背景 目前临床上已广泛使用海德堡视网膜断层扫描仪(HRT)诊断青光眼引起的视神经病变,有研究表明近视会影响HRT视盘参数测量结果,探索不同屈光状态和眼轴长度对HRT视盘结构参数的影响具有重要意义. 目的 评估屈光不正和眼轴长度对视盘结构参数的影响. 方法 采用前瞻性描述性系列病例观察研究方法.选取2006年7月至2011年8月参加“广州双生子研究”的家长作为研究对象.所有受检者行视力、裂隙灯显微镜和90 D前置镜眼底检查,并用电脑自动验光仪采集受检眼的屈光度,采用人工晶状体(IOL) Master测量眼轴长度,视盘结构参数的测量借助HRT-Ⅲ.对所有受检者右眼的自动验光、HRT和IOLMaster测量数据进行分析,采用Pearson直线相关分析法和多重线性回归分析对HRT测量的视盘结构参数与等效球镜度(SE)及眼轴长度间的关系进行评估.结果 共1748名健康成人纳入研究.高度近视组的视盘面积(DA) (P=0.021)、盘沿面积(RA) (P＜0.001)、盘沿容积(RV) (P＜0.001)、平均视网膜神经纤维层厚度(mRNFLt)(P＜0.001)和RNFL横断面积(RNFLcsa)(P＜0.001)明显大于正视组,差异均有统计学意义,而视杯面积(CA) (P=0.004)、杯盘面积比(C/DAR) (P＜0.001)和视杯容积(CV) (P＜0.001)则小于正视组,差异均有统计学意义；在中低度近视组,其RV(P＜0.001)、mRNFLt(P＜0.001)和RNFLcsa (P＜0.001)明显大于正视组,而DA (P=0.038)、CA (P＜0.001)、C/DAR(P＜0.001)和CV (P=0.001)则明显小于正视组；远视组受检者视盘结构参数与正视组比较差异均无统计学意义(P＞0.05).受检者DA值与SE间无明显相关性(r=-0.032,P=0.186),但CA、C/DAR、CV、平均视杯深度(MCD)和最大视杯深度(MxCD)与SE间均呈正相关(r=0.139、0.163、0.130、0.004、0.054,P＜0.05),RA、RV、mRNFLt和RNFLcsa则与SE间均呈负相关(r=-0.178、-0.331、-0.241、-0.239,P＜0.001).眼轴越长,DA、RA、RV、视杯形态测量(CSM)、mRNFLt和RNFLcsa越大,而CV则越小.随着CA的增大,RA、C/DAR、CV、RV、MCD、MxCD、CSM和RNFLcsa均增大,而mRNFLt则变小. 结论 屈光不正与DA无相关性,但不同屈光组的部分视盘结构参数测量值存在差异,随着眼轴长度的增长DA逐渐增大,眼轴长度和DA会影响HRT视盘结构参数的测量结果.
