中华眼视光学与视觉科学杂志
中華眼視光學與視覺科學雜誌
중화안시광학여시각과학잡지
CHINESE JOURNAL OF OPTOMETRY OPHTHALMOLOGY AND VISUAL SCIENCE
2010年
3期
224-228
,共5页
邹文军%武志峰%严海燕%孙松%孟小妹
鄒文軍%武誌峰%嚴海燕%孫鬆%孟小妹
추문군%무지봉%엄해연%손송%맹소매
体层摄影术,光学相干%垂体瘤%视网膜%神经纤维%视野%视力%预后
體層攝影術,光學相榦%垂體瘤%視網膜%神經纖維%視野%視力%預後
체층섭영술,광학상간%수체류%시망막%신경섬유%시야%시력%예후
Tomography,optical coherence%Pituitary adenomas%Retina%Nerve fiber layer%Visual fields%Visual acuity%Prognosis
目的 应用光学相干断层扫描(OCT)测量视网膜神经纤维层(RNFL)厚度,探讨其在判断垂体瘤患者术后视功能预后的作用.方法 选取2007年1月至2008年12月经蝶窦垂体腺瘤切除术病理检查、MRI确诊的垂体瘤伴视交叉压迫患者16例(32眼),其中男性7例,女性9例.年龄23～67岁,平均(44.4±14.7)岁.在术前、术后1周、术后3个月,分别采用标准对数视力表、Stratus OCT Ⅲ和Humphrey视野分析仪,检测患者的矫正视力、平均RNFL厚度、4个象限的RNFL厚度和视野指数平均缺损(MD).根据术前视野缺损情况及随访变化,将研究对象分为3组:A组即术前有视野缺损,术后视野缺损无改善或加重;B组即术前有视野缺损,术后视野缺损改善;C组为术前及术后均无视野缺损.对所得数据进行相关统计学分析.结果 16例(32眼)患者中,A组10眼,B组11眼,C组11眼.术前有视野缺损者,平均RNFL越厚,视野缺损改善的比例越大(OR=1.189,P=0.020);下方RNFL厚度对视野缺损改善有显著影响(OR=6.093,P=0.000),而术前MD对术后视野缺损改善无显著影响(OR=0.955,P=0.509).术后1周及术后3个月,B组的视力均较术前提高(t=3.893,P=0.003;t=4.310,P=0.002),而A组和C组视力较术前差异均无统计学意义.术后3个月,A组平均RNFL厚度及颞侧RNFL厚度均较术前变薄(t=2.378,P=0.041;t=2.630,P=-0.025).而上方、下方及鼻侧RNFL厚度较术前差异均无统计学意义;B组的平均RNFL厚度、鼻侧及颞侧RNFL厚度均较术前增厚(t=2.438,P=0.035;t=2.630;P=0.025;t=4.457,P=0.001);C组平均RNFL厚度及4个象限RNFL厚度手术前后差异均无统计学意义.结论 运用OCT检测垂体瘤患者的平均RNFL厚度及下方RNFL厚度,可作为判断患者术后短期视功能预后的较敏感指标;手术前后RNFL厚度的变化与视野缺损的变化具有较好的一致性.
目的 應用光學相榦斷層掃描(OCT)測量視網膜神經纖維層(RNFL)厚度,探討其在判斷垂體瘤患者術後視功能預後的作用.方法 選取2007年1月至2008年12月經蝶竇垂體腺瘤切除術病理檢查、MRI確診的垂體瘤伴視交扠壓迫患者16例(32眼),其中男性7例,女性9例.年齡23～67歲,平均(44.4±14.7)歲.在術前、術後1週、術後3箇月,分彆採用標準對數視力錶、Stratus OCT Ⅲ和Humphrey視野分析儀,檢測患者的矯正視力、平均RNFL厚度、4箇象限的RNFL厚度和視野指數平均缺損(MD).根據術前視野缺損情況及隨訪變化,將研究對象分為3組:A組即術前有視野缺損,術後視野缺損無改善或加重;B組即術前有視野缺損,術後視野缺損改善;C組為術前及術後均無視野缺損.對所得數據進行相關統計學分析.結果 16例(32眼)患者中,A組10眼,B組11眼,C組11眼.術前有視野缺損者,平均RNFL越厚,視野缺損改善的比例越大(OR=1.189,P=0.020);下方RNFL厚度對視野缺損改善有顯著影響(OR=6.093,P=0.000),而術前MD對術後視野缺損改善無顯著影響(OR=0.955,P=0.509).術後1週及術後3箇月,B組的視力均較術前提高(t=3.893,P=0.003;t=4.310,P=0.002),而A組和C組視力較術前差異均無統計學意義.術後3箇月,A組平均RNFL厚度及顳側RNFL厚度均較術前變薄(t=2.378,P=0.041;t=2.630,P=-0.025).而上方、下方及鼻側RNFL厚度較術前差異均無統計學意義;B組的平均RNFL厚度、鼻側及顳側RNFL厚度均較術前增厚(t=2.438,P=0.035;t=2.630;P=0.025;t=4.457,P=0.001);C組平均RNFL厚度及4箇象限RNFL厚度手術前後差異均無統計學意義.結論 運用OCT檢測垂體瘤患者的平均RNFL厚度及下方RNFL厚度,可作為判斷患者術後短期視功能預後的較敏感指標;手術前後RNFL厚度的變化與視野缺損的變化具有較好的一緻性.
