应用OCT测量原发性急性闭角型青光眼视网膜神经纤维层厚度的初步研究
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摘要
目的:应用光学相干断层成像术(OCT)测量原发性急性闭角型青光眼(APACG)视网膜神经纤维层厚度,观察其变化规律。
方法:应用OCT测量首次急性发作(＜6小时)的原发性急性闭角型青光眼患者(26例)治疗后视网膜神经纤维层厚度的改变,测量时间为入院经治疗角膜透明后当天和经治疗眼压下降至正常范围后1周、1个月、3个月、6个月(共5次)。同时测量正常成人(年龄匹配,30人)的视网膜神经纤维层厚度作为对比。
结果:入院后经治疗角膜透明当天应用OCT测量视乳头周围平均视网膜神经纤维层厚度:(122.14±21.37)μm,较正常对照组增厚(P＜0.01)。经治疗眼压正常后1周,平均视网膜神经纤维层厚度:(110.25±17.43)μm,较正常对照组增厚(P＜0.05)。经治疗眼压正常后1个月,平均视网膜神经纤维层厚度:(103.34±15.19)μm,较正常稍增厚,差异无统计学差异(P＞0.05)。经治疗眼压正常后3个月,平均视网膜神经纤维层厚度:(102.56±14.11)μm,较正常对照组稍下降,差异无统计学意义(P＞0.05)。经治疗眼压正常后6个月,平均视网膜神经纤维层厚度:(101.22±15.54)μm,较正常者稍下降,差异无统计学差异(P＞0.05)。
结论:眼压急性升高在早期造成视网膜神经纤维层水肿,视网膜神经纤维层厚度增厚,而在经过治疗眼压降至正常范围后,视网膜神经纤维层厚度逐渐下降。眼压正常后3个月和6个月视网膜神经纤维层厚度趋于稳定且与正常对照组相比无统计学差异。
Objective:To determine the thickness of retinal nerve fiber layer(RNFL) by optical coherence tomography(OCT) in acute primary angle-closure glaucoma (APACG).
Methods:26 subjects of APACG patients with the first acute attack(＜6 hours) and 30 normal controls were included in our study.The retinal nerve fiber layer thickness was accessed by OCT in the first day when cornea became clear,1 week,1 month,3 months,6 months after intraocular pressure(IOP) controlled.The RNFLT was compared with the attacked eyes and the normal controls' eyes.
Results:The average of APACG patients' RNFLT in the first day(122.144±21.37)μm was thicker than that of normal control(P＜0.01).At 1 week after IOP controlled,the average of RNFL thickness(110.25±17.43 )μm was thicker than that of normal control(P＜0.05).At 1 month after IOP controlled,the average of RNFL thickness(103.344±15.19)μm was little thicker than that of normal control (P＞0.05),there was no significant difference.At 3 months(102.56±14.11)μm and 6 months(101.22±15.54)μm after IOP controlled,the average of RNFLT was little thinner than that of normal control(P＞0.05),there was no significant difference.
Conclusion:In the early period,acute rising of IOP cased the edema of retinal,RNFL thickness became thicker,but after treatment and IOP in normal range the RNFL thickness dropped gradually.At 3 months and 6 month after IOP normal,the RNFL thickness tended to be stable,and there was no significant difference with normal control.
方法:应用OCT测量首次急性发作(＜6小时)的原发性急性闭角型青光眼患者(26例)治疗后视网膜神经纤维层厚度的改变,测量时间为入院经治疗角膜透明后当天和经治疗眼压下降至正常范围后1周、1个月、3个月、6个月(共5次)。同时测量正常成人(年龄匹配,30人)的视网膜神经纤维层厚度作为对比。
结果:入院后经治疗角膜透明当天应用OCT测量视乳头周围平均视网膜神经纤维层厚度:(122.14±21.37)μm,较正常对照组增厚(P＜0.01)。经治疗眼压正常后1周,平均视网膜神经纤维层厚度:(110.25±17.43)μm,较正常对照组增厚(P＜0.05)。经治疗眼压正常后1个月,平均视网膜神经纤维层厚度:(103.34±15.19)μm,较正常稍增厚,差异无统计学差异(P＞0.05)。经治疗眼压正常后3个月,平均视网膜神经纤维层厚度:(102.56±14.11)μm,较正常对照组稍下降,差异无统计学意义(P＞0.05)。经治疗眼压正常后6个月,平均视网膜神经纤维层厚度:(101.22±15.54)μm,较正常者稍下降,差异无统计学差异(P＞0.05)。
结论:眼压急性升高在早期造成视网膜神经纤维层水肿,视网膜神经纤维层厚度增厚,而在经过治疗眼压降至正常范围后,视网膜神经纤维层厚度逐渐下降。眼压正常后3个月和6个月视网膜神经纤维层厚度趋于稳定且与正常对照组相比无统计学差异。
Objective:To determine the thickness of retinal nerve fiber layer(RNFL) by optical coherence tomography(OCT) in acute primary angle-closure glaucoma (APACG).