揹景 目前臨床上已廣汎使用海德堡視網膜斷層掃描儀(HRT)診斷青光眼引起的視神經病變,有研究錶明近視會影響HRT視盤參數測量結果,探索不同屈光狀態和眼軸長度對HRT視盤結構參數的影響具有重要意義. 目的 評估屈光不正和眼軸長度對視盤結構參數的影響. 方法 採用前瞻性描述性繫列病例觀察研究方法.選取2006年7月至2011年8月參加“廣州雙生子研究”的傢長作為研究對象.所有受檢者行視力、裂隙燈顯微鏡和90 D前置鏡眼底檢查,併用電腦自動驗光儀採集受檢眼的屈光度,採用人工晶狀體(IOL) Master測量眼軸長度,視盤結構參數的測量藉助HRT-Ⅲ.對所有受檢者右眼的自動驗光、HRT和IOLMaster測量數據進行分析,採用Pearson直線相關分析法和多重線性迴歸分析對HRT測量的視盤結構參數與等效毬鏡度(SE)及眼軸長度間的關繫進行評估.結果 共1748名健康成人納入研究.高度近視組的視盤麵積(DA) (P=0.021)、盤沿麵積(RA) (P＜0.001)、盤沿容積(RV) (P＜0.001)、平均視網膜神經纖維層厚度(mRNFLt)(P＜0.001)和RNFL橫斷麵積(RNFLcsa)(P＜0.001)明顯大于正視組,差異均有統計學意義,而視杯麵積(CA) (P=0.004)、杯盤麵積比(C/DAR) (P＜0.001)和視杯容積(CV) (P＜0.001)則小于正視組,差異均有統計學意義；在中低度近視組,其RV(P＜0.001)、mRNFLt(P＜0.001)和RNFLcsa (P＜0.001)明顯大于正視組,而DA (P=0.038)、CA (P＜0.001)、C/DAR(P＜0.001)和CV (P=0.001)則明顯小于正視組；遠視組受檢者視盤結構參數與正視組比較差異均無統計學意義(P＞0.05).受檢者DA值與SE間無明顯相關性(r=-0.032,P=0.186),但CA、C/DAR、CV、平均視杯深度(MCD)和最大視杯深度(MxCD)與SE間均呈正相關(r=0.139、0.163、0.130、0.004、0.054,P＜0.05),RA、RV、mRNFLt和RNFLcsa則與SE間均呈負相關(r=-0.178、-0.331、-0.241、-0.239,P＜0.001).眼軸越長,DA、RA、RV、視杯形態測量(CSM)、mRNFLt和RNFLcsa越大,而CV則越小.隨著CA的增大,RA、C/DAR、CV、RV、MCD、MxCD、CSM和RNFLcsa均增大,而mRNFLt則變小. 結論 屈光不正與DA無相關性,但不同屈光組的部分視盤結構參數測量值存在差異,隨著眼軸長度的增長DA逐漸增大,眼軸長度和DA會影響HRT視盤結構參數的測量結果.
배경 목전림상상이엄범사용해덕보시망막단층소묘의(HRT)진단청광안인기적시신경병변,유연구표명근시회영향HRT시반삼수측량결과,탐색불동굴광상태화안축장도대HRT시반결구삼수적영향구유중요의의. 목적 평고굴광불정화안축장도대시반결구삼수적영향. 방법 채용전첨성묘술성계렬병례관찰연구방법.선취2006년7월지2011년8월삼가“엄주쌍생자연구”적가장작위연구대상.소유수검자행시력、렬극등현미경화90 D전치경안저검사,병용전뇌자동험광의채집수검안적굴광도,채용인공정상체(IOL) Master측량안축장도,시반결구삼수적측량차조HRT-Ⅲ.대소유수검자우안적자동험광、HRT화IOLMaster측량수거진행분석,채용Pearson직선상관분석법화다중선성회귀분석대HRT측량적시반결구삼수여등효구경도(SE)급안축장도간적관계진행평고.결과 공1748명건강성인납입연구.고도근시조적시반면적(DA) (P=0.021)、반연면적(RA) (P＜0.001)、반연용적(RV) (P＜0.001)、평균시망막신경섬유층후도(mRNFLt)(P＜0.001)화RNFL횡단면적(RNFLcsa)(P＜0.001)명현대우정시조,차이균유통계학의의,이시배면적(CA) (P=0.004)、배반면적비(C/DAR) (P＜0.001)화시배용적(CV) (P＜0.001)칙소우정시조,차이균유통계학의의；재중저도근시조,기RV(P＜0.001)、mRNFLt(P＜0.001)화RNFLcsa (P＜0.001)명현대우정시조,이DA (P=0.038)、CA (P＜0.001)、C/DAR(P＜0.001)화CV (P=0.001)칙명현소우정시조；원시조수검자시반결구삼수여정시조비교차이균무통계학의의(P＞0.05).수검자DA치여SE간무명현상관성(r=-0.032,P=0.186),단CA、C/DAR、CV、평균시배심도(MCD)화최대시배심도(MxCD)여SE간균정정상관(r=0.139、0.163、0.130、0.004、0.054,P＜0.05),RA、RV、mRNFLt화RNFLcsa칙여SE간균정부상관(r=-0.178、-0.331、-0.241、-0.239,P＜0.001).안축월장,DA、RA、RV、시배형태측량(CSM)、mRNFLt화RNFLcsa월대,이CV칙월소.수착CA적증대,RA、C/DAR、CV、RV、MCD、MxCD、CSM화RNFLcsa균증대,이mRNFLt칙변소. 결론 굴광불정여DA무상관성,단불동굴광조적부분시반결구삼수측량치존재차이,수착안축장도적증장DA축점증대,안축장도화DA회영향HRT시반결구삼수적측량결과.
