中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2013年
2期
116-121
,共6页
青光眼,开角型%视网膜%神经纤维%脉络膜%体层摄影术,光学相干
青光眼,開角型%視網膜%神經纖維%脈絡膜%體層攝影術,光學相榦
청광안,개각형%시망막%신경섬유%맥락막%체층섭영술,광학상간
Glaucoma,open-angle%Retina%Nerve fibers%Choroid%Tomography,optical coherence
目的 研究原发性开角型青光眼(POAG)患者视乳头周围脉络膜厚度与正常人之间的差异及其与视野缺损间的关系.方法 横断面研究.应用增强深部成像的相干光断层扫描(EDI-OCT)仪对40例(40只眼)POAG患者和41例(41只眼)正常人进行以视乳头中心为圆心、直径为3.4 mm圆周的视网膜神经纤维层(RNFL)厚度测量.再由检测者手动描绘视网膜色素上皮外缘和巩膜内界面,由软件自动获得相应部位的脉络膜厚度；信度分析采用组内相关系数(ICC),其值越大表明测量结果越稳定、可重复性越好.POAG患者与正常人视乳头周围各象限RNFL和脉络膜厚度比较,采用成组设计t检验；视乳头周围各象限脉络膜厚度比较,采用重复测量的方差分析和LSD-t检验(该软件仅提供P值)；脉络膜厚度与年龄和RNFL厚度的相关性分析,采用Pearson相关分析法；视乳头全周RNFL和脉络膜平均厚度与视野平均缺损(非正态分布)之间的相关性分析,采用Spearman秩相关分析法.结果 测量各象限脉络膜厚度的信度分析,检测者内ICC值为0.993 ～0.999,检测者间ICC值为0.993～0.998.POAG患者和正常人各象限脉络膜厚度均随年龄增加而变薄(r=-0.509～-0.608,-0.549～-0.668;P ＜0.05),但与相应部位的RNFL厚度之间无相关性(r=-0.186 ～0.273,-0.090～0.132;P ＞0.05)；视乳头周围脉络膜厚度特征为颞上、鼻上象限最厚,其次为鼻、颞侧,颞下和鼻下象限最薄(P=0.000～0.036).POAG患者视乳头全周RNFL厚度为(64.8±14.3)μm,脉络膜厚度为(139.6 ±60.3)μm;正常对照者视乳头全周RNFL厚度为(106.5±7.8) μm,脉络膜厚度为(138.2±56.7) μm;患者与对照者全周RNFL厚度差异有统计学意义(t=16.087,P＜0.05),但脉络膜厚度差异无统计学意义(t=-0.107,P＞0.05).POAG患者其余各象限RNFL厚度也均明显薄于正常人(t=6.975 ～ 13.454,P＜0.05),而脉络膜厚度的差异无统计学意义(t=-0.474～0.367,P＞0.05).POAG患者视乳头全周RNFL平均厚度与视野平均缺损之间呈负相关性(rs=-0.511,P＜0.05),而脉络膜平均厚度与视野平均缺损之间无相关性(rs=-0.285,P＞0.05).结论 POAG患者的视乳头周围脉络膜厚度与正常人并无不同,且与RNFL厚度、视野平均缺损之间无相关性.因此,不支持将视乳头周围脉络膜厚度作为诊断POAG和病情评估的指标.
目的 研究原髮性開角型青光眼(POAG)患者視乳頭週圍脈絡膜厚度與正常人之間的差異及其與視野缺損間的關繫.方法 橫斷麵研究.應用增彊深部成像的相榦光斷層掃描(EDI-OCT)儀對40例(40隻眼)POAG患者和41例(41隻眼)正常人進行以視乳頭中心為圓心、直徑為3.4 mm圓週的視網膜神經纖維層(RNFL)厚度測量.再由檢測者手動描繪視網膜色素上皮外緣和鞏膜內界麵,由軟件自動穫得相應部位的脈絡膜厚度；信度分析採用組內相關繫數(ICC),其值越大錶明測量結果越穩定、可重複性越好.POAG患者與正常人視乳頭週圍各象限RNFL和脈絡膜厚度比較,採用成組設計t檢驗；視乳頭週圍各象限脈絡膜厚度比較,採用重複測量的方差分析和LSD-t檢驗(該軟件僅提供P值)；脈絡膜厚度與年齡和RNFL厚度的相關性分析,採用Pearson相關分析法；視乳頭全週RNFL和脈絡膜平均厚度與視野平均缺損(非正態分佈)之間的相關性分析,採用Spearman秩相關分析法.結果 測量各象限脈絡膜厚度的信度分析,檢測者內ICC值為0.993 ～0.999,檢測者間ICC值為0.993～0.998.POAG患者和正常人各象限脈絡膜厚度均隨年齡增加而變薄(r=-0.509～-0.608,-0.549～-0.668;P ＜0.05),但與相應部位的RNFL厚度之間無相關性(r=-0.186 ～0.273,-0.090～0.132;P ＞0.05)；視乳頭週圍脈絡膜厚度特徵為顳上、鼻上象限最厚,其次為鼻、顳側,顳下和鼻下象限最薄(P=0.000～0.036).POAG患者視乳頭全週RNFL厚度為(64.8±14.3)μm,脈絡膜厚度為(139.6 ±60.3)μm;正常對照者視乳頭全週RNFL厚度為(106.5±7.8) μm,脈絡膜厚度為(138.2±56.7) μm;患者與對照者全週RNFL厚度差異有統計學意義(t=16.087,P＜0.05),但脈絡膜厚度差異無統計學意義(t=-0.107,P＞0.05).POAG患者其餘各象限RNFL厚度也均明顯薄于正常人(t=6.975 ～ 13.454,P＜0.05),而脈絡膜厚度的差異無統計學意義(t=-0.474～0.367,P＞0.05).POAG患者視乳頭全週RNFL平均厚度與視野平均缺損之間呈負相關性(rs=-0.511,P＜0.05),而脈絡膜平均厚度與視野平均缺損之間無相關性(rs=-0.285,P＞0.05).結論 POAG患者的視乳頭週圍脈絡膜厚度與正常人併無不同,且與RNFL厚度、視野平均缺損之間無相關性.因此,不支持將視乳頭週圍脈絡膜厚度作為診斷POAG和病情評估的指標.
