颈内动脉狭窄及合并缺血性脑卒中患者视网膜微血管神经改变特征

目的　对比单侧颈内动脉狭窄（ICAS）患者双眼视网膜厚度及血流密度（VD）、视网膜神经纤维层（RNFL）厚度及神经节细胞复合体（GCC）厚度,探讨颈内动脉狭窄及合并缺血性脑卒中患者视网膜微血管神经的变化特点。方法　横断面研究。收集2019年12月至2021年12月在我院就诊的单侧ICAS≥70％（狭窄侧眼组）、对侧颈内动脉无狭窄或狭窄<50％（对侧眼组）的27例患者的临床资料。所有患者均行眼科常规及光学相干断层扫描血管成像（OCTA）检查。对比观察双眼视网膜厚度、VD、RNFL厚度及GCC厚度,并根据是否合并缺血性脑卒中进行亚组分析。结果　ICAS≥70％的患者狭窄侧眼组黄斑区浅层、深层视网膜及黄斑中心凹无灌注区面积周围300 μm环内的VD均较对侧眼组明显降低（均为P<0.05）,狭窄侧眼组的视盘下颞区及颞下区VD均较对侧眼组明显降低（均为P<0.05）。合并缺血性脑卒中的ICAS患者狭窄侧眼组黄斑区视网膜浅层和深层VD、视盘下颞及颞下区VD、下半部GCC厚度均较对侧眼组显著降低（P<0.05）。不合并脑卒中的ICAS患者狭窄侧眼组与对侧眼组黄斑区及视盘的VD、RNFL厚度、GCC厚度差异均无统计学意义（均为P>0.05)。结论　重度及以上ICAS的患者已经出现视网膜微循环障碍,且在合并有缺血性脑卒中的患者中表现更明显,并出现神经节细胞的损伤,提示ICAS合并视网膜微血管和神经节细胞的损伤有可能是缺血性脑卒中发生的危险因素。     

视盘水肿患者视盘周围区域厚度参数的改变

目的 采用光学相干断层扫描(optical coherence tomography,OCT)观察视盘水肿患者视盘周围区域厚度参数的改变,为视盘水肿的临床评估寻找新方法.方法 选取2012年10月至2015年10月在我院门诊就诊和住院的视盘水肿患者36例(36眼)作为研究对象,同时选取在我院体检的无眼科疾病的正常人51人(51眼)作为对照组.所有研究对象均检测视力、裂隙灯、眼底及眼底照相,全部研究眼均行OCT扫描检测视盘周围视网膜神经纤维厚度(circumpapillary retinal nerve fiber layer thickness,cpRNFLT)及视盘周围视网膜总厚度(circumpapillary total retinal thickness,cpTRT).结果 本研究选取的36例视盘水肿患者中轻度5例,中度15例,重度16例.OCT扫描后,连续检查3次均不能获得满意图像或计算机无法正确分析者将被剔除,最后有25例视盘水肿患者(轻度5例,中度14例,重度6例)符合分析cpRNFLT的要求;30例视盘水肿患者(轻度5例,中度15例,重度10例)符合分析cpTRT的要求;对照组有50人符合条件纳入研究.两组受试者年龄以及性别构成差异均无统计学意义(均为P＞0.05).OCT视网膜断面图显示视盘水肿组cpRNFLT及cpTRT光带明显增宽,神经纤维层下无反射区宽度增加;视盘水肿组患者的平均及各象限cpRNFLT明显增厚,cpRNFLT以上方增厚最明显,其次是下方,然后是鼻侧和颞侧,与对照组相比差异均有统计学意义(均为P ＜0.001).OCT检查结果显示,视盘水肿组患者平均及各象限cpTRT明显增厚,cpTRT以下方增厚最明显,其次是上方,然后是鼻侧和颞侧,与对照组相比差异亦均有统计学意义(均为P ＜0.001).结论 视盘水肿患者视盘周围区域厚度参数均较正常人明显增厚,这些参数可作为视盘水肿诊断以及研究的参考指标.     

