關(guān)新輝，李　麗，梁　勇

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OCT-GPA技術(shù)在監(jiān)測原發(fā)性開角型青光眼進(jìn)展中的作用

關(guān)新輝，李麗，梁勇

Department of Ophthalmology, the Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China

Correspondence to:Yong Liang. Department of Ophthalmology, the Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China. iohey@163.com

Abstract

?AIM:To evaluate the ability of Cirrus spectral domain optical coherence tomography (SD-OCT)-guided progression analysis (GPA) software to detect glaucomatous progression in primary open angle glaucoma (POAG) patients.

?METHODS:Longitudinal study. The study examined 45 eyes of 36 patients with POAG over a 2y period. All eyes underwent at least four serial retinal nerve fiber layer (RNFL) thickness measurements performed by Cirrus OCT, with the first and last measurement separated by at least 2y. Visual field (VF) testing was performed by using the Swedish interactive threshold algorithm (SITA) Standard 30-2 program of the Humphrey field analyzer within the same week as the optic disc/RNFL photography. Serial RNFL thickness were assessed by the GPA software program. Glaucomatous eyes were classified as either early or advanced stage according to VF severity. At the same time each eye was labeled with status of RNFL (diffuse RNFL defect; localized RNFL defect; no RNFL defect; unidentifiable RNFL status) based on baseline RNFL photographs. Reference standard of glaucoma progression was defined by expert assessment of optic disc/RNFL photographs or VF data. Sensitivity and specificity of OCT GPA, as well as agreement between OCT GPA findings and each reference standard data were estimated.

?RESULTS: Eighteen eyes showed progression by optic disc/RNFL photographs or VF data, while 15 eyes by OCT GPA. When expert assessment of optic disc/RNFL photographs and VF data was used as the reference standard, the sensitivity and specificity of OCT GPA employed to detect glaucoma progression were 38.9% and 70.4%. Agreement between OCT GPA and either optic disc/RNFL photographic evaluation or VF analysis was poor (к=0.211, -0.036 respectively). When expert assessment of optic disc/RNFL photographs was used as the reference standard, 6 eyes were detected progression only by photographs, 2 eyes showed a new disc hemorrhage while 4 eyes with optic disc rim thinning. Among 9 eyes processed only by OCT GPA, 8 eyes were in early stage of POAG, of which 5 eyes had a diffuse RNFL defect and 2 eyes with no RNFL defect at baseline. VF analysis used as the reference standard, 7 eyes were detected progression only by VF testing, of which 5 eyes in advanced stage of POAG. Twelve eyes were processed only by OCT GPA, of which 10 in early stage of POAG.

?CONCLUSION:The Cirrus OCT GPA is more sensitive in eyes with a diffuse RNFL defect and may be useful for progression detection in earlier stage of glaucoma to complement other reference standard strategies.

目的：探討頻域光學(xué)相干斷層掃描(spectral-domain optical coherence tomography，SD-OCT)的青光眼進(jìn)展引導(dǎo)分析(guided progression analysis，GPA)技術(shù)在判斷原發(fā)性開角型青光眼(primary open angle glaucoma，POAG)進(jìn)展中的作用。

方法：隨訪36例45眼POAG患者2a，行視盤OCT、眼底照相及視野檢查，至少有4次可信的OCT檢查結(jié)果。根據(jù)視野結(jié)果將受試者劃分為早期和中晚期。根據(jù)基線眼底照相判斷視網(wǎng)膜神經(jīng)纖維層(retinal nerve fiber layer，RNFL)情況(彌漫RNFL缺損、局限缺損、無缺損及無法判斷缺損者)。由兩位青光眼專家根據(jù)眼底照相及視野結(jié)果將其分為進(jìn)展型及非進(jìn)展型。分析OCT-GPA技術(shù)同視野、眼底照相判斷的一致性，計(jì)算靈敏度及特異度。

