0.602,均P＜0.001).平均GCC、上方GCC、下方GCC、FLV、GLV、平均RNFL、上方RNFL和下方RNFL的AUC值分别为0.965、0.924、0.979、0.985、0.980、0.990、0.979和0.992(均P＜O.001).GCC参数中FLV与下方RNFL的AUC值比较,差异无统计学意义(P＞0.05). 结论 POAG患者下方GCC厚度更容易受到损伤,GCC参数中FLV和GLV是诊断POAG的敏感指标,GCC厚度可以作为诊断和判断POAG病情进展的有效指标.     

OCT测量的黄斑区GCC和视盘RNFL厚度对前部缺血性视神经病变诊断效能的评估

背景 前部缺血性视神经病变(AION)是常见的眼部病变,预后较差,其早期诊断对视力预后至关重要.频域光相干断层扫描(FD-OCT)能在活体实时显示视网膜组织的细微结构,可定量测量黄斑区神经节细胞复合体(GCC)及视盘神经纤维层厚度(RNFL)厚度.以往的研究多用视盘RNFL厚度来评估AION患者视网膜神经节细胞(RGCs)的丢失情况,近期研究显示GCC厚度可检测出AION患者视网膜结构变化,但鲜见视盘RNFL厚度和GCC厚度对AION诊断效能的比较研究. 目的 评估OCT测量的GCC和RNFL对AION的诊断效能.方法 采用诊断试验研究方法,于2013年12月至2014年7月纳入在天津医科大学眼科医院就诊的AION患者15例15眼,同期纳入天津医科大学眼科医院职工及门诊就诊的年龄和性别匹配的正常对照者14人14眼,采用频域OCT测量黄斑区GCC厚度及视盘RNFL厚度,黄斑区GCC厚度测量指标包括黄斑区周围6mm×6mm范围上方、下方GCC厚度和平均GCC厚度,计算局部丢失体积(FLV)和整体丢失体积(GLV);视盘RNFL厚度测量指标包括视盘上方、下方及平均RNFL厚度,比较AION组与正常对照组间检测结果的差异.采用受试者工作特征(ROC)曲线下面积(AUC)评估FD-OCT测量的黄斑区GCC厚度及视盘RNFL厚度对AION的诊断效能.结果 与正常对照组比较,AION组受检眼黄斑区上方、下方及平均GCC厚度均明显薄于正常对照组,差异均有统计学意义(t=-3.402,P=0.002;t 2.690,P=0.012;t=2.913,P=0.007);AION组受检眼FLV值和GLV值分别为(8.39±4.54) μm3和(19.57±10.66) μm3,明显低于正常对照组的(0.64±0.48) μm3和(1.14±0.91) μm3,差异均有统计学意义(t=5.036、6.723,均P＜0.01).AION组受检眼视盘上方、下方及平均RNFL厚度较正常对照组均明显变薄,差异均有统计学意义(t=2.815,P=0.009;t=2.392,P=0.024;t=2.863,P=0.008).AION眼测量的FLV和GLV的AUC值均为1.000,黄斑区上方、平均GCC厚度及下方GCC厚度AUC依次为0.871、0.819和0.795,视盘平均RNFL厚度及视盘上方、下方RNFL厚度AUC依次为0.814、0.809和0.762. 结论 OCT测量的GCC厚度和RNFL厚度在AION诊断能力中具有可比性,FLV和GLV在AION患者的神经节细胞层检测方面能力较强,黄斑区GCC厚度与RNFL厚度测量在AION的诊断中可互为补充.     

