不同类型闭角型青光眼患者的视网膜神经纤维层厚度的变化

Changes of retinal nerve fiber layer thickness in patients with different types of angle-closure glaucoma

摘要:

目的：分析急慢性闭角型青光眼患者的视网膜神经纤维层厚度的变化及其意义。

方法：选取2016-01/2018-01我院收治的急性闭角型青光眼患者37例40眼和慢性闭角型青光眼患者35例38眼为研究对象，并选取同期在我院进行检查的正常体检者30例为正常组。所有研究对象均进行视野检查和OCT检查，根据视野检查结果将患病组分为视野缺损和视野未缺损2个亚组，对三组及亚组上方、下方、鼻侧、颞侧和平均RNFL厚度进行比较； 研究RNFL厚度与视野缺损的关系。

结果：急性组的上方、下方、鼻侧和平均RNFL厚度均明显高于正常组(160.41±39.87μm vs 124.50±14.86μm、155.38±31.79μm vs 127.75±20.08μm、96.12±32.01μm vs 75.79±13.10μm、121.49±21.46μm vs 101.79±10.34μm)，而慢性组的各象限(上方：91.57±30.22μm； 下方：96.23±30.68μm； 鼻侧：65.46±16.94μm； 颞侧：63.28±16.94μm)及平均RNFL厚度(80.58±22.18μm)均明显低于正常组，差异有统计学意义(P<0.05)。急性组视野正常者上方、下方的RNFL厚度低于本组视野缺损者(159.68±27.49μm vs 163.32±37.76μm，152.31±21.86μm vs 161.27±32.09μm)，差异有统计学意义(P<0.05)，而鼻侧、颞侧和平均RNFL厚度两者间差异无统计学意义(P>0.05)； 慢性组视野缺损者各象限RNFL厚度显著低于视野正常者(120.83±13.19μm vs 88.82±25.18μm、124.83±17.01μm vs 85.89±30.91μm、76.06±11.79μm vs 62.03±12.13μm、75.17±9.99μm vs 63.09±8.24μm)，差异有统计学意义(P<0.05)。

结论：急性PACG的RNFL变厚主要原因为视神经水肿，而慢性PACG的RNFL变薄的主要原因是节细胞的损害和神经纤维的丢失，不同的原因导致不同类型PACG的RNFL厚度差异。

Abstract:

AIM: To investigate the changes and significance of retinal nerve fiber layer(RNFL)thickness in patients with acute and chronic angle-closure glaucoma.

METHODS: Totally 37 patients(40 eyes)with acute angle-closure glaucoma and 35 cases(38 eyes)patients with chronic angle-closure glaucoma in our hospital from January 2016 to January 2018 were studied, and 30 cases with normal check-up in our hospital were compared. All the objects were scanned by optical coherence tomography(OCT). All subjects underwent visual field examination and OCT examination. According to the visual field examination results, the patients were divided into 2 subgroups of visual field defect and normal visual field. To study the relationship between RNFL thickness and visual field defect.

RESULTS: The superior, inferior, nasal side and average RNFL thickness of the acute group were obviously higher than that in the normal group(160.41±39.87μm vs 124.50±14.86μm, 155.38±31.79μm vs 127.75±20.08μm, 96.12±32.01μm vs 75. 79±13.10μm, 121.49±21.46μm vs 101.79±10.34μm), and the average RNFL thickness of the chronic group was lower than that in the normal group(superior: 91.57±30.22μm, inferior: 96.23±30.68μm, nasal side: 65.46±16.94μm, temporal side: 63.28±16.94μm, average: 80.58±22.18μm; P<0.05). The RNFL thickness of the superior and inferior part of normal visual field in the acute group was lower than that of the same group with visual field defect(159.68±27.49μm vs 163.32±37.76μm; 152.31±21.86μm vs 161.27±32.09μm; P<0.05); however, there was no significant difference on nasal side, temporal side and average RNFL thickness between the two subgroups(P>0.05). And the RNFL thickness of the subjects in chronic group with visual field defect was significantly lower than that in normal visual field(120.83±13.19μm vs 88.82±25.18μm, 124.83±17.01μm vs 85.89±30.91μm, 76.06±11.79μm vs 62.03±12.13μm, 75.17±9.99μm vs 63.09±8.24μm; P<0.05).

CONCLUSION: The RNFL thickening of acute PACG is mainly caused by optic nerve edema, while chronic PACG's RNFL thinning is due to the damage of ganglion cells and the loss of nerve fibers, different reasons cause different PACG thickness.