結(jié)果：眼底照相或視野判斷為POAG進(jìn)展者18眼(40%)，OCT-GPA判斷POAG進(jìn)展者15眼(33%)。以眼底照相及視野判斷為標(biāo)準(zhǔn)，OCT-GPA技術(shù)的靈敏度和特異度為38.9%和70.4%。OCT-GPA同眼底照相及視野判斷結(jié)果的一致性較差(к=0.211、-0.036)。以眼底照相為標(biāo)準(zhǔn)，僅眼底照相判斷進(jìn)展者6眼，2眼為新的盤周出血，4眼為盤沿變窄；僅OCT-GPA判斷為進(jìn)展者9眼，8眼為早期，其中5眼基線眼底照相提示彌漫性RNFL缺損，2眼無明顯RNFL缺損。以視野為判斷標(biāo)準(zhǔn)，僅視野判斷進(jìn)展者7眼，5眼為中晚期；僅OCT-GPA判斷進(jìn)展者12眼，10眼為早期。

結(jié)論：OCT-GPA在判斷早期POAG進(jìn)展及彌漫性RNFL缺損上有一定優(yōu)勢，但最好聯(lián)合視野及眼底照相檢查共同判斷。

光學(xué)相干斷層掃描；原發(fā)性開角型青光眼；青光眼進(jìn)展分析；眼底照相

引用：關(guān)新輝，李麗，梁勇. OCT-GPA技術(shù)在監(jiān)測原發(fā)性開角型青光眼進(jìn)展中的作用.國際眼科雜志2016;16(9):1687-1691

0引言

原發(fā)性開角型青光眼是一組具有特征性視網(wǎng)膜神經(jīng)纖維損害和視野缺損的進(jìn)行性致盲性眼病。起病及進(jìn)展隱匿，損害多不可逆，有效的病情監(jiān)測對原發(fā)性開角型青光眼(primary open angle glaucoma，POAG)患者管理極為重要。全面準(zhǔn)確判斷POAG進(jìn)展情況應(yīng)同時(shí)行結(jié)構(gòu)性及功能性檢查[1]。視野是目前較公認(rèn)的功能性判斷指標(biāo)，許多大型多中心青光眼臨床試驗(yàn)均以此為標(biāo)準(zhǔn)[2-4]，但其有一定的滯后性、主觀性及波動性。眼底照相為結(jié)構(gòu)性定性判斷，專家意見亦可存在較明顯的差異[5-6]。目前尚無判斷青光眼進(jìn)展的結(jié)構(gòu)性金標(biāo)準(zhǔn)。光學(xué)相干斷層掃描作為一種非接觸性、非侵入性、高分辨率的生物組織結(jié)構(gòu)顯像技術(shù)，已成為青光眼眼底結(jié)構(gòu)客觀定量檢測的重要方法[7-10]。文獻(xiàn)報(bào)道其不僅有助于POAG的早期診斷，更可用于監(jiān)測青光眼進(jìn)展[11-17]。光學(xué)相干斷層掃描成像青光眼進(jìn)展引導(dǎo)分析技術(shù)(optical coherence tomography-guided progression analysis，OCT-GPA)技術(shù)通過追蹤視網(wǎng)膜神經(jīng)纖維層(retinal nerve fiber layer，RNFL)厚度序列變化，自動排列比較基線及隨訪圖像，像素比對，提供可視化的RNFL變化區(qū)域及RNFL厚度變化數(shù)值，從而判斷青光眼進(jìn)展情況。

目前對OCT-GPA判斷青光眼進(jìn)展診斷效能的相關(guān)文獻(xiàn)報(bào)道較少，本研究擬對POAG患者隨訪視盤OCT，利用OCT-GPA技術(shù)判斷進(jìn)展情況，以視野及眼底照相判斷結(jié)果為標(biāo)準(zhǔn)，計(jì)算OCT-GPA技術(shù)的靈敏度及特異度，評價(jià)其診斷效能及分析優(yōu)劣勢。