Structural measurements and vessel density of spectral-domain optic coherence tomography in early, moderate, and severe primary angle-closure glaucoma

AIM: To compare the macular ganglion cell-inner plexiform layer (GCIPL) thickness, retinal nerve fiber layer (RNFL) thickness, optic nerve head (ONH) parameters, and retinal vessel density (VD) measured by spectral-domain optical coherence tomography (SD-OCT) and analyze the correlations between them in the early, moderate, severe primary angle-closure glaucoma (PACG) and normal eyes. METHODS: Totally 70 PACG eyes and 20 normal eyes were recruited for this retrospective analysis. PACG eyes were further separated into early, moderate, or severe PACG eyes using the Enhanced Glaucoma Staging System (GSS2). The GCIPL thickness, RNFL thickness, ONH parameters, and retinal VD were measured by SD-OCT, differences among the groups and correlations within the same group were calculated. RESULTS: The inferior and superotemporal sectors of the GCIPL thickness, rim area of ONH, average and inferior sector of the retinal VD were significantly reduced (all P<0.05) in the early PACG eyes compared to the normal and the optic disc area, cup to disc ratio (C/D), and cup volume were significantly higher (all P<0.05); but the RNFL was not significant changes in early and moderate PACG. In severe group, the GCIPL and RNFL thickness were obvious thinning with retinal VD were decreasing as well as C/D and cup volume increasing than other three groups (all P<0.01). In the early PACG subgroup, there were significant positive correlations between retinal VD and GCIPL thickness (except superonasal and inferonasal sectors, r=0.573 to 0.641, all P<0.05), superior sectors of RNFL thickness (r=0.055, P=0.049). More obvious significant positive correlations were existed in moderate PACG eyes between retinal VD and superior sectors of RNFL thickness (r=0.650, P=0.022), and temporal sectors of RNFL thickness (r=0.740, P=0.006). In the severe PACG eyes, neither GCIPL nor RNFL thickness was associated with retinal VD. CONCLUSION: The ONH damage and retinal VD loss appears earlier than RNFL thickness loss in PACG eyes. As the PACG disease progressed from the early to the moderate stage, the correlations between the retinal VD and RNFL thickness increases.     

Study of long term structural and functional changes in medically controlled glaucoma

AIM:Prospectively analyze the long term structural and functional changes in patients of primary open angle glaucoma (POAG) receiving medical therapy (beta blockers and non beta blockers). In this study an attempt has been made to evaluate whether medical reduction of IOP prevents or delays the progression of glaucomatous visual field loss and/or optic nerve damage in patients with open angle glaucoma.METHODS:Study conducted over a period of 27 months, at a tertiary eye care hospital including both eyes of 40 patients with POAG. Group 1 (20 patients, 40 eyes) received beta-blockers, and Group 2 (20 patients, 40 eyes) received non-beta-blockers. Each patient underwent intraocular pressure measurement, best corrected visual acuity, slit-lamp, fundus examination, gonioscopy, central corneal thickness, visual field assessment by Humphrey automated perimetry and retinal nerve fibre layer thickness by Stratus optical coherence tomography at baseline and at two subsequent visits. The average time interval between each visit was 10-11 months. The statistical analysis was done using one-way analysis of variance (ANOVA). Post-hoc test, using tukey’ method were adopted. Probablity (P) value of 0.05 or less was considered to be statistically significant.RESULTS:A total of 80 eyes of 40 patients of POAG were enrolled, 24 males, 16 females, age group 50-80 years. In both beta and non beta blocker group, reduction (improvement) in mean IOP from initial levels to the levels achieved at the 2nd and 3rd visits was statistically significant. One way ANOVA (df=2), fisher f value=11.64, P=0.000, one way ANOVA (df=3), fisher f value=35.61, P=0.000. Both mean deviation (MD) and pattern standard deviation (PSD) in both beta and non beta blockers at different visits were not statistically significant. Retinal nerve fibre layer thickness (RNFL) -only mean inferior retinal nerve fibre layer, the difference between the mean value in beta and non beta blocker groupwere statistically significant. [unpaired t test value (df=78) =2.27, P=0.03]. Side effects with beta blocker were conjunctival hyperemia (10%), burning (5%), and conjunctival hyperemia (5%) in non beta blockers.CONCLUSION: Non-beta-blockers are as effective as beta-blockers in bringing about a significant lowering of intraocular pressure to the normal range, and in preventing progressive damage to the visual fields and retinal nerve fibre layer. The absence of systemic side effects and superior IOP lowering efficacy has made non beta-blockers attractive for first line therapy for the treatment of glaucoma worldwide.     