Diagnostic ability of ganglion cell complex thickness to detect glaucoma in high myopia eyes by Fourier domain optical coherence tomography

AIM: To evaluate the ability of macular ganglion cell complex (GCC) thickness using Fourier domain optical coherence tomography (FD-OCT) to detect glaucoma in highly myopic eyes. METHODS: Cross-sectional study. A total of 114 participants, consecutively were enrolled. Macular GCC thickness and peripapillary retinal nerve fiber layer (RNFL) thickness were obtained with RTVue FD-OCT. Receiver operating characteristics curves were constructed for each measurement parameter, and areas under the curves (AUCs) were compared. RESULTS: Both the average GCC and average RNFL thickness showed negative correlations with axial length (rGCC=-0.404, P=0.001; rRNFL=-0.561, P<0.001). The largest AUCs from GCC, and RNFL parameters were 0.968 [global loss volume (GLV)], and 0.855 (average RNFL), respectively. GLV was significantly better for detecting high myopic glaucoma than average RNFL (P<0.001). CONCLUSION: Macular GCC thickness has higher diagnostic power than peripapillary RNFL thickness to discriminate glaucoma patients from non-glaucoma subjects in high myopia.     

Leber遗传性视神经病变视神经纤维层厚度及黄斑区神经节细胞复合体相关参数分析

目的观察Leber遗传性视神经病变（LHON）不同病变期患者的视网膜神经纤维层（RNFL）厚度和黄斑神经节细胞复合体（GCC）相关参数的变化特征。方法回顾性病例对照研究。纳入经线粒体基因检测确诊的LHON患者32例（64眼）,根据病变程度分为早期组18眼,进展期组22眼,晚期组24眼。选取眼部检查正常的健康志愿者60例（60眼）作为正常对照组。采用傅里叶频域光学相干断层扫描对所有受检者的视盘和黄斑区进行扫描,测量视盘平均、上方、下方、颞上、颞下、鼻上、鼻下、颞侧偏上、颞侧偏下、鼻侧偏上、鼻侧偏下象限的RNFL厚度等参数以及黄斑平均GCC、上方GCC、下方GCC厚度和局部丢失体积（FLV）、整体丢失体积（GLV）值。组间比较采用单因素方差分析。结果LHON早期组颞上、颞侧偏上、颞侧偏下、颞下、鼻下、上方、下方及平均RNFL厚度较正常对照组厚（P<0.05）;进展期组颞侧偏上、颞侧偏下、鼻侧偏下较正常对照组薄（P<0.05）;晚期组各象限RNFL厚度分别较正常对照组、早期组、进展组明显薄（P<0.05）。与正常对照组比较,LHON各期组平均GCC厚度、上方GCC厚度及下方GCC厚度均明显较薄（F=61.7、39.5、61.5,P<0.01）,FLV、GLV值均增大（F=29.6、40.8,P<0.01）。结论LHON发病早期,RNFL增厚,黄斑GCC明显变薄;病情进展期,颞侧和下方RNFL变薄,黄斑GCC进一步变薄;晚期各象限RNFL及黄斑GCC显著变薄。LHON发病存在慢性潜在性损害,且表现为急性发作的特征。     

【In Press】 Comparison of peripapillary retinal nerve fiber layer thickness between myopia severity groups and controls

AIM: To compare the peripapillary retinal nerve fiber layer (RNFL) thickness measured via optical coherence tomography (OCT) between different groups of myopia severity and controls. METHODS: This was a prospective cross-sectional study. All subjects underwent a full ophthalmic examination, refraction, visual field analysis and A-scan biometry. Myopic patients were classified as low myopia [spherical equivalent (SE) from greater than -0.5 D, up to -3.0 D], moderate myopia (SE greater than -3.0 D, up to -6.0 D) and high myopia (SE greater than -6.0 D). The control group was emmetropia, defined as a SE from +0.5 D to -0.5D. A Zeiss Cirrus HD-OCT machine was used to measure the peripapillary RNFL thickness of both eyes of each subject. The mean peripapillary RNFL thickness between groups was compared using both analysis of variance and analysis of covariance. RESULTS: A total of 403 eyes of 403 subjects were included in this study. The mean age was 31.48±10.23. There were 180 (44.7%) eyes with emmetropia, 124 (30.8%) with low myopia, 73 (18.1%) with moderate myopia and 26 (6.5%) with high myopia. All groups of myopia severity had a thinner average RNFL than the emmetropia group, but after controlling for gender, age, and axial eye length, only the high myopia group differed significantly from the emmetropia group (P=0.017). Likewise, the superior, inferior and nasal RNFL was thinner in all myopia groups compared to controls, but after controlling for confounders, only the inferior quadrant RNFL was significantly thinner in the high myopia group, when compared to the emmetropia group (P=0.017). CONCLUSION: The average and inferior quadrant RNFL is thinner in highly myopic eyes compared to emmetropic eyes. Refractive status must be taken into consideration when interpreting the OCT of myopic patients, as RNFL thickness varies with the degree of myopia.     