목적 연구원발성개각형청광안(POAG)환자시유두주위맥락막후도여정상인지간적차이급기여시야결손간적관계.방법 횡단면연구.응용증강심부성상적상간광단층소묘(EDI-OCT)의대40례(40지안)POAG환자화41례(41지안)정상인진행이시유두중심위원심、직경위3.4 mm원주적시망막신경섬유층(RNFL)후도측량.재유검측자수동묘회시망막색소상피외연화공막내계면,유연건자동획득상응부위적맥락막후도；신도분석채용조내상관계수(ICC),기치월대표명측량결과월은정、가중복성월호.POAG환자여정상인시유두주위각상한RNFL화맥락막후도비교,채용성조설계t검험；시유두주위각상한맥락막후도비교,채용중복측량적방차분석화LSD-t검험(해연건부제공P치)；맥락막후도여년령화RNFL후도적상관성분석,채용Pearson상관분석법；시유두전주RNFL화맥락막평균후도여시야평균결손(비정태분포)지간적상관성분석,채용Spearman질상관분석법.결과 측량각상한맥락막후도적신도분석,검측자내ICC치위0.993 ～0.999,검측자간ICC치위0.993～0.998.POAG환자화정상인각상한맥락막후도균수년령증가이변박(r=-0.509～-0.608,-0.549～-0.668;P ＜0.05),단여상응부위적RNFL후도지간무상관성(r=-0.186 ～0.273,-0.090～0.132;P ＞0.05)；시유두주위맥락막후도특정위섭상、비상상한최후,기차위비、섭측,섭하화비하상한최박(P=0.000～0.036).POAG환자시유두전주RNFL후도위(64.8±14.3)μm,맥락막후도위(139.6 ±60.3)μm;정상대조자시유두전주RNFL후도위(106.5±7.8) μm,맥락막후도위(138.2±56.7) μm;환자여대조자전주RNFL후도차이유통계학의의(t=16.087,P＜0.05),단맥락막후도차이무통계학의의(t=-0.107,P＞0.05).POAG환자기여각상한RNFL후도야균명현박우정상인(t=6.975 ～ 13.454,P＜0.05),이맥락막후도적차이무통계학의의(t=-0.474～0.367,P＞0.05).POAG환자시유두전주RNFL평균후도여시야평균결손지간정부상관성(rs=-0.511,P＜0.05),이맥락막평균후도여시야평균결손지간무상관성(rs=-0.285,P＞0.05).결론 POAG환자적시유두주위맥락막후도여정상인병무불동,차여RNFL후도、시야평균결손지간무상관성.인차,불지지장시유두주위맥락막후도작위진단POAG화병정평고적지표.
Objective To compare peripapillary choroidal thickness (CT) between primary open angle glaucoma(POAG) and normal subjects using enhanced depth imaging optical coherence tomography (EDI-OCT).Methods This research was a cross-sectional study.A 360-degree 3.4 mm diameter peripapillary circle scan was performed for retinal nerve fiber layer (RNFL) assessment by EDI-OCT in one eye of 40 POAG patients and 41 age-and sex-matched normal subjects.The observer used the manual segmentation function to delineate the posterior edge of the retinal pigment epithelium and the sclerochoroidal interface.The RNFL thickness algorithm function was used to automatically generate the CT in corresponding sectors.The intra-and inter-observer reproducibility was evaluated by intraclass correlation coefficient (ICC).Repeated measures ANOVA and LSD-t test were used to analyze differences in CT by peripapillary location.A Pearson correlation was calculated for variation in CT relative to age and RNFL.Spearman rank correlation was calculated to test the strength of the relationship between global mean RNFL and visual field mean deviation MD) and between CT and MD.Independent-samples t-test was conducted to compare mean RNFL and CT between POAG and normal subjects.Results The intra-and interobserver ICC values ranged from 0.993 to 0.999 and 0.993 to 0.998 respectively.In both groups,the CT showed a negative correlation with age at each peripapillary location (r =-0.509 to-0.608,-0.549 to-0.668 ; P =0.000 to 0.001)but no significant correlation with RNFL for any location (r =-0.186 to 0.273,-0.090 to 0.132 ; P =0.092 to 0.869).The peripapillary CT was thickest superotemporally and superonasally,then nasally and temporally,and was thinnest inferotemporally and inferonasally (P =0.000 to 0.036).Compared to normal subjects,eyes with POAG had significantly thinner RNFL at all locations (t =6.975 to 16.087,P =0.000),but CT measurements did not differ between groups for any location (t =-0.474 to 0.367,P =0.637 to 0.978).In POAG patients,the global mean RNFL (rs =-0.511,P =0.001) but not CT (rs =-0.285,P =0.079) was found to significantly correlate with visual field MD.Conclusions The peripapillary CT in POAG neither differ from that in normal subjects nor correlate with RNFL and visual field index,which des not support using it as a clinical parameter in glaucoma diagnosis or management.
