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目的探讨FD-OCT与HRT-Ⅲ两种检测手段测量近视眼的主要青光眼诊断参数差异性、一致性及其特征。设计前瞻性比较性病例系列。研究对象2012年10月至2013年3月在北京地区招募的131例近视患者及82例正视眼者。方法行常规眼科检查及验光、眼轴测量,符合入选条件者行FD-OCT(“ONH”模式)、HRT-Ⅲ(青光眼模块)检查,随机选取一眼作为研究对象。根据屈光度的不同将近视眼分成高度(高于-6.00 D)、中度(-3.00~-6.00 D)、低度(低于-3.00 D)近视三组。运用单因素方差分析和LSD法以及秩和检验分别比较FD-OCT、HRT-Ⅲ两种测量手段测得的近视眼组与正视眼组之间,各青光眼诊断参数的结果是否存在差异。运用Pearson相关分析,评价重要青光眼诊断参数结果与屈光度和眼轴的关系。主要指标视网膜神经纤维层(RNFL)厚度参数和视盘参数。结果(1)RNFL厚度:FD-OCT(除低度近视)HRT-Ⅲ(除高度近视)两种方法测得近视组与正视组的平均视网膜神经纤维层(m RNFL)厚度均有差异(P均<0.05),FD-OCT测量的近视组m RNFL较正视眼组薄,而HRT-Ⅲ的测量值较正视眼组厚。分区指标中,近视组FD-OCT的大部分16分区RNFL较正视组薄(P均<0.05),高、中度近视较低度者有更多具有统计学差异的参数;而HRT-Ⅲ的6分区RNFL,主要表现为中度近视的大部分参数较正视组厚(P均<0.05),高、低度近视与正视组间基本无差异(P均>0.05)。(2)视盘参数:FD-OCT及HRT-Ⅲ一致表现为所测得的近视组视盘面积、盘沿面积较正视组小(P均<0.01),其他大部分参数无统计学差异(P均>0.05)。(3)FD-OCT测得的m RNFL厚度以及部分分区的RNFL厚度、盘沿面积和容积与屈光度和眼轴长度呈负相关(P均<0.01),而HRT测量的RNFL及视盘指标与两者均无相关性(P均>0.05)。结论 FD-OCT和HRT-Ⅲ测量近视眼的青光眼诊断参数存在差异性及一致性,FD-OCT测得的RNFL相关参数多较正视眼者小,而HRT获得的结果多较正视眼者大;两种手段测得近视眼的视盘和盘沿面积较正视眼者小。这可能会干扰近视患者的青光眼早期诊断。
Objective To investigate the difference, consistency and characteristics of diagnostic parameters of major glaucoma measured by FD-OCT and HRT-Ⅲ. Design prospective comparative case series. Participants 131 patients with myopia and 82 patients with face-up were recruited in Beijing from October 2012 to March 2013. Methods The routine ophthalmological examination, optometry and axial measurement were performed. FD-OCT ( “ONH ” mode) and HRT-III (glaucoma module) examination were performed to meet the inclusion criteria. Myopia according to the different diopters into high (more than -6.00 D), moderate (-3.00 ~ -6.00 D), low (less than -3.00 D) myopia three groups. One-way analysis of variance (ANOVA), LSD and rank sum test were used to compare the diagnostic results of FD-OCT and HRT-III between the two groups. Pearson correlation analysis was used to evaluate the relationship between the results of important diagnostic parameters of glaucoma and diopter and axial length. The main indicators of retinal nerve fiber layer (RNFL) thickness parameters and optic disc parameters. Results (1) The average RNFL thickness of RNFL in both myopia group and orthophoria group was different between the two methods of RNFL thickness and HRT-Ⅲ (except for low myopia) in FD-OCT group (P All <0.05). The m RNFL in myopic group measured by FD-OCT was thinner than that in eyelid group, and the measured value of HRT-Ⅲ was thicker than that in eyelid group. In the zonal index, most of the 16-segment RNFL in FD-OCT of myopia group were thinner than that of the orthoptic group (all P <0.05), and there were more statistically significant parameters in lower degree of myopia and moderate myopia. However, HRT-Ⅲ 6 District RNFL, most of the parameters for moderate myopia were thicker than those for the positive group (P <0.05). There was no difference between the high and low myopia and the positive group (P> 0.05). (2) The parameters of optic disc: FD-OCT and HRT-III were consistent with the measured optic disc area of myopia group, the disc area was smaller than that of the positive group (P <0.01), and most of the other parameters were not statistically significant > 0.05). (3) The thickness of RNFLF measured by FD-OCT, the RNFL thickness, the area and volume of disc RNFL were negatively correlated with the diopter and axial length (P <0.01) No correlation (P> 0.05). Conclusion The diagnostic parameters of glaucoma measured by FD-OCT and HRT-III are different and consistent. The relative parameters of RNFL measured by FD-OCT are smaller than that of the normal people, but the results obtained by HRT are more than that of the normal people. Measured by two means myopia optic disc and disk area is smaller than the eyes. This may interfere with the early diagnosis of glaucoma in myopic patients.