撤稿：黄斑神经节细胞–内丛状层厚度与视神经纤维层双眼不对称分析在早期开角型青光眼诊断中的价值

Abstract

目的：应用高分辨率OCT测量早期开角型青光眼患者双眼视神经纤维层厚度(RNFL)、黄斑区节细胞–内丛状层厚度(GCIPL)，通过双眼不对称分析，评价RNFL、GCIPL不对称分析在早期开角型青光眼诊断中价值。方法：在我院就诊发现原发性开角型青光眼患者中筛选出40例早期原发性开角型青光眼纳入研究，并设置40例正常人作为对照组，测量所有纳入个体视神经纤维层厚度、视神经纤维层上方及下方厚度、黄斑区神经节细胞–内丛状层厚度，黄斑区神经节细胞–内丛状层上方及下方厚度，将双眼平均RNFL及GCIPL厚度绝对差作为不对称参数1，上方与上方、下方与下方厚度绝对差中的最大值作为不对称参2，应用SPSS软件对上述测量参数进行统计分析，评价各参数诊断价值。结果：正常组RNFL平均值(100.11 ± 9.76)高于青光眼组RNFL平均值(81.59 ± 17.48)，P < 0.01，正常组GCIPL(84.11 ± 5.28)高于青光眼组GCIPL(73.78 ± 11.56)，P < 0.01。青光眼RNFL、GCIPL不对称参数明显高于正常组，正常组与青光眼组RNFL厚度不对称参数1分别为3.08 ± 2.93和12.48 ± 8.59，P < 0.01。正常组与青光眼组RNFL厚度不对称参数2分别为11.90 ± 6.30和27.10 ± 13.63，P < 0.01。正常组与青光眼组GCIPL不对称参数1分别为1.78 ± 1.66和11.20 ± 1.78，P < 0.01。正常组与青光眼组GCIPL不对称参数2分别为3.38 ± 1.94和14.18 ± 10.45，P < 0.01。RNFL厚度、GCIPL厚度、双眼RNFL不对称参数1、双眼RNFL不对称参数2、双眼GCIPL不对称参1、双眼RNFL不对称参数2在早期开角型青光眼诊断AUC值分别为0.820、0.823、0.864、0.874、0.856、0.911。结论：高分辨率OCT测量青光眼组平均GCIPL与RNFL均低于正常组，青光眼组不对称参数较正常组高，且在早期青光眼中诊断效能较平均GCIPL、RNFL效能高。 Objective: To evaluate the glaucoma diagnosic performance of the asymmetry in biocular macular ganglion cell inner plexiform layer thickness and retinal nerve fibre layer thickness. All parameters are measured by Cirrus HD-OCT. Method: Forty patient with early primary open angle glaucoma and forty age-matched healthy subjects were enrolled in the study. The macular average GCIPL thickness, inferior and superior GCIPL thickness, peripapillary RNFL thickness, inferior and superior RNFL thickness were measured in each eye. Absolute difference of binocular RNFL/GCIPL thicknesses were used as asymmetrical parameters 1. The maximum absolute difference of binoc-ular superior RNFL/GCIPL and inferior RNFL/GCIPL thicknesses were used as asymmetrical pa-rameters 2. All the measurements were analysed by SPSS 19.0, and evaluated in the diagnosis of early glaucoma by ROC. Result: There were significant differences in all measurement parameters between normal and early glaucoma. The average RNFL (100.11 ± 9.76) and GCIPL (84.11 ± 5.28) in normal persons were higher than average RNFL (81.59 ± 17.48) and GCIPL (73.78 ± 11.56) in glaucoma patients. The asymmetrical parameters in glaucoma patients were higher than in normal persons. RNFL asymmetrical parameters 1 in normal persons and in glaucoma patients were 1.78 ± 1.66 and 11.20 ± 1.78; RNFL asymmetrical parameters 2 were 11.90 ± 6.30 and 27.10 ± 13.63; GCIPL asymmetrical parameters 1 were 1.78 ± 1.66 and 11.20 ± 1.78; GCIPL asymmetrical parameters 2 were 3.38 ± 1.94 and 14.18 ± 10.45. The AUC of average RNFL, average GCIPL, RNFL asymmetrical parameters 1, RNFL asymmetrical parameters 2, GCIPL asymmetrical parameters 1, GCIPL asymmetrical parameters 2 were 0.820, 0.823, 0.864, 0.874, 0.856, 0.911. Conclusion: The average GCIPL and RNFL measured by Cirrus HD-OCT in glaucoma patients were lower than in normal persons, but binocular asymmetrical parameters in glaucoma patients were much higher than in normal persons, and the diagnostic performance was better than average GCIPL and RNFL.