Comparison of peripapillary retinal nerve fiber layer thickness between myopia severity groups and controls

AIM: To compare the peripapillary retinal nerve fiber layer (RNFL) thickness measured via optical coherence tomography (OCT) between different groups of myopia severity and controls. METHODS: This was a prospective cross-sectional study. All subjects underwent a full ophthalmic examination, refraction, visual field analysis and A-scan biometry. Myopic patients were classified as low myopia (LM) [spherical equivalent (SE) from greater than -0.5 D, up to -3.0 D], moderate myopia (MM; SE greater than -3.0 D, up to -6.0 D) and high myopia (HM; SE greater than -6.0 D). The control group consisted of emmetropic (EM) patients (SE from +0.5 D to -0.5 D). A Zeiss Cirrus HD-OCT machine was used to measure the peripapillary RNFL thickness of both eyes of each subject. The mean peripapillary RNFL thickness between groups was compared using both analysis of variance and analysis of covariance. RESULTS: A total of 403 eyes of 403 subjects were included in this study. The mean age was 31.48±10.23y. There were 180 (44.7%) eyes with EM, 124 (30.8%) with LM, 73 (18.1%) with MM and 26 (6.5%) with HM. All groups of myopia severity had a thinner average RNFL than the EM group, but after controlling for gender, age, and axial eye length, only the HM group differed significantly from the EM group (P=0.017). Likewise, the superior, inferior and nasal RNFL was thinner in all myopia groups compared to controls, but after controlling for confounders, only the inferior quadrant RNFL was significantly thinner in the HM group, when compared to the EM group (P=0.017). CONCLUSION: The average and inferior quadrant RNFL is thinner in highly myopic eyes compared to emmetropic eyes. Refractive status must be taken into consideration when interpreting the OCT of myopic patients, as RNFL thickness varies with the degree of myopia.     

基于视网膜神经纤维层厚度及神经节细胞复合体诊断POAG的效能分析

目的：比较原发性开角型青光眼( primary open angle glaucoma,POAG)与正常对照组盘周视网膜神经纤维层厚度( retinal nerve fiber layer thickness,RNFL)及黄斑区神经节细胞复合体( ganglion cell complex,GCC)厚度差异,并评价盘周 RNFL 厚度及黄斑 GCC 厚度在 POAG 中的诊断价值。
　　方法：采用横断面研究。连续的POAG患者56例纳入研究。选择同期年龄、性别、屈光度及眼轴匹配的正常人60名60眼作为正常对照组。用RTVue-100光学相干断层扫描技术( optical coherence tomography,OCT)检测并比较POAG组及对照组盘周RNFL厚度及黄斑GCC厚度。采用受试者工作特征曲线( receiver operating characteristic curve,ROC)及ROC曲线下面积( area under curve,AUC)评价盘周 RNFL 厚度及黄斑 GCC 厚度对青光眼的诊断价值。
　　结果：POAG组患者盘周所有象限RNFL均薄于正常对照组,差异有统计学意义( P<0.001)。 POAG组患者黄斑所有区域GCC厚度均小于正常对照组,差异有统计学意义(P<0.001)。多因素线性回归分析结果,PAOG诊断是盘周RNFL厚度与黄斑GCC厚度的独立相关因素。 ROC及AUC分析提示：杯盘比AUC值最大( AUC=0.936;95%CI=0.903~0.964),其次为上方 RNFL 厚度( AUC=0.910;95%CI=0.889~9.455),诊断价值高,盘周鼻侧,下方,颞侧RNFL厚度以及黄斑上方,下方平均GCC厚度AUC值均大于0.8,具有较好的诊断价值。
　　结论：POAG患者盘周RNFL厚度与黄斑GCC厚度均明显变薄,变薄的盘周RNFL厚度与黄斑GCC厚度与POAG诊断存在相关性。盘周RNFL厚度与黄斑GCC厚度均有较好的诊断价值。     