Methods:26 subjects of APACG patients with the first acute attack(＜6 hours) and 30 normal controls were included in our study.The retinal nerve fiber layer thickness was accessed by OCT in the first day when cornea became clear,1 week,1 month,3 months,6 months after intraocular pressure(IOP) controlled.The RNFLT was compared with the attacked eyes and the normal controls' eyes.
Results:The average of APACG patients' RNFLT in the first day(122.144±21.37)μm was thicker than that of normal control(P＜0.01).At 1 week after IOP controlled,the average of RNFL thickness(110.25±17.43 )μm was thicker than that of normal control(P＜0.05).At 1 month after IOP controlled,the average of RNFL thickness(103.344±15.19)μm was little thicker than that of normal control (P＞0.05),there was no significant difference.At 3 months(102.56±14.11)μm and 6 months(101.22±15.54)μm after IOP controlled,the average of RNFLT was little thinner than that of normal control(P＞0.05),there was no significant difference.
Conclusion:In the early period,acute rising of IOP cased the edema of retinal,RNFL thickness became thicker,but after treatment and IOP in normal range the RNFL thickness dropped gradually.At 3 months and 6 month after IOP normal,the RNFL thickness tended to be stable,and there was no significant difference with normal control.
引文
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[2]Izatt JA,et al.Micro-scale resolution imaging of the anterior eye in vivo with optical coherence tomography[J].Arch Ophthalmol,1994.112:1584
[3]Hee M R,et al.Optical coherence tomography of human retina[J].Arch Ophthalmol,1995.113:325
[4]刘杏,黄时洲,凌运兰,等.眼科临床光学相干断层成像学[M].广州:广州科技出版社,2006.
[5]Harry AQ,Earl MD,et al.Optic nerve damage in human glaucoma:Ⅲ.Quantitative correlation of nerve fiber loss and visual field defect in glaucoma,ischemic neuropathy,papilledema,and toxic neuropathy[J].Arch ophthalmic,1982,100:135-146.
[6]刘杏,凌运兰。光学相干断层成像术对原发性开角型青光眼视网膜神经纤维层的定性和定量测量[J]。中华眼科杂志,2000,36:420-424
[7]Sommer A.The nerve fiber layer in the diagnosis of glaucoma[J].Arch Ophthalmol,1977,95:2149-2151.
[8]Fang AW,Qu J,et al.Measurement of retinal nerve fiber layer in primary acute angle closure glaucoma by optical coherence tomography[J].J Glaucoma,2007,16:78-184
[9]Pascale Massin,MD,Eric Vicaut,MD,PhD,Belkaem naouchone,MD,et al.Reproducibility of retinal mapping using optical coherence tomography[J].Arch Ophthalmic,2001,119:1135-1142
[10]Goebel W,Kretzchmar-Gross T.Retinopathy:a study using optical coherence tomography(OCT)[J].Retina,2002,22:759-767
[11]Schuman JS.Optical coherence tomography for imaging and quantification of the nerve fiber layer thickness.IN:Schuman JS,ed.Imaging in Glaucoma.Thorofare,NJ:SLACK,1996:7.4 Leonard W.Yip,Vernon K.Y.Yong,etal.Optical coherence tomography of optic disc swelling in acute primary angle-closure glaucoma[J].Acta Ophthalmol,2006,123:567-569.
[12]黄丽娜,Schuman J,Wang N.光学相干断层成像与组织形态学检测猴青光眼 视网膜神经纤维层厚度的比较[J].中华眼科杂志,2001,37(7):189-193
[13]SchumanJS,Hee MR,PuliafitoCA.Quantificationofnerve fiber layer thickness in normaland glaucomatouseyes using optical coherence tomog-raphy[J].Arch Ophthalmol,1995,113(5):586
[14]黄晶晶,刘杏,曾阳发,等.光学相干断层扫描仪不同扫描程序测量视网膜神经纤维层厚度的比较[J].眼科,2005,14(6):400-404。
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