1對象和方法

1.1對象縱向研究。選取2013-01/2015-08我院眼科門診就診并確診的36例45眼POAG患者。此項(xiàng)研究遵循赫爾辛基宣言中的倫理學(xué)標(biāo)準(zhǔn)，并經(jīng)醫(yī)院臨床研究倫理委員會同意，所有參與者均為自愿，對檢測予以認(rèn)可并簽署了知情同意書。所有POAG患者均進(jìn)行了全面的眼科檢查，包括視力、非接觸性眼壓、裂隙燈及前置鏡下眼底檢查、屈光度、前房角檢查。POAG診斷標(biāo)準(zhǔn)：(1)至少2次眼壓>21mmHg(1mmHg=0.133kPa)；(2)房角鏡檢查前房角開放；(3)青光眼性視乳頭損害和/或視網(wǎng)膜神經(jīng)纖維層缺損；(4)青光眼性視野缺損。具有(1)、(2)項(xiàng)與(3)或(4)方可診斷成立。納入標(biāo)準(zhǔn)為：最佳矯正視力不低于0.5，球鏡-6.00～+3.00D，無可能影響視網(wǎng)膜的全身及眼部其他疾患，1a內(nèi)無眼部手術(shù)及眼內(nèi)激光史。采用Hodapp等1993年建議的HPA國際視野分期法分期，將受試者分為早期及中晚期。早期包括初期和早期POAG，中晚期包括中期和晚期POAG。所有POAG患者治療方案均參見《我國原發(fā)性青光眼診斷和治療專家共識(2014年)》，隨訪期間均為藥物治療調(diào)整，無接受手術(shù)及激光者。

1.2方法受試者均行視盤眼底照相、Humphrey視野(中心30-2程序)及視盤OCT(Cirrus HD-OCT，Carl Zeiss Meditec，Dublin，CA)檢查，各項(xiàng)檢查間隔時(shí)間在1wk內(nèi)，隨訪2a，OCT至少有4次可信結(jié)果。

1.2.1眼底照相眼底照相為對視盤20°范圍照相及RNFL 45°范圍無赤光照相。在患眼散瞳后，由技術(shù)熟練的同一技師采用眼底彩色照相機(jī)獲取。兩位青光眼專家采用雙盲法獨(dú)立評估基線眼底照相，將受試者分為彌漫性RNFL缺損、局限楔狀缺損、無明顯RNFL缺損及不確定RNFL缺損者。彌漫及局限楔狀缺損混合者劃為彌漫性缺損。不確定RNFL缺損多因?yàn)楸P周色素沉著及絕對期青光眼。兩位青光眼專家采用雙盲法獨(dú)立評估2a內(nèi)眼底照相結(jié)果，判斷青光眼進(jìn)展與否及注明判斷依據(jù)。當(dāng)意見不一致時(shí)，以第三位青光眼專家判斷為準(zhǔn)。眼底照相中盤沿變窄、RNFL缺損增寬加深或出現(xiàn)新的RNFL缺損、新的盤周出血判定為青光眼進(jìn)展[18-20]。

1.2.2視野視野采用Humphery自動視野計(jì)，中心30-2程序。所有受試者均有兩次以上視野檢查經(jīng)驗(yàn)，第1次正式檢查，至少行3次檢查，每次間隔至少30min，取最近一次檢查的視野結(jié)果。各次視野檢查均在相同條件下由同一視野師進(jìn)行操作。符合以下條件認(rèn)為視野結(jié)果可信：注視丟失<20%、假陽性率和假陰性率<30%；視野缺損的位置和視盤損害的位置相對應(yīng)。兩位青光眼專家采用雙盲法獨(dú)立評估2a內(nèi)視野結(jié)果，判斷青光眼進(jìn)展情況。意見不一致時(shí)以第3位青光眼專家判斷為準(zhǔn)。視野進(jìn)展標(biāo)準(zhǔn)：(1)基線暗點(diǎn)范圍內(nèi)兩個(gè)或兩個(gè)以上的暗點(diǎn)加深10dB；(2)暗點(diǎn)擴(kuò)大：兩個(gè)或兩個(gè)以上加深10dB的位點(diǎn)與基線暗點(diǎn)相連；(3)出現(xiàn)新的暗點(diǎn)：基線暗點(diǎn)范圍內(nèi)或者與基線暗點(diǎn)相鄰的兩個(gè)或更多位點(diǎn)出現(xiàn)缺損，其模式偏差概率P值=1%；或者視野中心10°內(nèi)之前正常的位點(diǎn)敏感度下降10dB。以上改變，在同一位點(diǎn)至少有一種改變在以后兩次或三次連續(xù)隨訪視野結(jié)果中出現(xiàn)，則認(rèn)為青光眼可能或極可能進(jìn)展[21]。

