OCT测量黄斑区GCC与视盘周围RNFL厚度在早期青光眼诊断中的应用

Application of OCT measurement of macular GCC and RNFL thickness around optic disc in the diagnosis of early glaucoma

摘要:

目的：研究OCT测量黄斑区节细胞复合体(macular ganglion cell complex，mGCC)和视盘周围视网膜神经纤维层(peripapillary retinal nerve fiber layer，pRNFL)厚度在青光眼早期诊断中的应用。

方法：病例对照研究，选取86例86眼研究对象，其中正常人30眼，疑似原发性开角型青光眼患者27眼，原发性开角型青光眼早期患者29眼。利用光学断层扫描仪技术(optical conherence tomography，OCT)分别测量mGCC和pRNFL厚度，对不同受试者的各项参数做比较，对结果进行比较分析。

结果：正常人组、疑似青光眼组和早期青光眼组之间平均pRNFL厚度、上方pRNFL厚度、下方pRNFL厚度差异有统计学意义(P=0.001、0.004、0.011)，平均mGCC厚度、上方mGCC厚度、下方mGCC厚度差异有统计学意义(P=0.008、0.002、0.003)； 三组之间整体丢失体积(general loss of volume，GLV)和局部丢失体积(focal loss of volume，FLV)的差异有统计学意义(P=0.002)。疑似青光眼组与正常组比较，所有pRNFL和所有mGCC参数均有较高ROC下面积(area under the receiver operating characteristic，AROC)，FLV的AROC最大为0.801，除上方pRNLF的AROC为0.688外，余参数AROC均>0.700。青光眼早期组与正常组相比较，所有pRNFL和mGCC参数有较高AROC，平均mGCC的AROC最大为0.804，除平均pRNFL为0.683外，余参数AROC均>0.700。疑似青光眼组有58%患者有异常mGCC厚度，23%患者有异常的pRNFL厚度； 早期青光眼组有98%异常mGCC厚度，90%患者有异常的pRNFL厚度； 正常人组有93%异常mGCC厚度，93%患者有异常的pRNFL厚度。三组之间有统计学意义(χ²=12.11，P<0.05)。

结论：OCT测量mGCC厚度和pRNFL厚度在早期青光眼中均有良好的诊断能力，mGCC厚度测量可以作为早期青光眼诊断的有效方法。

Abstract:

AIM: To study the application of macular ganglion cell complex(mGCC)and peripapillary retinal nerve fiber layer thickness(pRNFL)measured by optical coherence tomography(OCT)in the early diagnosis of glaucoma.

METHODS: Case-control study. Eighty-six subjects, including 30 eyes in normal subjects, 27 eyes in suspected primary open angle glaucoma, 29 eyes in primary open angle glaucoma were enrolled in this study. The thickness of mGCC and pRNFL were measured by OCT. The area under the receiver operating characteristic(AROC)curve at fixed specificities were calculated for each parameter.

RESULTS: There were significant differences in mean pRNFL thickness, superior pRNFL thickness and inferior pRNFL thickness between normal group, suspected glaucoma group and early glaucoma group(P=0.001, 0.004, 0.011). The mean mGCC thickness, the thickness of the top mGCC, the thickness of the lower mGCC were statistically significant(P=0.008, 0.002, 0.003); the difference of general loss of volume(GLV)and focal loss of volume(FLV)between the three groups was statistically significant(P=0.002). Compared with the normal group, all the pRNFL and the mGCC parameters were higher in the suspected glaucoma group, and the FLV had the highest AROC(0.801), all the remaining AROC was >0.700 except above Prnlf(0.688). Compared with the normal group and the early glaucoma group, all the pRNFL and the mGCC had higher AROC, average mGCC was hightest(0.804), all parameters AROC were >0.700 except mean pRNFL(0.683). In suspected glaucoma group, 58% patients had abnormal mGCC thickness and 23% had abnormal pRNFL thickness; in early glaucoma group, 98%patients had abnormal mGCC thickness and 90% had abnormal pRNFL thickness; in normal group, 93%patients had abnormal mGCC thickness and 93%had abnormal pRNFL thickness, the correlation between the three groups was statistically significant(χ²=12.11, P<0.05).

CONCLUSION: OCT measurement of mGCC thickness and pRNFL thickness in early glaucoma have good diagnostic ability; mGCC thickness measurement can be used as an effective method for early diagnosis of glaucoma.