목적 응용광학상간단층소묘(OCT)측량시망막신경섬유층(RNFL)후도,탐토기재판단수체류환자술후시공능예후적작용.방법 선취2007년1월지2008년12월경접두수체선류절제술병리검사、MRI학진적수체류반시교차압박환자16례(32안),기중남성7례,녀성9례.년령23～67세,평균(44.4±14.7)세.재술전、술후1주、술후3개월,분별채용표준대수시력표、Stratus OCT Ⅲ화Humphrey시야분석의,검측환자적교정시력、평균RNFL후도、4개상한적RNFL후도화시야지수평균결손(MD).근거술전시야결손정황급수방변화,장연구대상분위3조:A조즉술전유시야결손,술후시야결손무개선혹가중;B조즉술전유시야결손,술후시야결손개선;C조위술전급술후균무시야결손.대소득수거진행상관통계학분석.결과 16례(32안)환자중,A조10안,B조11안,C조11안.술전유시야결손자,평균RNFL월후,시야결손개선적비례월대(OR=1.189,P=0.020);하방RNFL후도대시야결손개선유현저영향(OR=6.093,P=0.000),이술전MD대술후시야결손개선무현저영향(OR=0.955,P=0.509).술후1주급술후3개월,B조적시력균교술전제고(t=3.893,P=0.003;t=4.310,P=0.002),이A조화C조시력교술전차이균무통계학의의.술후3개월,A조평균RNFL후도급섭측RNFL후도균교술전변박(t=2.378,P=0.041;t=2.630,P=-0.025).이상방、하방급비측RNFL후도교술전차이균무통계학의의;B조적평균RNFL후도、비측급섭측RNFL후도균교술전증후(t=2.438,P=0.035;t=2.630;P=0.025;t=4.457,P=0.001);C조평균RNFL후도급4개상한RNFL후도수술전후차이균무통계학의의.결론 운용OCT검측수체류환자적평균RNFL후도급하방RNFL후도,가작위판단환자술후단기시공능예후적교민감지표;수술전후RNFL후도적변화여시야결손적변화구유교호적일치성.
Objective To assess if optical coherence tomography (OCT) can provide objective measurements of the thickness of the retinal nerve fiber layer (RNFL) in patients with pituitary adenomas, offering a dependable prediction of visual function. Methods Thirty-two eyes of 16 consecutive patients who visited our hospital between January 2007 and December 2008 and were diagnosed with pituitary adenomas compressing the chiasma as determined by magnetic resonance imaging (MRI) were included in the study. All patients underwent transsphenoidal resection of pathologically proven pituitary adenomas by the same surgeon. The patient group consisted of 7 males and 9 females, and the mean age of the patients was (44.4±14.7)years (range 23-67 years). Visual acuity, automated visual fields (VF) and OCT (fast-RNFL program) were assessed before treatment, and 1 week and 3 months after treatment. RNFL thickness was measured with the Stratus OCT Ⅲ and mean deviation (MD) visual field (VF) with the automated Humphrey Field Analyzer (both from Carl Zeiss Meditec, Dublin, CA). Eyes were divided into 3 groups based on the initial VF defect and its evolution. The presence of an initial VF defect in group A either without improvement or had worsened 3 months after treatment, the presence of an initial VF defect in group B with improvement 3 months after treatment, and group C without VF defect either initially or after treatment. Covariance analysis was applied to analyze the data for the mean RNFL measurements and the initial VF defect in the groups. A logistic regression model was used to evaluate the prognostic value of the initial VF defect and the RNFL thickness on the final visual outcome. A paired samples t-test was used to compare preoperative visual acuity and mean RNFL thickness with postoperative visual acuity and thickness. Results For all patients (32 eyes), there are 10 eyes in group A, 11 eyes in group B and 11 eyes in group C. In the eyes with a VF defect before treatment, a greater mean RNFL thickness increased the probability of improvement from the initial VF defect (OR=1.189, P=0.020). Inferior RNFL was a very strong prognostic factor (OR=6.093, P=0.000), but the effect of the initial VF defect did not reach significance (OR =0.955, P=0.509). At 1 week and 3 months, respectively, after group B was treated, visual acuity improved (t=3.894, 4.310; P=0.003, 0.002). At 3 months after treatment, both the mean RNFL and temporal RNFL were thinner (t=-2.378, -2.630; P=0.041, 0.025) in group A, and the mean RNFL, the nasal RNFL and temporal RNFL were thicker (t = 2.438, 2.630, 4.457; P=0.035, 0.025, 0.001) in group B. In group C there was no significant difference between preoperative and postoperative RNFL thickness. Conclusion Mean RNFL thickness and inferior RNFL thickness measured by OCT are prognostic factors influencing the short-term prognosis of pituitary adenomas compressing the chiasma. The change between pre- and postoperative RNFL thickness seems to be consistent with the VF defect.