原发性青光眼视网膜神经纤维层厚度和视盘周围血管密度分析

目的　探讨原发性闭角型青光眼(PACG)和原发性开角型青光眼（POAG）患者视网膜神经纤维层（retinal nerve fiber layer,RNFL）厚度、视盘周围血管密度（circumpapillary vascular density,cpVD）及视野平均敏感度(mean sensitivity,MS)之间的关系,以了解两种疾病本质是否有差异。方法　选取2016年7月至2018年7月本院就诊的POAG患者120例（120眼）及与POAG患者年龄、视野平均缺损（mean deviation,MD）相匹配的120例（120眼）PACG患者临床资料进行回顾性分析。采用光学相干断层扫描血管成像（OCTA）检测平均RNFL厚度、cpVD及不同方向［上方颞侧（superotemporal,ST）、上方鼻侧（superonasal,SN）、鼻上（nasoupper,NU）、鼻下（nasolower,NL）、下方鼻侧（inferonasal,IN）、下方颞侧（inferotemoporal,IT）、颞下（temporolower,TL）、颞上（temporoupper,TU）］ RNFL厚度,采用自动视野计检测总视野MS及不同方向视野MS。分析不同方向RNFL厚度、cpVD和视野MS之间关系及影响cpVD的相关因素。结果　PACG组和POAG组患者平均RNFL厚度、平均cpVD、平均视野MS间均相关（均为P＜0.05）。PACG组患者RNFL厚度在ST、SN、IT、IN 4个方向上与相应的视野MS均相关（均为P＜0.05）,cpVD在ST、SN、IT、IN和TL 5个方向上与相应的视野MS均相关（均为P＜0.05）。PACG组各方位RNFL厚度与cpVD均相关（均为P<0.05）。POAG组患者在所有方向上cpVD、RNFL厚度、视野MS均两两相关（均为P＜0.05）。PACG组眼压和RNFL厚度是影响cpVD的独立危险因素（均为P＜0.05）;而POAG组仅有RNFL厚度是影响cpVD的独立危险因素（P＜0.05）。结论　与POAG患者相比,PACG患者中cpVD与视野MS的相关性强,说明两者在血管和功能关系上具有一定差异,可能与两者发病机制不同有关。     

Ex-press青光眼引流器植入术对视野和视网膜神经纤维层厚度影响

目的：观察并分析Ex-press 青光眼引流器植入术对原发性开角型青光眼视野和视网膜神经纤维层厚度影响。
　　方法：选取原发性开角型青光眼患者14例24眼,均行Ex-press青光眼引流器植入术。收集术前裸眼视力、眼压、角膜内皮细胞计数、视野平均缺损( MD)、视野模式标准差(PSD)、视网膜神经纤维层厚度,术后1wk,1、3mo的裸眼视力、眼压,术后3 mo的角膜内皮细胞计数、MD、PSD、视网膜神经纤维层厚度,观察随访期间的并发症及相关处理,统计手术成功率。
　　结果：术前,术后1wk,1、3mo 裸眼视力分别进行两两比较,得出差异均无统计学意义(P>0.05),术后视力无明显下降。术后1wk,1、3mo眼压与术前降低,差异有统计学意义(P<0.05),且术后3mo内眼压保持平稳。术后3mo视网膜神经纤维层厚度和术前比较差异有统计学意义(P=0.018)。术后3 mo MD绝对值和 PSD 较术前相比,差异均无统计学意义(P>0.05)。术后3mo的角膜内皮细胞较术前减少,差异有统计学意义(Z=-2.585,P=0.01)。手术成功率：完全成功19眼(79%),条件成功2眼(8%),失败3眼(13%)。
　　结论：Ex-press青光眼引流器植入术术后短时间内可能会引起视网膜神经纤维层厚度变薄,稳定的降眼压效果能有效减缓视野进展,手术未影响视力,降眼压效果好,是治疗原发性开角型青光眼安全、有效的手术方法。     

mGCC对原发性青光眼的诊断价值及其与pRNFL和视野的相关性

目的：分析黄斑区节细胞复合体(macular ganglion cell complex,mGCC)对原发性青光眼的诊断价值,探讨mGCC与视乳头周围视网膜神经纤维层(peripapillary retinal nerve fiber layer,pRNFL)及视野的相关性,以期为原发性青光眼的诊治提供科学参考依据。