Background Heidelberg Retinal Tomograph (HRT) has been widely used in clinical diagnosis of glaucomatous optic neuropathy,importantly,the measurement results of HRT may be affected by myopia.Therefore,studying the effect of different refractive status and axial length on structural parameters of the optic disc is important.Objective This study was to evaluate the influence of refractive error and axial length to optic nerve head parameter measured by HRT.Methods The parents who participate in Guangzhou Twin Study were enrolled in this investigation from July 2006 to August 2011.The regular eye examinations,including visual acuity,slit lamp,fundus,auto-refraction,HRT-Ⅲ and intraocular lens (IOL) Master,were performed on all the subjects.Thc data from right eyes of subjects were collected and analyzed.The linear correlation analysis and multiple linear regression analysis were applied to analyze the correlation between HRT optic papilla configuration parameter and equivalent sphere and ocular axis length.Results A pilot prospective series cases observational study was designed.1748subjects were enrolled in this study.The disc area (DA) (P=0.021),rim area (RA) (P＜0.001),rim volume (RV) (P＜0.001),mean retinal nerve fiber layer thickness (mRNFLt) (P＜0.001) and retinal nerve fiber layer cross section area (RNFLcsa) in the high myopia were greater than those of the emmetropic group,with significant difference between the two groups (P＜0.001).However,the cup area (CA),cup/disk area ratio (C/DAR) and cup volume (CV) were less in the high myopic group than those of the emmetropic group (P=0.004,P＜0.001 and P＜O.001),respectively.In the mild-moderatc myopic group,the RV,mRNFLt and RNFLcsa were greater than those of the emmetropic group (all of the P value less than 0.001),but the numbers of DA,CA,C/DAR,and CV were less than those of the emmetropic group,the differences were significant and their P valuables were 0.038,＜ 0.001,＜0.001 and 0.001 respectively.The differences of structure parameters between the hyperopia group and the emmetropic group were not statistically significant (P＞0.05).The DA,CA,RA,C/DAR,CV,RV,mean cup depth (MCD),maximum cup depth (MxCD),cup shape measure (CSM),mRNFLt and RNTLcsa were (2.04±0.43) mm2,(0.49±0.34) mm2,(1.55 ± 0.34) mm2,0.23-0.13,(0.11 ± 0.12) mm3,(0.45 ± 0.19) mm3,(0.21 ± 0.09) mm,(0.60±0.21) mm,-0.21 ± 0.07,(0.29 ± 0.07) mm and (1.46 ± 0.36)mm2,respectively,in the 1748 eyes of 1748 subjects.No significant correlation was found between the DA value with SE (r=-0.032,P =0.186).However,weaker positive correlations were seen between the CA,C/DAR,CV,MCD,MxCD with SE (r=0.139,0.163,0.130,0.004,0.054,P＜ 0.05) and negative correlation between RA,RV,mRNFLt and RNFLcsa with SE (r =-0.178,-0.331,0.241,-0.239,P＜0.001).With the increase of the ocular axial length,the DA,RA,RV,mRNFLt and RNFLcsa values were enlarged,and the CV value was smaller.With the increase of CA,the RA,C/DAR,CV,RV,MCD,MxCD,CSM and RNFLcsa values elevated,but mRNFLt value was decreased.Conclusions Refractive error is not associated with DA,but the measuring results are different among various refractive groups.Refractive error,ocular axial length and DA affect the measuring result of HRT.
