OCT测量视网膜神经纤维层和黄斑厚度在青光眼早期诊断中的意义

目的应用光学相干断层成像术（optical coherence tomography，OCT）测量青光眼患者的视网膜神经纤维层（retinal nerve fiber layer，RNFL）厚度和黄斑厚度，比较两者在青光眼早期诊断中的作用。方法应用Stratus OCT测量62例（101眼）正常人和41例（64眼）青光眼患者的RNFL厚度和黄斑厚度，比较正常人和青光眼患者之间．正常人和早期青光眼患者之间上、下、鼻、颞四个象限与平均RNFL厚度、黄斑区内外环各象限厚度和总黄斑体积等参数有无统计学差异：用受试者工作特征曲线下面积（area under the receive operating characteristi ccurve，AROC）评价各个参数在青光眼早期诊断中的作用。结果青光眼患者各象限、平均RNFL厚度和各分区黄斑厚度、总黄斑体积均比正常人减少．差异有显著性（P=0．014—0．000），视乳头旁平均RNFL的AROC最大（0．961），其次为下方RNFL（0．928）和上方RNFL（0．924）。黄斑下方外环区AROC最大（0．876）。早期青光眼患者各象限、平均RNFL厚度和黄斑外环各分区、总黄斑体积较正常人减少，差异有显著性（P=0．021～0．000），而黄斑内环各区与正常人差异无显著性。视乳头旁平均RNFL的AROC最大（0．877），其次为上方RNFL（0．783）和下方RNFL（0．767）。黄斑下方外环区AROC最大（0．728）。结论测量RNFL厚度较测量黄斑厚度具有更强的青光眼早期诊断价值。黄斑厚度测量为青光眼的早期诊断提供了一种新的手段。

The significance of the retinal nerve fiber layer and macular thickness measurements in the early diagnosis of glaucoma using optical coherence tomography

Objective To measure the retinal nerve fiber layer （RNFL） and macular thickness in glaucoma patients using optical coherence tomography （OCT） and to compare the correlation of both measurements with the early diagnosis of glaucoma. Methods The retinal nerve fiber layer and macular thickness of 41 glaucoma patients （64 eyes） and 62 normal subjects（101 eyes）were measured with a Stratus OCT. Parameters were compared between normal subjects and both early glaucoma patients and glaucoma patients. Comparisons included RNFL thickness in the superior, inferior, nasal, and temporal quadrants and the mean macular thickness in 4 quadrants of the inner and outer rings and total macular volume. The power of each parameter to detect early glaucoma was evaluated by area using the receive operating characteristic curve （ROC）. Results All RNFL and macular parameters （RNFL thickness in 4 quadrants and mean macular thickness in different sections and total macular volume） showed statistically significant differences when normal subjects and glaucoma patients were compared （P= 0.014-0.000）. The highest ROC value for RNFL was mean thickness （0.961） followed by the inferior （0.928） and superior （0.924） RNFL. The highest ROC value for the macula was the inferior outer ring （0.876）. All RNFL measurements and the four quadrants of the macular outer ring,and total macular volume showed statistically significant differences when normal subjects and early glaucoma patients were compared （P =0.021-0.000）. The highest ROC value for RNFL was mean thickness（0.877）followed by the superior （0.783） and inferior （0.767） RNFL. The highest ROC value for the macula was for the inferior outer ring （0.728）. Conclusion RNFL thickness is a more powerful indicator than macular thickness for detecting glaucoma. However, macular thickness provides a new detection method for the early diagnosis of glaucoma.