方法：选取2015-01/2016-12在我院接受诊治的原发性青光眼患者67例80眼为观察组,另纳入同期我院健康体检者40例80眼为对照组。采用光学断层扫描仪(OCT)测量并比较两组受检者mGCC、pRNFL厚度,分析mGCC对原发性青光眼的诊断价值,探讨mGCC与pRNFL及视野平均缺损(MD)的相关性。

结果：观察组患者上方、下方及平均mGCC厚度显著低于对照组,差异均有统计学意义(P<0.05)。观察组患者上方、下方及平均pRNFL厚度均显著低于对照组,差异有统计学意义(P<0.05)。观察组患者MD 显著高于对照组,差异有统计学意义(P<0.05)。Pearson相关性分析显示,观察组患者mGCC与pRNFL呈显著正相关关系(r=0.58,P<0.01),与MD呈显著负相关关系(r=-0.69,P<0.01)。ROC曲线分析显示,以86.39μm为截点值,mGCC诊断原发性青光眼的敏感性为82.5%,特异性为76.25%。

结论：mGCC对原发性青光眼具有一定的诊断价值,且与pRNFL呈正相关关系,与MD呈负相关关系。     

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.     

Peripapillary vessel density and retinal nerve fiber layer thickness changes in early diabetes retinopathy

AIM: To perform a quantitative analysis of the peripapillary vessel density (VD) and retinal nerve fiber layer (RNFL) thickness changes in patients with early stage of diabetic retinopathy (DR). METHODS: In this case-control study, swept-source optical coherence tomography angiography (SS-OCTA) imaging was used to examine diabetic and age-matched healthy subjects. The optic disc HD 6×6 mm2 blood flow imaging scan mode was selected. Automatic software was used to measure the peripapillary VD, capillary vessel density (CVD), and RNLF in an optic nerve head (ONH) filed based on the Garway-Heath map. In addition, the correlation between peripapillary VD, CVD, and RNFL was further investigated. RESULTS: The cohort consisted of 32 healthy individuals and 72 patients with diabetes (34 eyes with no DR and 38 eyes with mild-moderate NPDR). Peripapillary VD decreased in the mild-moderate NPDR group compared to the control group in most regions (P<0.05). Peripapillary CVD and RNFL thickness were significantly lower in the mild-moderate NPDR group in the superior temporal (ST) quadrants (P=0.018, P=0.030). In the correlation analysis of each region, the RNFL thickness in the NS region was positively correlated with the peripapillary VD and CVD (r=0.233, P=0.05; r=0.288, P=0.015). In the TI region, the RNFL thickness was positively correlated with the peripapillary CVD (r=0.237, P=0.047). CONCLUSION: The measurement based on the ONH topographic map may be helpful in detecting functional and structural impairments in DR. The peripapillary VD, CVD and RNFL decrease in early DR, and the RNFL thickness altered in association with the CVD or/and VD in some regions.     

mGCC和pRNFL厚度及视野对新生血管性青光眼的诊断价值

目的:分析黄斑区节细胞复合体(mGCC)和视乳头周围视网膜神经纤维层(pRNFL)厚度及视野对新生血管性青光眼(NVG)的诊断价值。方法:回顾性研究。收集2018-01/2021-10本院收治的NVG患者92例100眼,按病理分期分为新生血管性青光眼前期患者31例32眼、开角型青光眼期患者31例36眼及闭角型青光眼期患者30例32眼。选择同期于我院接受健康体检者50例100眼者作为对照组。采用Pearson相关性分析mGCC、pRNFL厚度与MD的相关性,以受试者工作特征(ROC)曲线研究各指标诊断效能。结果:新生血管性青光眼前期、开角型青光眼期和闭角型青光眼期mGCC-平均(a)、mGCC-上方(s)、mGCC-下方(i)厚度均低于对照组(均P<0.001),新生血管性青光眼前期、开角型青光眼期mGCC-a、mGCC-s、mGCC-i均高于闭角型青光眼期(均P<0.001),新生血管性青光眼前期mGCC-a、mGCC-s、mGCC-i均高于开角型青光眼期(均P<0.001)。新生血管性青光眼前期、开角型青光眼期和闭角型青光眼期pRNFL-a、pRNFL-颞侧(t)、...     

