【作者】 陈悦；

【导师】 王英；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2020， 硕士

【摘要】 背景青光眼是一类多因素相关的视神经疾病,最典型和最突出的表现是视神经乳头的凹陷性萎缩和视野的特征性缺损缩小,如果不能及时有效地治疗控制病情变化,最终视野将会全部丧失,以至失明。闭角型青光眼是我国主要的青光眼类型。闭角型青光眼的具体发病机制仍然不明确,解剖结构异常是闭角型青光眼患者的特点,但脉络膜厚度在慢性闭角型青光眼中的变化情况目前仍不明确。目的本研究应用频域光学相干断层扫描(Optical Coherence Tomography,OCT)技术测量慢性闭角型青光眼(chronic primary angle-closure glaucoma,CPACG)患者眼底黄斑区脉络膜和视网膜厚度,观察慢性闭角型青光眼患者与正常人脉络膜、视网膜厚度的差异。方法我们选取2018年12月至2019年12月在我院住院的慢性闭角型青光眼患者(33例60眼)及眼科门诊正常对照组患者,本实验研究分为三组,慢性闭角型青光眼手术治疗组(33例36眼)、慢性闭角型青光眼患者行激光治疗组(24例24眼)、正常对照组(32例45眼)。我们采集每个患者黄斑的图像,保留水平和横断面图像,运用频域光学相干断层扫描仪Cirrus HD OCT,对黄斑区行增强深度扫描(enhanced depth imaging,EDI)。根据采集的图像对黄斑区域视网膜和脉络膜的厚度进行手动测量,共有9个测量位点,分别为黄斑中心凹下和距黄斑中心凹1mm、3mm的鼻侧、颞侧、上方、下方。为保证测量的准确性以及误差最小,对所有数据的测量需进行3次,并取其平均值作为最后的测量值。所有研究的测量工作均为同一位经验丰富医师进行操作。结果1、在脉络膜厚度测量中,黄斑下,距离黄斑上方1mm,鼻侧1mm,下方1mm,颞侧1mm,上方3mm,下方3mm的地方三组脉络膜厚度无显著差异,P>0.05。2、在脉络膜厚度测量中,距离黄斑鼻侧3mm处三组脉络膜厚度有显著差异,P<0.05。CPACG患者手术治疗组脉络膜厚度在距离黄斑鼻侧3mm与激光治疗组相比增厚,差异有统计学意义,P<0.05。手术治疗组脉络膜厚度与正常对照组相比差异无统计学意义,P>0.05。激光治疗组脉络膜厚度与正常对照组相比差异无统计学意义,P>0.05。3、在脉络膜厚度测量中,距离黄斑颞侧3mm三组脉络膜厚度有显著差异,P<0.05。在此处,CPACG患者手术治疗组脉络膜厚度比激光治疗组厚,差异有统计学意义,P<0.05。正常对照组脉络膜厚度比激光治疗组厚,差异有统计学意义,P<0.05。手术治疗组与正常对照组比较差异无统计学意义,P>0.05。4、在视网膜厚度测量中,三组在各个方位视网膜厚度均有显著差异,P<0.05。5、CPACG患者手术治疗组比正常对照组在九个方位测量中视网膜厚度均偏薄,差异有统计学意义,P<0.05。6、CPACG患者手术治疗组与激光治疗组相比,除黄斑区视网膜厚度无显著差异,其余八个方位视网膜厚度均偏薄,差异有统计学意义,P<0.05。7、CPACG患者激光治疗组与正常对照组相比视网膜厚度均无显著差异,P>0.05。结论1、CPACG患者手术治疗组与正常对照组相比黄斑区脉络膜厚度无显著差异。2、CPACG患者手术治疗组脉络膜厚度在距离黄斑鼻侧3mm和颞侧3mm与慢性闭角型青光眼激光治疗组相比增厚,差异有统计学意义。3、CPACG患者手术治疗组比正常对照组黄斑区视网膜厚度偏薄,差异有统计学意义。4、CPACG患者手术治疗组比激光治疗组黄斑区视网膜厚度偏薄,差异有统计学意义。5、CPACG患者激光治疗组与正常对照组相比黄斑区视网膜厚度无显著差异。更多还原

