脑肿瘤所致视交叉受压时神经节细胞复合体的丧失
Ganglion Cell Complex Loss in Chiasmal Compression by Brain Tumors.
作者信息
Tieger Marisa G, Hedges Thomas R, Ho Joseph, Erlich-Malona Natalie K, Vuong Laurel N, Athappilly Geetha K, Mendoza-Santiesteban Carlos E
机构信息
New England Eye Center (MG, TRH, JH, NE, LNV, GKA, CEM), Tufts Medical Center, School of Medicine, Tufts University, Boston, MassachusettsDysautonomia Center (CEM), NYU Langone Medical Center, Schools of Medicine, New York University, New York, New York.
出版信息
J Neuroophthalmol. 2017 Mar;37(1):7-12. doi: 10.1097/WNO.0000000000000424.
BACKGROUND
Patterns of ganglion cell complex (GCC) loss detected by optical coherence tomography provide an objective measure of optic nerve injury. These patterns aid in early diagnosis and localization of chiasmal lesions.
METHODS
Twenty-three patients with chiasmal compression seen between 2010 and 2015 were imaged with the Cirrus high-definition optical coherence tomography macular cube 512 × 128, retinal nerve fiber layer (RNFL) scan protocols and automated (30-2 Humphrey) visual fields (VFs). Age-matched controls were included for comparison. Generalized estimating equations were performed comparing RNFL and GCC thicknesses between patients and their controls. Effect size (d) was calculated to assess the magnitude of difference between patients and controls. The average GCC and RNFL thicknesses also were correlated with VF mean deviation (MD). Pre operative average GCC thickness was correlated to post operative VF MD.
RESULTS
Patterns of GCC thinning corresponded to VF defects. The average GCC thickness was 67 ± 9 μm in patients and 86 ± 5 μm in controls (P < 0.001). The effect size was the greatest for GCC thickness (d = 2.72). The mean deviation was better correlated with GCC thickness (r =0.25) than RNFL thicknesses (r =0.15). Postoperatively, VF MD improved in 7 of 8 patients with persistent nasal GCC thinning. Six patients had no VF defect and showed statistically significant loss of GCC compared with controls (P = 0.001).
CONCLUSIONS
Distinct patterns of GCC loss were identified in patients with chiasmal compression. Binasal GCC loss was typical and could be seen with minimal or no detectable VF loss. Thinning of the GCC may be detected before loss of the RNFL in some patients. After decompression, the majority of patients showed improvement in VF despite persistent GCC loss. Patients with less GCC loss before decompression had better postoperative VFs. Therefore, GCC analysis may be an objective method to diagnose and follow patients with chiasmal lesions.
背景
光学相干断层扫描检测到的神经节细胞复合体（GCC）丢失模式为视神经损伤提供了一种客观的测量方法。这些模式有助于交叉病变的早期诊断和定位。
方法
对2010年至2015年间就诊的23例交叉受压患者进行了Cirrus高清光学相干断层扫描黄斑立方体512×128成像、视网膜神经纤维层（RNFL）扫描方案和自动（30-2 Humphrey）视野（VF）检查。纳入年龄匹配的对照组进行比较。采用广义估计方程比较患者及其对照组之间的RNFL和GCC厚度。计算效应量（d）以评估患者与对照组之间差异的大小。平均GCC和RNFL厚度也与VF平均偏差（MD）相关。术前平均GCC厚度与术后VF MD相关。
结果
GCC变薄模式与VF缺陷相对应。患者的平均GCC厚度为67±9μm，对照组为86±5μm（P<0.001）。GCC厚度的效应量最大（d=2.72）。平均偏差与GCC厚度（r=0.25）的相关性优于与RNFL厚度（r=0.15）的相关性。术后，8例持续性鼻侧GCC变薄患者中有7例VF MD改善。6例患者无VF缺陷，但与对照组相比，GCC有统计学意义的丢失（P=0.001）。
结论
在交叉受压患者中发现了不同的GCC丢失模式。双侧鼻侧GCC丢失是典型的，在VF丢失极少或未检测到VF丢失的情况下也可出现。在一些患者中，GCC变薄可能在RNFL丢失之前被检测到。减压后，大多数患者尽管GCC持续丢失，但VF仍有改善。减压前GCC丢失较少的患者术后VF较好。因此，GCC分析可能是诊断和随访交叉病变患者的一种客观方法。
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