睡眠呼吸障碍患者黄斑区神经节细胞复合体厚度研究

目的:比较不同程度睡眠呼吸障碍患者黄斑区神经节细胞复合体(GCC)的厚度变化。方法:采用横断面研究,收集2015-06/2018-06间于我校附属医院诊断为阻塞性睡眠呼吸障碍综合征的患者和健康体检者,将呼吸暂停低通气指数(AHI)≥5的58例患者纳入睡眠呼吸障碍组,根据AHI值将其分为轻、中、重度三个亚组,将AHI<5的50例健康体检者纳入对照组。采用RTVUE 100-2型相干光断层扫描检查仪对黄斑区视网膜进行扫描,测量黄斑区GCC总体平均厚度(GCC-Avg)、上方平均厚度(GCC-Sup)、下方平均厚度(GCC-Inf)、局部丢失容积(FLV)与整体丢失容积(GLV)。分析比较各组间GCC厚度的差异。结果:不同程度睡眠呼吸障碍组各区GCC厚度均较对照组变薄(P<0.05),但FLV和GLV均较对照组增加(P<0.05),不同程度睡眠呼吸障碍组组间FLV比较无差异(P>0.05),不同程度睡眠呼吸障碍组组间GLV比较有差异(P<0.05)。结论:随着睡眠呼吸障碍程度的加重黄斑区GCC厚度变薄。     

Retinal nerve fiber layer measurements in myopia: An optical coherence tomography study

PURPOSE: To evaluate the relationship between retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) and the axial length/refractive error of the eye. METHODS: A total of 115 eyes of 115 healthy subjects, comprising 75 eyes with high myopia (spherical equivalent [SE] < -6.0 D) and 40 eyes with low to moderate myopia (SE between -6.0 D and -0.5D), were analyzed in this cross-sectional study. Total average and mean clock hour RNFL thicknesses were measured by OCT and compared between the two myopia groups. Associations between RNFL measurements and axial length and spherical equivalent were evaluated by linear regression analysis. RESULTS: The RNFL measurements were significantly lower in the high myopia group compared with those of the low-to-moderate myopia group at 12, 1, and 7 o'clock (right eye orientation). Apart from the temporal clock hours, significant correlations were evident between RNFL measurements and the axial length and spherical equivalent. The average RNFL thickness decreased with increasing axial length (r = -0.314, P = 0.001) and negative refractive power (r = 0.291, P = 0.002). A significant proportion of myopic eyes were classified as outside normal limits, with reference to the normative database. The most frequently abnormal sector was at 2 o'clock, where 16.5% of myopic eyes were outside normal limits. CONCLUSIONS: RNFL measurements vary with the axial length/refractive error of the eye. Analysis of RNFL thickness in the evaluation of glaucoma should always be interpreted with reference to the refractive status. Although the normative database provided by OCT has been helpful in identifying ocular diseases involving the RNFL, it may not be reliable in the analysis of myopic eyes.     

