应用MAIA微视野计评估青光眼黄斑部功能改变

Evaluation of macular function changes in glaucoma using MAIA microperimetry

摘要:

目的：观察青光眼患者微视野特征，探讨微视野检测值与最佳矫正视力(BCVA)、标准自动视野检测指标和光学相干断层扫描(OCT)检测指标的相关性。

方法：病例对照研究。纳入青光眼患者45例76眼，其中原发开角型青光眼15例25眼，慢性闭角型青光眼30例51眼； 正常对照组40例76眼。所有受检眼进行了MAIA微视野、Humphrey视野、BCVA检测，并与OCT测量的结构指标进行相关性分析。

结果：青光眼患者与正常人群相比，微视野测出的黄斑平均光敏感度(MS)、OCT测出的神经节细胞复合体(GCC)、神经纤维层(RNFL)厚度低于正常对照组，Humphrey视野计10-2程序测出的视野平均缺损(MD)、GCC局部丢失体积(FLV)、GCC整体丢失体积(GLV)、63%双曲线椭圆面积(BCEA)高于正常对照组。青光眼组MS与MD、FLV、GLV、BCVA(LogMAR)呈负相关(r_s=-0.839、-0.665、-0.530、-0.424，均P<0.01)。青光眼组MS与GCC、RNFL呈正相关(r_s=0.437、0.500，均P<0.01)。MAIA微视野计检测时间更短。ROC曲线分析表明微视野对青光眼的诊断准确度为中等。

结论：MAIA微视野计敏感性高，能检测到OCT结构损伤区域的视网膜光敏感度降低。微视野检测值与BCVA、标准自动视野检测指标和OCT检测指标具有相关性，MAIA微视野计与OCT相结合能提高青光眼的早期诊断率。

Abstract:

AIM: To observe the characteristics of microperimetry in patients with glaucoma, and investigate the correlation between microperimetry and best corrected visual acuity(BCVA), standard automatic perimetry and optical coherence tomography(OCT)index.

METHODS: This case-control study included 45 patients(76 eyes)with glaucoma(glaucoma group), among which 15 patients(25 eyes)with primary open-angle glaucoma and 30 patients(51 eyes)with chronic angle-closure glaucoma, and 40 healthy individuals(76 eyes)were included in the control group. MAIA microperimetry, Humphrey perimetry, and BCVA tests were performed in all examined eyes. Correlation analysis was performed using the structural indices measured by OCT.

RESULTS: The mean sensitivity(MS)in macular area measured by microperimetry and the ganglion cell complex(GCC)and retinal nerve fiber layer(RNFL)thickness measured by OCT were decreased in glaucoma patients when compared to the control group. Additionally, the mean defect(MD)measured by Humphrey perimetry(10-2 visual field test), focal loss volume(FLV), global loss volume(GLV)measured by OCT, and 63% bivariate contour ellipse area(BCEA )measured by MAIA microperimetry were higher than those of the control group. The MS was negatively correlated with MD, FLV, GLV and BCVA(LogMAR)in the glaucoma group(r_s=-0.839, -0.665, -0.530, and -0.424, all P<0.01). In contrast, MS was positively correlated with GCC and RNFL in the glaucoma group(r_s=0.437, 0.500, all P<0.01). MAIA microperimetry had a shorter detection time. Receiver operating characteristic(ROC)curve analysis showed that MAIA microperimetry had moderate accuracy for the diagnosis of glaucoma.

CONCLUSIONS: MAIA microperimetry has high sensitivity and can detect retinal sensitivity reduction in areas of structural damage tested by OCT. The microperimetry values were correlated with BCVA, standard automatic perimetry parameters, and OCT parameters. MAIA microperimetry combined with OCT will increase the early diagnosis rate of glaucoma.