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视网膜神经纤维层厚度的局部改变作为青光眼局部功能改变的一个预测指标

Gardiner SK, Fortune B, Demirel S

期刊名称:American Journal of Ophthalmology

卷期:2016年第170卷

摘要

目的:决定局部视网膜神经纤维层厚度(RNFLT)变化率与青光眼视野相应位置敏感性变化率的相关性。设计:回顾性队列研究。方法:用视野检查和光学相干断层扫描(OCT)每6个月检查191名根据临床经验可疑或者确诊青光眼患者的364只眼睛。每个24-2视野位置,相应扇形视神经盘RNFLT用30度扇形定义,集中在进入视神经头的神经纤维角度。逐点敏感性和扇形RNFLT的变化率用过去8次访问获得的可信数据进行计算。用Passing-Bablok回归从每个位置扇形RNFLT变化率预测逐点敏感性变化率。结果:扇形RNFLT变化率明显可以预测该区域所有位置逐点敏感性变化率。关联性适中,平均0.15,根据位置从0.03到0.25不等。相应扇形区一个1mm/y快速变薄与上部视野0.3dB/y迅速丢失有关,与下部视野许多位置0.1 dB/y快速丢失无关。结论:局部RNFLT变薄与视野相应位置敏感性缺失有关,其变化率关联性显著。视神经盘RNFLT可以用来检测青光眼引起的对患者视力产生可以测量到的结果的局部改变。

Purpose:To determine how well rates of localized retinal nerve fiber layer thickness (RNFLT) change correlate with rates of sensitivity change at corresponding locations in the visual field in glaucoma.

Design:Retrospective cohort study.

Methods:Three hundred and sixty-four eyes of 191 participants with suspected or confirmed glaucoma, as judged by experienced clinicians, were tested every 6months with perimetry and optical coherence tomography (OCT). For each 24-2 visual field location, the corresponding sectoral peripapillary RNFLT was defined using a 30-degree sector, centered on the angle of nerve fiber entry into the optic nerve head. Rates of change of pointwise sensitivity and sectoral RNFLT were calculated over the last 8 visits at which reliable data were obtained. Passing-Bablok regression was used to predict the rate of pointwise sensitivity change from the rate of sectoral RNFLT change, for eachlocation.

Results:Rates of sectoral RNFLT change were significantly predictive of rates of pointwise sensitivity change at all locations in the field. Correlations were modest, averaging 0.15, ranging from 0.03 to 0.25 depending on the location. A 1μm/y more rapid thinning in corresponding sectors was associated with 0.3 dB/y more rapid loss in the superior visual field but less than 0.1 dB/y more rapid loss at many locations in the inferior visual field.

Conclusions:Localized RNFL thinning is associated with sensitivity loss at corresponding locations in the visual field, and their rates of change are significantly correlated. Peripapillary RNFLT may be used to monitor localized changes caused by glaucoma that have measurable consequences for a patient's vision.


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