Inner retinal layer comparisons of eyes with exudative age-related macular degeneration and eyes with age-related macular degeneration and glaucoma

Background

The incidence of glaucoma increases with age, as does age-related macular degeneration (AMD), with the reported incidence of glaucoma among AMD subjects being 5.4 %. Optical coherence tomography (OCT) can detect glaucomatous changes in the inner retina with high sensitivity. The purpose of this study was to compare ganglion cell complex (GCC) parameters and the thickness of the peripapillary retinal nerve fiber layer (RNFL) in normal eyes to that observed in eyes with age-related macular degeneration (AMD) and eyes with both AMD and glaucoma.

Methods

The GCC components [GCC thickness, focal loss volume (FLV), and global loss volume (GLV)] and peripapillary RNFL thickness were measured using RTVue spectral-domain OCT (SD-OCT). The GCC and RNFL parameters of normal eyes, AMD eyes treated with different types of therapy, and AMD eyes with and without glaucoma were evaluated using nonparametric tests. Univariate and multivariate analyses were used to determine whether the GCC and RNFL parameters could be used to differentiate AMD eyes with glaucoma from those without glaucoma.

Results

Seventy-one normal eyes, 120 eyes with AMD, and 23 eyes with AMD and glaucoma were studied. The values of all GCC components were significantly different in the normal eyes from those observed in the eyes with AMD, except for the RNFL thicknesses. The GCC and RNFL parameters were not significantly different between the eyes receiving different types of therapy among the AMD groups. The RNFL thickness was significantly correlated with glaucoma diagnosis in AMD eyes.

Conclusions

These findings indicate that there is damage to the inner retinal layers in eyes with AMD. The RNFL thickness can be a useful parameter for differentiating eyes with AMD from eyes with both AMD and glaucoma.     

高度近视性弱视儿童视盘周围视网膜神经纤维层厚度分析

目的：分析高度近视性弱视儿童视盘周围视网膜神经纤维层厚度特点,并探讨与眼轴、年龄的关系。
　　方法：选择收集2014-01/07间在我院眼科门诊就诊的儿童35例59眼,平均年龄9.59±2.90岁,所有受检眼排除眼底的疾病和眼前节的病变。根据扩瞳验光的结果,分成高度近视性弱视组(22眼)、高度近视组(15眼)、正视眼组(22眼),运用频域OCT对视盘周围视网膜神经纤维层进行检测,通过A超测量出所有受检者眼轴长度。对各组视盘周围各方位视网膜神经纤维层厚度进行比较分析,探讨视盘周围各方位视网膜神经纤维层与眼轴、年龄的关系。
　　结果：高度近视性弱视组视盘颞侧RNFL厚度薄于高度
　　近视组,厚于正视眼组;视盘鼻侧、上方、下方、周围平均RNFL厚度与高度近视组、正视眼组相比均最薄,其中视盘下方及周围平均RNFL厚度与高度近视组相比变薄,有统计学差异(P<0.05),视盘鼻侧、上方、下方、周围平均RNFL厚度与正视眼组相比明显变薄,有统计学差异( P<0.01)。高度近视组视盘颞侧RNFL厚度与正视眼组相比明显增厚,视盘鼻侧、上方、下方、周围平均RNFL厚度与正视眼组相比均明显变薄,有统计学差异(P<0.05)。高度近视性弱视组视盘下方RNFL厚度与眼轴呈负相关性( R=0.474, R2=0.225, F=4.933, P=0.040)。高度近视组视盘上方RNFL厚度与眼轴呈负相关性(R=0.642, R2=0.412,F=9.104,P=0.010)。高度近视性弱视组、高度近视组、正视眼组各方位RNFL厚度与年龄均无明显相关性。
　　结论：高度近视性弱视儿童视网膜结构存在异常。     

