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海德堡视网膜断层扫描仪动态图与眼底立体像对青光眼性视神经损害判断的一致性研究

The consistency between heidelberg retina tomography dynamic image and fundus stereoscopic image in the diagnosis of glaucomatous optic nerve damage
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摘要 目的比较海德堡视网膜断层扫描仪(HRT)动态图和眼底立体像获得的视盘及周边神经纤维层(RNFL)形态的参数,评价两者的一致性,并探讨利用动态图对HRT结果进行定性判断的可能性。方法比较同时接受HRT和眼底立体像检查患者的HRT动态图和立体像所测盘沿宽度、视盘宽度、两者发现上下方盘沿小于鼻侧盘沿、RNFL存在缺损眼的数量。所有入选患者先接受HRT再行眼底立体像检查。采用配对t检验和一元线性回归分析比较两者测量的盘沿宽度是否具有相关性,用Kappa检验比较两者在判断是否存在青光眼性损伤上是否一致。结果共有26例(52只眼)患者入选,年龄(39.5±12.3)岁。HRT动态图所测上方及下方盘沿较立体像所测值高(t上方=4.65,t下方=5.98,P<0.001),但两者具有较好的相关性(r上方=0.84,r下方=0.82,P<0.001)。两者在定性判断视盘是否存在青光眼性改变上也有较好的一致性。在发现上、下方盘沿是否小于鼻侧盘沿、RNFL是否存在缺损三个问题上,两种方法的Kappa值分别为0.662、0.574和0.809(P<0.001)。结论利用HRT动态图对盘沿及RNFL是否出现青光眼性损伤进行定性判断与立体像有较好的一致性。利用其可对是否存在青光眼性视神经损害进行定性判断,有助于弥补由于测量参数重叠造成的定量诊断的不足。 Objective To investigate the consistency between HRT dynamic image and fundus stereoscopic image in diagnosing glaucomatous optic nerve damage, by comparing the data of optic disc and surrounding RNFL shape obtained from these images; and discuss the possibility of qualitative analysis of HRT results by using dynamic image. Methods All patients received HRT followed by fundus stereoscopic imaging. The rim width,disc width and the number of superior and inferior rims smaller than nasal rim and eyes with RNFL lesions were compared between HRT dynamic image and fundus stereoscopic image. The correlation of rim width obtained from both images was analyzed by paired t-test and unitary linear correlation analysis, and the consistency in diagnosing glaucomatous damage was determined by Kappa test. Results A total of 43 patients( 86 eyes) were included,with an average age of 39. 5 ± 12. 3 years. The superior and inferior rim widths measured by HRT dynamic image were wider than those obtained from stereoscopic image( tsup= 4. 65,t inf = 5. 98,P < 0. 001),but a good correlation was shown between the two images( r sup = 0. 84,r inf = 0. 82,P < 0. 001). And a good consistency in qualitative diagnosis of glaucomatous changes in optic disc was also demonstrated between the two images. The Kappa values were 0. 662 and 0. 574 for the identification of superior and inferior rims smaller than nasal rim,and 0. 809 for the identification of RNFL lesions( P < 0. 001). Conclusion HRT dynamic image and stereoscope image have a good consistency in qualitative diagnosis of glaucomatous lesions in rim and RNFL. This allows qualitative diagnosis of glaucomatous optic nerve damage,which can help to make up the deficiency of quantitative diagnosis due to the overlapping values of measured parameters.
出处 《中华眼科医学杂志(电子版)》 2011年第1期31-39,共9页 Chinese Journal of Ophthalmologic Medicine(Electronic Edition)
关键词 青光眼 视神经损伤 海德堡视网膜断层扫描仪 Glaucoma Optic nerve damage Heidelberg retina tomography
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