1.2.3視盤OCT檢查所有受試者均進(jìn)行Cirrus HD-OCT檢查。掃描模式為“optic disc cube mode”，為6mm×6mm×2mm立體掃描，分析計(jì)算直徑3.46mm圓周上的RNFL平均、象限及鐘點(diǎn)厚度。信號強(qiáng)度≥5并無眨眼、頭位等引起假陽性結(jié)果等認(rèn)為結(jié)果可信。均進(jìn)行GPA分析。各次檢查均在同一條件下由同一熟練技師操作。GPA分析時(shí)要求核對眼別、采用可信結(jié)果比較。Cirrus SD-OCT GPA技術(shù)分析內(nèi)容包括視網(wǎng)膜神經(jīng)纖維層厚度地圖(RNFL thickness maps)、神經(jīng)纖維層厚度散點(diǎn)圖(RNFL thickness value)及神經(jīng)纖維層厚度折線圖(RNFL thickness profiles)，見圖1。本研究中可能進(jìn)展(Possible Progression)和極可能進(jìn)展(Likely Progression)均視為青光眼進(jìn)展。

圖1Cirrus HD-OCT RNFL GPA隨訪報(bào)告A：視網(wǎng)膜神經(jīng)纖維層厚度地圖；B：神經(jīng)纖維層厚度散點(diǎn)圖；C：神經(jīng)纖維層厚度折線圖。

表1受試者一般情況

參數(shù)總數(shù)早期中晚期眼數(shù)452916進(jìn)展眼數(shù)1899年齡(x±s,歲)63.7±14.165.3±13.861.0±15.6球鏡度數(shù)(x±s,D)-0.9±2.2-0.7±2.0-1.3±2.6OCT信號強(qiáng)度(x±s)7.2±0.77.1±0.57.4±0.9平均MD(x±s,dB)-7.5±5.6-3.8±2.3-11.9±7.2平均PSD(x±s,dB)±6.01.8±0.512.3±3.9基線平均RNFL厚度(x±s,μm)71.3±18.978.0±15.361.3±16.5基線平均RNFL厚度(進(jìn)展型,x±s,μm)68.9±15.277.5±14.960.2±13.1基線平均RNFL厚度(非進(jìn)展型,x±s,μm)72.1±16.778.9±16.162.8±17.12a后平均RNFL厚度(x±s,μm)70.2±16.375.8±14.859.1±18.42a后平均RNFL厚度(進(jìn)展型,x±s,μm)66.9±17.474.1±16.758.7±15.42a后平均RNFL厚度(非進(jìn)展型,x±s,μm)71.6±16.576.8±15.860.1±18.3

統(tǒng)計(jì)學(xué)分析：采用SPSS 22.0統(tǒng)計(jì)軟件，以眼底照相和/或視野判斷青光眼進(jìn)展為標(biāo)準(zhǔn)，對OCT-GPA判斷數(shù)據(jù)進(jìn)行配對卡方檢驗(yàn)，計(jì)算OCT-GPA技術(shù)靈敏度、特異度及Kappa值。以P≤0.05為差異具有統(tǒng)計(jì)學(xué)意義。

2結(jié)果

2.1受試者一般情況本研究共36例45眼受試者，女20例20眼(44%)，平均隨訪2.1±0.3a，平均間隔時(shí)間為0.62(0.60～0.68)a，見表1。

2.2眼底照相/視野判斷POAG進(jìn)展情況患者18眼被判斷為青光眼進(jìn)展，其中早期9眼、中晚期9眼。早期組中，眼底照相判斷者8眼，視野判斷者4眼，兩者一致者3眼。中晚期組中，眼底照相判斷者4眼，視野判斷者6眼，兩者一致者1眼。

