摘要目的：:应用高分辨率光学相干断层扫描仪（Cirrus-HD OCT）测量服用乙胺丁醇（EMB）的结核病患者视盘周围视网膜神经纤维层（p-RNFL）厚度和黄斑区神经节细胞-内丛状层（GCIPL）的厚度，探讨EMB对视网膜神经节细胞的损害特点，评估高分辨率OCT在早期诊断中毒性视神经病变（EON）中的价值。方法：:病例对照研究。收集2018年1月至2019年3月就诊的服用EMB等抗结核药物的结核患者60例，剔除2例发病半年以上视神经萎缩者和9例合并其他眼底病变者，其中6例（12眼）确诊为EON纳入EON组，另43例（85眼）服药后视功能正常者纳入服药组，选择41例（82眼）与服药组年龄、性别匹配的正常人群纳入对照组1，另选择13例（26眼）与EON组年龄、性别匹配的正常人群纳入对照组2。对服药组和对照组1，EON组和对照组2，分别进行p-RNFL平均值及鼻、下、颞、上4个象限厚度的比较，以及黄斑GCIPL层平均厚度，GCIPL最小厚度及GCIPL鼻上、鼻下、下方、颞下、颞上、上方6个区域厚度的比较，分别进行独立样本 t检验。 结果：:与对照组1相比，服药组p-RNFL的平均厚度和鼻、下、颞、上4个象限的厚度差异均无统计学意义（ P>0.05），而GCIPL层除了颞下区差异无统计学意义（ P>0.05），GCIPL的平均厚度、最小厚度、鼻上、鼻下、下方、颞上、上方区域均明显变薄，差异有统计学意义（ t=-3.149、-2.880、-3.816、-3.697、-2.646、-2.231、-2.323， P<0.05）。与对照组2相比，EON组的p-RNFL在鼻侧和下方增厚，差异有统计学意义（ t=2.452、2.314， P<0.05），GCIPL层在鼻上、鼻下、下方、颞下、颞上和上方均变薄，差异有统计学意义（ t=-2.809、-2.622、-2.806、-2.461、-2.887、-3.478， P<0.05）。 结论：:高分辨率OCT能精确测量GCIPL厚度，更直接观察到视网膜神经节细胞的损害及其程度，结合p-RNFL和黄斑GCIPL厚度的测量，可帮助早期诊断EON。

abstractsObjective::To investigate the structural injury patterns in retinal ganglion cell injury from ethambutol (EMB) treatment, and the value of Cirrus-HD OCT examination in the early diagnosis of toxic optic neuropathy.Methods::This was a retrospective case-control study. Sixty tuberculosis (TB) patients who took anti-TB drugs containing EMB from January 2018 to March 2019 were recruited. Among them, 6 patients (12 eyes) who were diagnosed with ethambutal-induced optic neuropathy (EON) were included in the EON group, another 43 patients (85 eyes) who had normal visual function after taking the medicine were included in the drug group. Forty-one patients (82 eyes) who matched the age and gender of the drug group were included in control group 1, and 13 patients (26 eyes) who matched the age and gender of the EON group were included in control group 2. The thickness of the retinal nerve fiber layer (RNFL) and the ganglion cell-inner plexiform layer (GCIPL) on Cirrus-HD OCT images were compared with those of healthy controls.Results::No significant changes in RNFL thickness were found in the drug group compared with control group 1. Meanwhile, the ganglion cell layer visibly decreased in the nasal-superior, nasal-inferior, inferior, temporal-superior and the superior sectors compared with control group 1 ( t=-3.149, -2.880, -3.816, -3.697, -2.646, -2.231, -2.323, all P<0.05), except for the temporal inferior sector. The p-RNFL thickness of the EON group increased in the nasal and inferior sectors ( t=2.452, 2.314, both P<0.05), while the ganglion cell layer thickness decreased in the nasal-superior, nasal-inferior, inferior, temporal-inferior, temporal-superior and the superior sectors compared with the healthy controls in group 2. The differences were significant ( t=-2.809, -2.622, -2.806, -2.461, -2.887, -3.478, all P<0.05). Conclusions::Cirrus-HD OCT can accurately measure the thickness of the GCL layer, and enables more direct observance of damage to retinal ganglion cells. Combined with the measurement of p-RNFL and GCL thickness, it can assist in the early diagnosis of EON.