【Abstract】 BackgroundGlaucoma is a multifactorial optic nerve disease.Affected by genetic factors,the immediate relatives of glaucoma patients are at high risk.The rise of intraocular pressure is the direct cause of glaucoma,which can lead to progressive optic nerve injury(mainly optic nerve papilla with sunken atrophy)and visual field defect.When glaucoma is not actively treated and allowed to develop,it will not only cause pain to the patients,affect their vision,and eventually lead to blindness and darkness.The abnormal anatomical structure is the characteristics of angle closure glaucoma patients,but the change of choroidal thickness in chronic angle closure glaucoma is still unclear..PurposeThe thickness of retina and choroid in macular area of patients with chronic angle closure glaucoma was measured by optical coherence tomography(OCT),and the difference of thickness of retina and choroid between patients with chronic angle closure glaucoma and normal people was observed.MethodsFrom December 2018 to December 2019,chronic primary angle closure glaucoma(PACG)patients(hospitalized in our hospital)and normal control group were selected.The experimental study was divided into three groups:chronic PACG surgery eyes(33 cases 36 eyes),chronic PACG patients laser treatment group(24 cases 24 eyes),normal control group(32 cases 45 eyes),frequency domain optical coherence tomography cirrus HD OCT,enhanced depth imaging(EDI)was performed on the macular area to obtain the horizontal and vertical cross-sectional images through the macular fovea,and the thickness of retina and choroidal membrane at nine sites(nose,temporal,upper and lower)of the macular fovea and 1mm and 3mm from the macular fovea were measured manually.All measurements were performed by an experienced physician independently,three times respectively,and the average value was taken as the final reference data.Results1.In the measurement of choroidal thickness between three groups,there was no statistically significant(P > 0.05),sites include: under the macula(SFCT),1mm above the macula(S1CT),1mm from the nose of macula(N1CT),1mmbelow the macula(I1CT),1mm from temporal side of macula(T1CT),3mm above(S3CT)and 3mm below the macula(I3CT).2.In the measurement of choroidal thickness between three groups,there was statistically significant at 3mm of the nose of macula(P < 0.05).The thickness of choroid in the operation group of chronic PACG was thicker at 3mm of the nose of macula than that in the laser group of chronic PACG(P < 0.05).3.In the measurement of choroidal thickness between three groups,there was statistically significant at 3mm of the temporal of macula(P < 0.05).The thickness of choroid in the operation group of chronic PACG was thicker at 3mm of the temporal of macula than that in the laser group of chronic PACG(P <0.05).The thickness of choroid in the control group was thicker at 3mm of the temporal of macula than that in the laser group of chronic PACG(P < 0.05).4.In the measurement of retinal thickness between three groups,there was statistically significant in nine directions(P > 0.05).5.The thickness of retina in the operation group of chronic PACG was thinner than that in the control group in nine directions,the difference was statistically significant(P < 0.05)..6.There was no significant difference in the thickness of retina in the macular area.The other eight directions of chronic angle closure glaucoma patients in the operation group were thinner than those in the laser treatment group,the difference was statistically significant(P < 0.05).7.There was no significant difference in the thickness of retina between the laser treatment group and the control group(P > 0.05).Conclusion1.There was no significant difference in macular choroidal thickness of macular region between the operation group of chronic PACG and the control group.2.The thickness of choroid in the operation group of chronic PACG was thicker than that in the laser treatment group of chronic PACG at 3mm of the nose and temporal of macula,the difference was statistically significant.3.The thickness of macular retina in the operation group of chronic PACG was thinner than that in the control group,the difference was statistically significant.4.The thickness of macular retina in the operation group of chronic PACG was thinner than that in the laser group of chronic PACG.5.There was no significant difference in macular retinal thickness between the laser group of chronic PACG and the control group.更多还原