青光眼与微循环改变的研究进展

青光眼是全球范围内导致视功能障碍的一大主要原因,是一组涉及视神经和相关结构的疾病,最终导致不可逆的失明。研究认为,诱导青光眼的发病机制主要为机械压迫学说和血管学说(微循环)。随着临床研究及诊疗的发展,后者已成为青光眼研究的重点和发展方向。青光眼患者出现视乳头、视盘、甲床皱襞毛细血管等相应部位血管密度的降低,通过深度卷积神经网络和光学相干断层扫描血管造影等技术可客观阐述其微循环相应参数的改变,并对青光眼的病程进展具有一定监测作用。本文从青光眼与微循环改变进行综述,旨在扩充临床上对于青光眼的认识,从而进一步指导临床诊治。     

原发性开角型青光眼视盘周围血管密度变化的研究

目的：比较原发性开角型青光眼患者(POAG)与正常人视盘周围血管密度(VD)的差异,并评价视盘周围VD在POAG中的诊断价值。

方法：连续纳入2018-03/12期间在我院初诊的POAG患者60例。同时纳入60例年龄、性别匹配的正常志愿者作为对照。采用光相干断层扫描血流成像(OCTA)技术检测并比较POAG患者及正常人视盘周围VD。采用受试者工作特征曲线(ROC)及ROC曲线下面积(AUC)评价视盘周围VD诊断POAG的效能。

结果：与正常人相比,POAG患者视盘周围平均VD降低(P<0.001)。POAG患者视盘周围上方、下方的VD分别为52.38%±5.31%以及52.58%±5.32%。而对照组分别为58.43%±4.11%以及58.36%±3.40%(P<0.001)。多元线性回归分析结果显示杯盘比以及POAG诊断与视盘周围平均VD呈独立相关。ROC及AUC分析结果提示视盘周围平均VD的AUC值为0.808(95%CI：0.730～0.887)。

结论：POAG患者视盘周围VD明显变小,变小的视盘周围VD与POAG诊断存在显著相关性。视盘周围VD可作为其它常规诊断青光眼的补充手段。     

Evaluation of the Ganglion Cell Complex and Retinal Nerve Fiber Layer in Low,Moderate, and High Myopia: A Study by RTVue Spectral Domain Optical Coherence Tomography

Purpose: To assess the effect of low, moderate, and high myopia on the thickness of the retinal nerve fiber layer (RNFL) and Ganglion cell complex (GCC) measured by Spectral Domain Optical Coherence Tomography (SD-OCT) in non-glaucomatous subjects. Methods: The subjects were divided into three groups: low (n = 81, 35.6%), moderate (n = 79, 34.8%), and highly myopic eyes (n = 67, 29.5%). The RNFL thickness profile, including the average, superior, nasal, inferior, and temporal quadrant and each of the eight directional thicknesses, was measured. GCC parameters, including the average, superior, and inferior values, the focal loss volume (FLV), and the global loss volume (GLV), were measured. The correlation between the OCT measurements and the axial length was evaluated. Results: The average, superior, inferior, and nasal RNFL thicknesses of low and moderate myopic eyes were found to be significantly higher than those of highly myopic eyes. The temporal RNFL thicknesses were not different among the three groups. The average, superior, and inferior ganglion cell complex values of low and moderate myopic eyes were significantly higher than those of highly myopic eyes. The FLV and GLV of low and moderate myopic eyes were significantly higher than those of highly myopic eyes (p = 0.001 for all). In the moderate and high myopia groups, the average RNFL thickness and GCC thickness were both negatively correlated with the axial length. Conclusion: Highly myopic subjects tend to have thinner RNFL and GCC thicknesses than subjects with low and moderate 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。     

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。     

Relationship Between the s-wave Amplitude of the Multifocal Electroretinogram and the Retinal Nerve Fiber Layer Thickness in Glaucomatous Eyes

Purpose

To determine whether a significant correlation exists between the amplitude of the s wave of the multifocal electroretinogram (mfERG) and the retinal nerve fiber layer thickness (RNFLT) in glaucomatous eyes.