傅里叶域OCT对不同屈光状态非青光眼青年人群神经节细胞复合体的观察

目的：应用傅里叶域光学相干断层扫描（OCT）观察不同屈光状态非青光眼青年人群神经节细胞复合 体（GCC）形态特征,探讨眼轴长度（AL）与GCC的变化规律。方法：病例对照研究。基于AL纳入非 高度近视94眼和高度近视62眼,使用OCT测量其黄斑区GCC厚度、上/下半区GCC（GCC-S/GCC-I） 厚度、局部丢失体积（FLV）和整体丢失体积（GLV）并计算FLV与GLV比值（FGR）。使用线性回归 分析各指标与AL的相关性;采用受试者工作特征曲线下面积（AUC）评价2组间各指标差异及界值。 结果：线性回归结果示受试者GCC厚度（β=-0.698,P<0.001）、GCC-S厚度（β=-0.693,P<0.001）、 GCC-I厚度（β=-0.672,P<0.001）随AL延长而下降;FLV不随AL变化而变化（β=0.115,P=0.155）; GLV随AL延长而增高（β=0.346,P<0.001）,FGR随AL延长而降低（β=-0.473,P<0.001）。独立样 本t检验结果示高度近视组和非高度近视组间GCC厚度（t=7.398,P<0.001）、GCC-S厚度（t=7.313, P<0.001）、GCC-I厚度（t=7.022,P<0.001）、GLV（t=-3.482,P=0.001）及FGR（t=5.361,P<0.001） 差异有统计学意义,FLV差异无统计学意义（t=1.057,P=0.292）。AUCGCC为0.809（P<0.001）,最佳 界值99 μm;AUCGLV为0.689（P<0.001）,最佳界值3.42;AUCFGR为0.711（P<0.001）,最佳界值0.44; AUCFLV为0.546（P=0.330）。结论：OCT可观察不同屈光状态非青光眼青年人群GCC,平均GCC厚度、 GCC-S厚度、GCC-I厚度、GLV和FGR随AL变化而发生改变。     

Scanning laser polarimetry in myopic and hyperopic subjects

Purpose To investigate the effect of refraction error and axial length on retinal nerve fiber layer (RNFL) measurements as obtained by scanning laser polarimetry (SLP).Methods Besides ophthalmological standard examination (refractive error, keratometry, visual acuity, slit-lamp examination, applanation tonometry, funduscopy), perimetry, axial length measurement by means of ultrasound, and SLP were performed. Seventy-five myopic eyes (between –0.75 D and –8.5 D), 24 hyperopic eyes (0.75 D–6.5 D) and 40 emmetropic eyes were investigated. SLP parameters were compared in the different groups.Results The statistical analysis of the absolute thickness values of SLP revealed highly significant (P<0.01) reductions in average thickness, ellipse average, superior average, inferior average, and superior integral in both myopic and hyperopic eyes in comparison with the emmetropic control eyes. The amount of reduction was between 12.9% (inferior average; myopia) and 30.2% (superior integral; hyperopia). There were no significant differences between myopes and hyperopes. A significant linear correlation for many of the SLP parameters with the refractive error (spherical equivalent) but not with axial length was found in both the hyperopic and the myopic group.Conclusions Despite a wide interindividual range, SLP measurement values decrease with increasing myopia and hyperopia. In clinical practice, such reduced RNFL thickness values should be viewed with the necessary caution and additional polarimetric signs for glaucomatous damage should be taken into consideration.     

Evaluation of spectral domain optical coherence tomography parameters in discriminating preperimetric glaucoma from high myopia

