Application Research Of Retinal Nerve Fiber Layer Thickness And Macular Retinal Thickness In The Diagnosis Of Glaucoma

Objective: To obtain the difference among the thickness of circumpapillary retinal never fiber layer(cpRNFL),macular retinal nerve fiber layer(mRNFL),macular ganglion cell layer(m GCL)and macular inner plexiform layer(mIPL)in healthy men,patients with early glaucoma,and patients with glaucoma evolutum using Germany Heidelberg frequency domain optical coherence tomography(Spectralis optical coherence tomography,Spectralis OCT),and then explore the value of these parameters in the diagnosis of glaucoma.Methods: A cross-sectional study method was used in this study.According to inclusion and exclusion criteria,a total of 53 cases(90 eyes)was collected from March2015 to December 2015,which came from ophthalmology clinic patients in the First Affiliated Hospital of Dalian Medical University,normal volunteers and the hospital staff,and then were divided into three groups:18 cases(36 eyes)in the Normal group,which included 6 cases(12 eyes)of male,12 cases(24 eyes)of female,and aged26-80(54.6 + 15.5);18 cases(29 eyes)of patients in the Early Glaucoma group,which included 7 cases(11 eyes)of male,11 cases(18 eyes)of female,and aged 29-84(54.6 +14.1);17 cases(25 eyes)of patients in the Glaucoma Evolutum group,which included 6cases(9 eyes)of male,11 cases(16 eyes)of female,and aged 29-81(60.0 + 13.8).Differences on gender and age composition ratio between Three groups was no statistical significance(P>0.05).All research subjects accepted systematical eye examinations,including the best corrected visual acuity(BCVA),computeroptometry,tonometry,slit-lamp examination,gonioscopy,A-scan for corneal thickness measurement,fundus photography,Humphrey vision inspection and Spectralis OCT examination,etc.When used Spectralis OCT to check all the research subjects,the Glaucoma mode(Glaucoma)depending on the nipple surrounding retinal optic fiber(RNFL)and posterior pole of the retina(P.P OLE)scanning were choosed.RNFL scanning provided seven parameters: temporal,supratemporal,subtemporal,nasal,supranasal,subnasal and the average cpRNFL thickness.P.P OLE scanning provided 12parameters: superior,inferior,nasal,temporal mRNFL,mGCL,mIPL.Comparing the differences of those parameters between three groups,using the area under the receiver-operating characteristic curve(AROC)analysis diagnostic ability of each parameter.Difference is statistically significant(P<0.05).Results: Comparing cpRNFL thickness between groups,temporal,supratemporal,subtemporal,supranasal,subnasal and the average cpRNFL thickness is statistical significance(P < 0.05)between three groups;Nasal cpRNFL thickness between the Normal group and the Glaucoma Evolutum group,the Early Glaucoma group and the Glaucoma Evolutum group has statistical significance(P < 0.05),while there is no statistically significant difference compared the Normal group with the Early Glaucoma group(P = 0.189).Comparing mRNFL thickness between groups,inferior mRNFL thickness between three groups showing statistical significance(P < 0.05),while temporal mRNFL thickness has no statistical significance(P = 0.989,0.646,0.289);superior mRNFL thickness between the Normal group and the Early Glaucoma group,between the Normal group and the Glaucoma Evolutum group has statistical significance(P < 0.05),but difference between the Early Glaucoma group and the Glaucoma Evolutum group has no statistical significance(P = 0.059);nasal mRNFL thickness between the Normal group and the Glaucoma Evolutum group,the Early Glaucoma group and the Glaucoma Evolutum group has statistical significance(P < 0.05),while in the Normal group there is no statistically significant difference compared with the Early Glaucoma group(P =0.066).Comparing mGCL thickness between groups,inferior,nasal and temporal mGCL thickness between three groups have statistical significance(P < 0.05);superior mGCL thickness between the Normal group and the Early Glaucoma group,comparing differences between the Normal group and the Glaucoma Evolutum group has statistical significance(P < 0.05),while comparing differences between the Early Glaucoma group and the Glaucoma Evolutum group has no statistical significance(P = 0.093).Comparing mIPL thickness between groups,among the three groups inferior and temporal mIPL thickness have statistical significance(P < 0.05);superior mIPL thickness between the Normal group and the Early Glaucoma group,the Normal group and the Glaucoma Evolutum group has statistically significant(P < 0.05),while in the Early group comparing differences between the Glaucoma Evolutum group has no statistical significance(P = 0.329);and nasal mIPL thickness between the Normal group and the Early Glaucoma group has statistical significance(P < 0.05),between the Normal group and the Glaucoma Evolutum group,the Early Glaucoma group and the Glaucoma Evolutum group has no statistical significance(P = 0.757,0.668).AROC between the Normal group and the Early Glaucoma group: supratemporal cpRNFL thickness AROC values is the biggest(0.830),followed by inferior mIPL thickness(0.818),average cpRNFL thickness(0.814),inferior m GCL thickness(0.786)and nasal m IPL thickness(0.778).Corresponding sensitivity: supratemporal cpRNFL thickness(0.586)> average cpRNFL thickness(0.552)> inferior mGCL thickness(0.414)> inferior mIPL thickness(0.379)> nasal mIPL thickness(0.379).AROC between the Normal group and the Glaucoma Evolutum group: average cpRNFL thickness AROC values is the biggest(0.974),followed by subtemporal cpRNFL thickness(0.958),superatemporal cpRNFL thickness(0.956),subnasal cpRNFL thickness(0.936)and inferior mIPL thickness(0.932).Corresponding sensitivity: average cpRNFL thickness(0.960)> subtemporal cpRNFL thickness(0.920)> supratemporal cpRNFL thickness(0.880)> subnasal cpRNFL thickness(0.760)> inferior mIPL thickness(0.640).Conclusion: 1.cpRNFL thickness has the advantage in the diagnosis of glaucoma,especially supratemporal and average cpRNFL thickness2.The thickness of mRNFL,mGCL and mIPL in glaucoma patients has partical thinning,while for the early diagnosis of glaucoma,detection of mIPL thickness is more sensitive than mGCL and mRNFL thickness,can be used as a supplementary diagnostic means;3.The apoptosis of retinal ganglion cell and the loss of retinal nerve fiber have been confirmed in the pathologic of glaucoma,but the change of inner plexiform layer is worth further research and discussion.