Application Of Optical Coherence Tomography On Retinal Nerve Fiber Layer In Patients With Glaucoma

Part I: Characteristics of retinal nerve fiber layer in patients with acute angle closure glaucomaObjective: To observe characteristics of retinal nerve fiber layer(RNFL)thickness change in early acute episodes of acute angle closure glaucoma.Methods: 45 patients with single acute episode of acute angle closure glaucoma were collected,and RNFL thickness was measured by optical coherence tomography(OCT)imaging within 2 weeks after acute attack.The data of the attacked eyes were compared with the fellow eyes.The correlation of RNFL thickness with intraocular pressure before treatment,intraocular pressure duration and age was analyzed.Results: Average RNFL and RNFL of each quadrant(superior,inferior,nasal and temporal)of the attacked eyes was thicker than the fellow eyes,and all these differences were statistically significant(P < 0.05).RNFL thickness of the attacked eyes(microns)were: average 118.80 ±38.45,superior 148.67±58.59,inferior 159.8±57.82,nasal89.6±31.37,and temporal 79.47±27.54.RNFL thickness of the fellow eyes(microns)were: average 98.20±16.89,superior 120.13±23.61,inferior 131.6±27.41,nasal74±18.07,and temporal 67.8±13.41.The average RNFL thickness of the attacked eyes was positively correlated with intraocular pressure before treatment(the correlation coefficient was 0.370,P < 0.05)and it was also positively correlated with high intraocular pressure duration(the correlation coefficient was 0.603,P < 0.01).However,it was not correlated with age(the correlation coefficient was 0.317,P > 0.05).Conclusion: After a single acute attack of acute angle closure glaucoma,RNFL edema was obvious,which can last 2 weeks.In addition,the degree of RNFL edema was aggravated by higher intraocular pressure before treatment and longer duration of high intraocular pressure.Part II Characteristics of RNFL in patients with primary open angle glaucomaObjective: To discuss the RNFL in patients with primary open angle glaucoma(POAG),thereby providing effective reference support for early clinical diagnosis.Methods: 28 cases of POAG were recruited in our hospital and the healthy control during the same period was also included to compare the RNFL.Results: The RNFL on superior,inferior,nasal and temporal quadrants and circumferential average in control group was respectively 118.95±18.71μm,127.70±21.42μm,64.48±8.74μm,70.22±13.06μm and 92.03±15.08μm.The RNFL on superior,inferior,nasal and temporal quadrants and circumferential average in early POAG group was respectively 107.98±13.90μm,104.95±12.96μm,57.93±11.38μm,55.08±12.70μm and 76.50±12.07μm.The RNFL on superior,inferior,nasal and temporal quadrants and circumferential average in progressive POAG group was respectively 88.71±10.98μm,81.95±14.41μm,44.79±10.68μm,51.06±10.24μm and72.07±10.19μm.The average thickness of the RNFL and the other RNFL thickness around the optic disc were obviously different except for the average value of the early,the progression and the temporal RNFL thickness(P<0.05).Conclusion: RNFL could be employed as scientific and quantitative index for degree of visual function impairment,which could be helpful for diagnosis,monitoring and identify the disease condition of glaucoma.Part III Characteristics of RNFL change in patients with chronic closure angle glaucomaObjective: The aim of this study was to compare the RNFL on visual disk with OCT modality,thereby providing preventive treatment for glaucoma in clinical practice.Methods: A total of 25 eyes from 22 patients with chronic angle closure glaucoma(CACG)were collected and YAG laser operation and normal trabeculectomy-operation was respectively applied in 7 eyes and 18 eyes.The RNFL on visual disk and macular area was measured by OCT at preoperation and Day3,7,Week 1 and Week 2postoperation.The RNFL data was compared.Results: The average preoperation RNFL on visual disk was 66.22±26.26 μm,which showed no significant difference when comparing with Day 1(65.70±27.13 μm,P=0.64)and Day 3(72.26±26.67 μm,P=0.12)postoperation,but significantly difference when compared Week 1(75.70±28.11 μm,P=0.04)and Week 2 postoperation(78.28±28.65μm,P=0.008).Conclusion: Significantly changes on RNFL in visual disk could be observed in patients with CACG after operation.