AIM: To evaluate the diagnostic ability of macular ganglion cell-inner plexiform layer (GCIPL) thickness obtained by spectral-domain optical coherence tomography (SD-OCT) in discriminating non-highly myopic eyes with preperimetric glaucoma (PPG) from highly myopic healthy eyes. METHODS: A total of 254 eyes, including 76 normal controls (NC), 116 eyes with high myopia (HM) and 62 non-highly myopic eyes with PPG were enrolled. The diagnostic ability of OCT parameters was accessed by the areas under the receiver operating characteristic (AUROC) curve in two distinguishing groups: PPG eyes with non-glaucomatous eyes including NC and HM (Group 1), and PPG eyes with HM eyes (Group 2). Differences in diagnostic performance between GCIPL and RNFL parameters were evaluated. RESULTS: The minimum (AUROC curve of 0.782), inferotemporal (0.758) and inferior (0.705) GCIPL thickness were the top three GCIPL parameters in discriminating PPG from non-glaucomatous eyes, all of which had statistically significant lower diagnostic ability than average RNFL thickness (0.847). In discriminating PPG from HM, the best GCIPL parameter was minimum (0.689), statistically significant lower in diagnostic ability than average RNFL thickness (0.789) and three other RNFL thickness parameters of temporal and inferotemporal clock-hour sectors. CONCLUSION: The minimum GCIPL thickness is the best GCIPL parameter to detect non-highly myopic PPG from highly myopic eyes, whose diagnostic ability is inferior to that of average RNFL thickness and RNFL thickness of several temporal and inferotemporal clock-hour sectors. The average RNFL thickness is recommended for discriminating PPG from highly myopic healthy eyes in current clinical practice in a Chinese population.     

Cirrus HD OCT检测近视眼视网膜神经纤维层厚度的研究

目的：应用Cirrus HD OCT检测近视眼视网膜神纤维层厚度,探讨近视眼神经纤维层厚度分布特点及其与屈光度的关系。 方法：将近视眼106例196眼分为低、中、高度近视组和正常对照组38例60眼,应用Cirrus HD OCT进行以视盘为中心,直径3.46 mm圆周的RNFL厚度测量,计算各组平均、各象限及各钟点RNFL厚度,各近视组分别与正常对照组对比,研究近视眼RNFL厚度与屈光度的关系。 结果：各近视组平均、上方象限及下方象限RNFL厚度较正常对照组变薄,其中中度、高度近视与正常对照组相比有统计学差异（ P〈0.05）,鼻侧象限RNFL厚度变薄,无统计学显著性差异（ P〉0.05）,颞侧象限RNFL厚度增加,有统计学差异（ P〈0.05）;各近视组2：00,6：00,12：00位RNFL厚度较正常对照组变薄,有统计学差异（ P〈0.05）,8：00,9：00,10：00位RNFL厚度较正常对照组增加,有统计学差异（ P〈0.05）,中、高度近视1：00,5：00位厚度较正常对照组变薄,有统计学差异（P〈0.05）。 结论：近视眼平均、上方及下方象限、2：00,6：00,12：00位RNFL厚度较正常对照组变薄,颞侧象限、8：00,9：00,10：00位RNFL厚度较正常对照组相比明显增加,这是近视眼RNFL厚度的特点,当临床出现RNFL厚度异常时,应考虑屈光度的影响,综合评价其临床意义;近视眼7：00,8：00,10：00,11：00位RNFL厚度与正常对照组相比均未变薄,出现异常变薄时,应考虑青光眼可能。     

Width of abnormal ganglion cell complex area determined using optical coherence tomography to predict glaucoma

Purposes

We examined the relationships of ganglion cell complex (GCC) parameters determined on spectral-domain optical coherence tomography (SD-OCT), especially the width of abnormal areas, and its ability to detect various stages of glaucoma.

Methods

OCT parameters of glaucomatous and normal eyes were determined with the RTVue SD-OCT. Widths of abnormal GCC areas marked by either red or yellow on the OCT significance map were quantified with image J software. The relationships between the abnormal GCC area and other GCC parameters [thickness, focal loss volume (FLV), and global loss volume (GLV)] and the peripapillary retinal nerve fiber layer (RNFL) thickness were determined using regression analyses. The potential of using the GCC and RNFL parameters to discriminate between glaucomatous and normal eyes was examined using the area under the curve (AUC) of receiver operating characteristics (ROC).

