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目的:使用光学相干断层成像术(OCT)评估原发性开角型青光眼(POAG)各个病程时期的视网膜神经纤维层(RNFL)与视盘参数的差异,从而探讨青光眼RNFL厚度的变化与盘沿面积和杯盘面积比(C/D AR)之间的关系,确定OCT检测参数对青光眼病程变化的参考意义。方法:应用OCT检查技术分别对40例(60只眼)的POAG患者的RNFL及视盘进行检测。数据包括颞侧(TEMP)、上方(SUP)、鼻侧(NAS)、下方(INF)RNFL厚度以及平均RNFL厚度与盘沿面积和C/D AR。按青光眼诊断标准和视野分期法分为早期、中期和晚期3组。比较和分析3组的RNFL变化趋势以及与视盘参数的相关性。结果:青光眼早期、中期和晚期3组之间RNFL和视盘参数的比较具有显著性差异(P<0.01)。RNFL平均厚度与盘沿面积有正相关性,r=0.719,P<0.01;与C/D AR有负相关性,r=-0.712,P<0.01。结论:POAG各个时期中RNFL厚度逐渐变薄,同时盘沿面积减少和C/D AR扩大。盘沿面积占影响RNFL厚度的因素比重较大,比C/D AR更能反映RNFL的变化。青光眼的病程发展能通过RNFL的减少变化来反映。OCT的客观检查所得的各项参数也对原发性青光眼的病情发展的评估具有一定的意义。
OBJECTIVE: To evaluate the difference of retinal nerve fiber layer (RNFL) and optic disc parameters of primary open-angle glaucoma (POAG) at various stages of disease by optical coherence tomography (OCT) And the cup-plate area ratio (C / D AR), and to determine the reference value of the parameters of OCT for glaucoma course of disease. Methods: RNFL and optic disc of 40 POAG patients (60 eyes) were examined by OCT. Data included temporal (TEMP), supral (NAS), nasal (RN), inferior (INF) RNFL thickness and mean RNFL thickness versus disc area and C / D AR. According to glaucoma diagnostic criteria and visual field staging method is divided into early, middle and late groups. The changes of RNFL in three groups were compared and analyzed as well as the correlation with the parameters of optic disc. Results: There were significant differences in RNFL and optic disc parameters between the early, middle and late glaucoma groups (P <0.01). The average thickness of RNFL had a positive correlation with the area of the disc, r = 0.719, P <0.01, and negative correlation with C / D AR, r = -0.712, P <0.01. CONCLUSIONS: The thickness of RNFL is gradually thinning during each POAG period, with a decrease in disc area and an increase in C / D AR. The area of disc rim occupies a larger proportion of the factors affecting the thickness of RNFL, which reflects the change of RNFL more than C / D AR. The progression of glaucoma can be reflected by a decrease in RNFL. The parameters of objective examination of OCT also have some significance for the evaluation of the disease progression of primary glaucoma.