Methods

Twenty-three eyes of 23 patients with glaucoma were studied. In all eyes, the severity of the defects in the upper visual field differed significantly from the severity of those in the lower half. Patients having visual field halves with mean deviation (MD) values lower than ?5?dB were placed in group A, and patients having visual field halves with MD values greater than ?5?dB were placed in group B. The mfERGs were elicited by 37 stimulus elements alternating from white to black in a pseudorandom binary m-sequence at a frequency of 9.4?Hz. The mfERGs in the upper and lower visual field halves were summed to yield upper and lower averaged waves. The GDx variable corneal compensator and optical coherence tomography were used to measure the RNFLT.

Results

The retinal nerve fiber layer was significantly thinner in group A than in group B. There was a significant correlation between the RNFLT and the MD values of visual field defects. The s-wave amplitude was significantly smaller in group A than in group B. The s-wave amplitude also correlated significantly with the MD and the RNFLT.

Conclusion

The significant correlations between the s-wave amplitude and the MD, and between the S-wave amplitude and the RNFLT, indicate that the s-wave receives significant contributions from the retinal ganglion cells and their axons. Jpn J Ophthalmol 2005;49:481–490 © Japanese Ophthalmological Society 2005     

Retinal nerve fiber layer and macular inner retina measurements by spectral domain optical coherence tomograph in Indian eyes with early glaucoma

Purpose

To compare the diagnostic abilities of peripapillary retinal nerve fiber layer (RNFL) and macular inner retina (MIR) measurements by spectral domain optical coherence tomography (SD–OCT) in Indian eyes early glaucoma.

Methods

In an observational, cross-sectional study, 125 eyes of 64 normal subjects and 91 eyes of 59 early glaucoma patients underwent RNFL and MIR imaging with SD–OCT. Glaucomatous eyes had characteristic optic nerve and RNFL abnormalities and correlating visual field defects and a mean deviation of better than or equal to -6 dB on standard automated perimetry. Areas under the receiver operating characteristic curves (AUC), sensitivities at a fixed specificity and likelihood ratios (LRs) were estimated for all RNFL and MIR parameters.

Results

The AUCs for the RNFL parameters ranged from 0.537 for the temporal quadrant thickness to 0.821 for the inferior quadrant RNFL thickness. AUCs for the MIR parameters ranged from 0.603 for the superior minus inferior MIR thickness average to 0.908 for ganglion cell complex focal loss volume (GCC–FLV). AUC for the best MIR parameter (GCC–FLV) was significantly better (P<0.001) than that of the best RNFL parameter (inferior quadrant thickness). The sensitivities of these parameters at high specificity of 95%, however, were comparable (52.7% vs58.2%). Evaluation of the LRs showed that outside normal limits results of most of the RNFL and MIR parameters were associated with large effects on the post-test probability of disease.

Conclusion

MIR parameters with RTVue SD–OCT were as good as the RNFL parameters to detect early glaucoma.     

[In Press] Influence of corneal power on circumpapillary retinal nerve fiber layer and optic nerve head measurements by spectral-domain optical coherence tomography

AIM: To evaluate the influence of corneal power on circumpapillary retinal nerve fiber layer (cpRNFL) and optic nerve head (ONH) measurements by spectral-domain optical coherence tomography (SD-OCT). METHODS: Twenty-five eyes of 25 healthy participants (mean age 23.6±3.6y) were imaged by SD-OCT (3D OCT-2000, Topcon) using horizontal raster scans. Disposable soft contact lenses (1-day Acuvue; Johnson & Johnson Vision Care) of different powers (from ?11 to +5 diopters including 0 diopter) were worn to induce 2-diopter changes in corneal power. Differences in the cpRNFL and ONH measurements per diopter of change in corneal power were analyzed. RESULTS: As corneal power increased by 1 diopter, total and quadrant cpRNFL thicknesses, except for the nasal sector, decreased by ?0.19 to ?0.32 μm (P<0.01). Furthermore, the disc, cup, and rim areas decreased by ?0.017, ?0.007, and ?0.015 mm2, respectively (P<0.001); the cup and rim volumes decreased by ?0.0013 and ?0.006 mm3, respectively (P<0.01); and the vertical and horizontal disc diameters decreased by ?0.006 and ?0.007 mm, respectively (P<0.001). CONCLUSION: For more precise OCT imaging, the ocular magnification should be corrected by considering both the axial length and corneal power. However, the effect of corneal power changes on cpRNFL thickness and ONH topography are small when compared with those of the axial length.