mGCC和pRNFL厚度及视野对新生血管性青光眼的诊断价值

Diagnostic value of macular ganglion cell complex and thickness and visual field of peripapillary retinal nerve fiber layer on neovascular glaucoma

摘要:

目的：分析黄斑区节细胞复合体(mGCC)和视乳头周围视网膜神经纤维层(pRNFL)厚度及视野对新生血管性青光眼(NVG)的诊断价值。

方法：回顾性研究。收集2018-01/2021-10本院收治的NVG患者92例100眼，按病理分期分为新生血管性青光眼前期患者31例32眼、开角型青光眼期患者31例36眼及闭角型青光眼期患者30例32眼。选择同期于我院接受健康体检者50例100眼者作为对照组。采用Pearson相关性分析mGCC、pRNFL厚度与MD的相关性，以受试者工作特征(ROC)曲线研究各指标诊断效能。

结果：新生血管性青光眼前期、开角型青光眼期和闭角型青光眼期mGCC-平均(a)、mGCC-上方(s)、mGCC-下方(i)厚度均低于对照组(均P<0.001)，新生血管性青光眼前期、开角型青光眼期mGCC-a、mGCC-s、mGCC-i均高于闭角型青光眼期(均P<0.001)，新生血管性青光眼前期mGCC-a、mGCC-s、mGCC-i均高于开角型青光眼期(均P<0.001)。新生血管性青光眼前期、开角型青光眼期和闭角型青光眼期pRNFL-a、pRNFL-颞侧(t)、pRNFL-s、pRNFL-鼻侧(n)、pRNFL-i厚度均高于对照组，MD高于对照组(均P<0.001)； 新生血管性青光眼前期、开角型青光眼期pRNFL-a、pRNFL-t、pRNFL-s、pRNFL-n、pRNFL-i均高于闭角型青光眼期，MD高于闭角型青光眼期(均P<0.001)，新生血管性青光眼前期pRNFL-a、pRNFL-t、pRNFL-s、pRNFL-n、pRNFL-i均高于开角型青光眼期，MD高于开角型青光眼期(均P<0.001)。mGCC-a、mGCC-s、mGCC-i和pRNFL-a、pRNFL-t、pRNFL-s、pRNFL-n、pRNFL-i与MD呈负相关性(均P<0.001)。mGCC、pRNFL厚度及MD联合诊断NVG的效能最高(敏感度为79.00%，特异度为87.00，AUC=0.973，95%CI=0.956～0.990，P<0.05)。

结论： NVG患者mGCC、pRNFL厚度与MD呈负相关关系，mGCC、pRNFL厚度及MD对NVG有一定的诊断价值，且以联合检测的诊断效能最高。

Abstract:

AIM: To analyze the diagnostic value of macular ganglion cell complex(mGCC)and thickness and visual field of peripapillary retinal nerve fiber layer(pRNFL)on neovascular glaucoma(NVG).

METHODS: Retrospective study. A total of 92 patients(100 eyes)with NVG who were admitted to our hospital from January 2018 to October 2021 were selected. They were divided into 31 cases(32 eyes)with early NVG, 31 cases(36 eyes)with open angle glaucoma and 30 cases(32 eyes)with angle-closure glaucoma according to their pathology and term. Additionally, 50 cases(100 eyes)receiving health examination in our hospital at the same period were selected as the control group. Pearson correlation was used to analyze the correlation among mGCC, pRNFL thickness and mean deviation(MD), and the diagnostic efficiency of each index was studied by the receiver operating characteristic(ROC)curve.

RESULTS: The levels of mGCC-average(a), mGCC-superior(s)and mGCC-inferior(i)in the patients with early NVG, open-angle glaucoma and angle-closure glaucoma were lower than those in the control group(all P<0.001). The levels of mGCC-a, mGCC-s and mGCC-i in the patients with early NVG and the open-angle glaucoma group were higher than those in the angle-closure glaucoma group(all P<0.001). The levels of mGCC-a, mGCC-s and mGCC-i in the patients with early NVG were higher than patients with open-angle glaucoma group(all P<0.001). The thickness of pRNFL-a, pRNFL-temporal(t), pRNFL-s, pRNFL-nasal(n), and pRNFL-i in the patients with early NVG, open-angle glaucoma and angle-closure glaucoma was lower than that in the control group, while the MD was higher than that in the control group(all P<0.001). The thickness of pRNFL-a, pRNFL-t, pRNFL-s, pRNFL-n and pRNFL-i in the patients with early NVG and the open-angle glaucoma was higher than that of patients with angle-closure glaucoma group, while the MD level was higher than that in the patients with angle-closure glaucoma(all P<0.001). The thickness of pRNFL-a, pRNFL-t, pRNFL-s, pRNFL-n and pRNFL-i in the patients with early NVG was higher than that in the patients with open-angle glaucoma, while the MD level was higher than that those with open-angle glaucoma(all P<0.001). The mGCC-a, mGCC-s, mGCC-i, and the thickness of pRNFL-a, pRNFL-t, pRNFL-s, pRNFL-n, and pRNFL-i had a negative correlation with MD(all P<0.001). The combined diagnosis of mGCC, pRNFL thickness and MD had the highest efficiency in NVG(sensitivity: 79.00%, specificity: 87.00, AUC=0.973, 95%CI=0.956-0.990, P<0.05).

CONCLUSION: The mGCC and thickness of pRNFL in patients with NVG had a negative correlation with MD. mGCC, pRNFL thickness and MD have a certain diagnostic value on NVG, and the efficiency of combined diagnosis is the highest.