Results

One hundred and eighteen glaucomatous eyes and 45 normal control eyes were studied. Nonlinear models best described the relationships between abnormal GCC area and other GCC parameters. Scatter plots showed changes in the average thickness of the GCC and RNFL, and the average sizes of the GLV preceded changes of abnormal areas of the GCC. The width of the abnormal areas on the GCC thickness map was comparable with other parameters for diagnosing glaucoma.

Conclusions

OCT thickness parameters appeared to decrease faster than the area parameter at the initial stage of glaucoma. The sizes of abnormal areas of the GCC were the most pertinent parameters for detecting glaucoma.     

Effect of peripapillary chorioretinal atrophy on GDx parametersin patients with degenerative myopia

Purpose: To determine the effect of peripapillary chorio­retinal atrophy in degenerative myopia on the retinal nerve fibre layer (RNFL) thickness measurements performed by scanning laser polarimetry. Methods: Polarimetric RNFL analysis was done in 41 degenerative myopic eyes of 25 patients with spherical refractive errors between ?7.50 and ?22.00 D (mean ?12.50 D; SD 3.5). Analysis was also performed on 46 eyes of 24 age‐matched healthy subjects with spherical refractive errors between ?1.00 and +1.00 D (mean ?0.25 D; SD 0.50) with GDx Nerve Fiber Analyzer (Version 1.0.12). All of the myopic patients had clinically evident peripapillary chorio­retinal atrophy in their fundus examination. Results: In myopic patients most of the GDx parameters were statistically different from the control group (P < 0.05). Although average thickness, ellipse average, number, inferior maximum and inferior average were found to be higher than the healthy subjects, the modu­lation parameters and the ratio‐based parameters were significantly decreased in degenerative myopic patients (P < 0.05). The TSNIT (temporal, superior, nasal, inferior, temporal) graph showed irregular high spikes with loss of the regular double hump pattern, especially in quadrants with large chorioretinal atrophy and visible sclera. Conclusion: Peripapillary chorioretinal atrophy increased retardation values, which might be explained by the high reflectivity of the bare sclera in these areas.     

Evaluation of peripapillary retinal nerve fiber layer, macula and ganglion cell thickness in amblyopia using spectral optical coherence tomography

AIM:To investigate peripapillary retinal nerve fiber layer (RNFL), macula and ganglion cell layer thicknesses (GCC) in amblyopic eyes with spectral domain optical coherence tomography (SD-OCT).METHODS:Thirty six patients with a history of unilateral amblyopia and thirty two children who had emmetropia without amblyopia were included in this study.In this institutional study, 36 eyes of 36 patients with amblyopia (AE), 36 fellow eyes without amblyopia (FE), and 32 eyes of 32 normal subjects (NE) were included. RNFL, GCC and macular thickness measurements were performed with RS-3000 OCT Retina Scan (Nidek Inc CA. USA).RESULTS:The mean global thicknesses of the RNFL were 113.22±21.47, 111.57±18.25, 109.96±11.31µm in the AE, FE, and NE, respectively. There was no statistically significant difference for mean global RNFL thickness among the eyes (P=0.13). The mean thicknesses of the macula were 258.25±18.31, 258.75±19.54, 248.62±10.57μm in the AE, FE and NE, respectively. There was no statistically significant difference for thickness of macula among the eyes (P=0.06). The GCC was investigated into two parts:superior and inferior. The mean thicknesses of superior GCC were 102.57±13.32, 103.32±10.64, 100.52±5.88μm in the AE, FE, and NE, respectively. The mean thicknesses of inferior GCC were 103.82±12.60, 107.82±12.33, 105.86±10.79μm in the AE, FE and NE, respectively. There was no statistically significant difference for thickness of superior and inferior GCC between the eyes (P=0.63, P=0.46).CONCLUSION:The macular thicknesses of AE and FEwere greater than the NE, although it was not statistically significant. Amblyopia does not seem to have a profound effect on the RNFL, macula and GCC.