摘要目的 观察视野前青光眼(PPG)患者视盘参数和黄斑神经节细胞复合体(GCC)结构的变化.方法 检查确诊的PPG患者18例18只眼(PPG组)、原发性开角型青光眼(POAG)患者22例22只眼(POAG组)、生理性大视杯者20例20只眼(生理性大杯组)纳入研究.随机选取同期健康自愿者为正常组.采用傅里叶域光相干断层扫描对所有受检者的视盘和黄斑区进行扫描,测量视盘平均、上方、下方、颞上、颞下、鼻上、鼻下、颞侧偏上、颞侧偏下、鼻侧偏上、鼻侧偏下象限的神经纤维层厚度(RNFL),视盘盘沿容积(RV)、视盘容积(NHV)、视盘面积(ODA)、盘沿面积(RA)、视杯容积(CV)、杯盘面积比(CDAR)、垂直杯盘比(VCDR)、水平杯盘比(HCDR)及视杯面积(CA)等参数以及黄斑GCC、上方GCC、下方CGG厚度和局部丢失体积(FLV)、整体丢失体积(GLV)值.比较各组间上述参数的差异.结果 PPG组较正常组颞上、颞下、颞侧偏上、颞侧偏下、上方、下方及平均RNFL厚度减少,差异有统计学意义(P＜0.05).PPG组鼻侧偏上的RNFL厚度较POAG组RNFL厚度增加,差异有统计学意义(P＜0.05).PPG组患眼RNFL厚度与POAG组相比,颞上、颞下、颞侧偏上、上方、下方、平均RNFL厚度减少,差异有统计学意义(P＜0.05).PPG组RV、NHV、ODA、RA较正常对照组均减少,差异有统计学意义(P＜0.05);CV、CDAR、VCDR、HCDR、CA较正常对照组均增大,差异有统计学意义(P＜0.05).PPG组各视盘参数与POAG组比较,差异均无统计学意义(P＞0.05).PPG组与生理性大视杯组比较,RV、NHV、ODA、RA均减少,CV、CDAR、HCDR、VCDR及CA均增加.CDAR、VCDR、RA差异有统计学意义(P＜0.05).PPG组与正常组比较,平均黄斑GCC、下方GCC、上方GCC厚度均降低,GLV、FLV值均增大,差异均有统计学意义(P＜0.05).PPG与平均黄斑GCC、下方GCC、上方GCC厚度与POAG组比较,差异均无统计学意义(P＞0.05).PPG组与生理性大视杯组比较,黄斑平均GCC、上方GCC、下方GCC均变薄,GLV、FLV值均增大,差异均有统计学意义(P＜0.05).结论 PPG患者RA、NHA、ODA、RV、黄斑GCC值较正常人、生理性大视杯者减小;与POAG者无明显差异.

abstractsObjective To observe the changes of glaucoma optic nerve head (ONH) parameters and macular ganglion cell complex (GCC) structure in preperimetric glaucoma (PPG) patients.Methods Eighteen PPG patients (18 eyes,PPG group),22 primary open-angle glaucoma (POAG) patients (22 eyes,POAG group),and 20 patients (20 eyes) with physiologic large optic cup (physiological big optic cup group) were included in this study.Seventeen healthy volunteers (17 eyes) were the normal control.The optic nerve head and macular was scanned by fourier-domain optic coherence tomography (FD-OCT) for all subjects.The following 15 parameters,including nerve fiber layer thickness (RNFL),the optic disk rim volume (RV),optic nerve head volume (NHV),optic disc area (ODA),rim area (RA),cup volume (CV),cup/disc area ratio (CDAR),vertical cup/disc ratio (VCDR),horizontal cup/disc ratio (HCDR) and optic cup area (CA),macular GCC,superior GCC,inferior GCC thickness,focal loss of volume (FLV) and global loss of volume (GLV),were measured at 10 different quadrants.The relationship between macular GCC thickness or optic disc RNFL thickness and RA was analyzed by simple linear regression analysis.Results The RNFL thickness of PPG patients was (99.29±19.93) μm (superior quadrant),(97.29±22.86) μm (inferior),(114.61±15.64) μm (superior temporal,ST),(119.22±26.19) μm (inferior temporal,IT),(116.11±39.32) μm (superior nasal,SN),(111.33±37.65) μm (inferior nasal,IN),(77.56±17.22) μm (temporal upper,TU),(76.78±10.34) μm (temporal lower,TL),(88.94± 42.54) μm (nasal upper,NU),and (82.33±43.83) μm (nasal lower,NL) respectively,which was thinner than normal control group and physiologic large cup group,but thicker than POAG patients.Compared to normal controls and physiologic large cup patients,PPG patients also had 4 parameters reduced (RV,NHV,ODA and RA),and 5 parameters increased (CV,CDAR,VCDR,HCDR and CA),the differences are statistically significant (P＜0.05).However,these parameters were similar to POAG patients (P＞ 0.05).For macular GCC parameters,PPG patients also had 3 parameters reduced (average GCC,superior and inferior GCC thickness),and 2 parameters increased (GLV and FLV) compared to normal control group and physiologic large cup patients (P＜0.05).However,these parameters were similar to POAG patients (P＞0.05).Simple linear regression analysis showed that,with the GCC macular thinning,reducing the number of ganglion cells reduced,optic disc RNFL thickness became thinner (regression coefficient=1.25,P=0.00) and RV reduced (regression coefficient =0.037,P =0.00).Conclusions PPG patients and normal control had a similar distribution of optic disc RNFL.Five parameters (RV,NHV,ODA,RA,macular GCC thickness) were less than normal control and physiological big optic cup group,but had no significant differences compared with POAG group.