表2各組受試者基線信息

檢查判斷進(jìn)展情況僅OCT-GPA僅視野和/或眼底照相tP眼數(shù)811年齡(x±s,歲)64.8±14.562.7±14.20.3040.765球鏡度數(shù)(x±s,D)-1.0±0.5-1.2±1.10.4370.668OCT信號強(qiáng)度(x±s)7.2±0.47.3±0.8-0.3000.768平均MD(x±s,dB)-4.8±2.6-10.0±5.12.7010.015平均PSD(x±s,dB)3.8±3.68.3±4.5-2.3420.032平均RNFL厚度(x±s,μm)76.4±11.562.4±9.92.8490.011

表3OCT-GPA技術(shù)和不同判斷標(biāo)準(zhǔn)的一致性分析

OCT-GPA技術(shù)眼底照相視野眼底照相及視野靈敏度50.0%30.0%38.9%特異度72.7%65.7%70.4%χ21.1510.0000.104P0.2831.0000.747κ值(SE)0.211(0.152)-0.036(0.141)0.095(0.149)早期κ值(SE)0.253(0.177)0.054(0.147)0.336(0.176)中晚期κ值(SE)0.091(0.262)-0.037(0.220)-0.159(0.187)

圖2眼底照相/視野和OCT-GPA判斷POAG進(jìn)展情況A：眼底照相與GPA判斷POAG進(jìn)展一致性分布情況；B：視野與GPA判斷POAG進(jìn)展一致性分布情況；C：眼底照相、視野與GPA判斷POAG進(jìn)展一致性分布情況。

2.3 OCT-GPA判斷POAG進(jìn)展情況OCT-GPA共判斷15眼為青光眼進(jìn)展，其中早期12眼、中晚期3眼。同眼底照相及視野結(jié)果一致性詳見圖2。26眼被至少3種檢查中的一種判斷為青光眼進(jìn)展。8眼僅OCT-GPA判斷為進(jìn)展，11眼僅視野和/或眼底照相判斷進(jìn)展，9眼被3種檢查中至少2種判斷為進(jìn)展。其各組基線信息見表2。僅由眼底照相和/或視野判斷進(jìn)展的受試者基線視功能情況更差。

2.4 OCT-GPA同視野、眼底照相一致性分析以眼底照相及視野結(jié)果為判斷標(biāo)準(zhǔn)，OCT-GPA技術(shù)總體判斷POAG進(jìn)展的靈敏度、特異度分別為38.9%和70.40%，Kappa值為0.095，一致性差。單項(xiàng)檢查為判斷標(biāo)準(zhǔn)，OCT-GPA同眼底照相早期組一致性最佳(κ值=0.253)。OCT-GPA技術(shù)和不同判斷標(biāo)準(zhǔn)的一致性詳見表3。

3討論

青光眼病理損害基礎(chǔ)是視網(wǎng)膜神經(jīng)節(jié)細(xì)胞及其軸突(神經(jīng)纖維)的進(jìn)行性損害，通常表現(xiàn)為視盤形態(tài)和RNFL厚度的改變[22]。當(dāng)視網(wǎng)膜神經(jīng)節(jié)細(xì)胞凋亡達(dá)到30%以上，方出現(xiàn)臨床上可以檢測到的視野缺損[23]。青光眼進(jìn)展可以是結(jié)構(gòu)性和(或)功能性的改變[24]。SD-OCT因其更快的掃描速率、更高的分辨率及眼球追蹤技術(shù)，檢查結(jié)果有較好的可重復(fù)性，目前正越來越多地被應(yīng)用于青光眼診斷和病情進(jìn)展監(jiān)測[25]。Cirrus HD-OCT GPA技術(shù)是2009年引入配置，通過追蹤RNFL序列變化，自動排列比較基線及隨訪圖像，像素比對，提供可視化的RNFL變化區(qū)域及RNFL厚度變化數(shù)值，從而判斷青光眼進(jìn)展情況[25]。

本組研究中，分別以眼底照相、視野、眼底照相及視野為參考標(biāo)準(zhǔn)，三組P值均大于0.05，提示OCT-GPA技術(shù)同視野及眼底照相判斷POAG進(jìn)展檢出率無顯著性差異。OCT-GPA同眼底照相、視野之間一致性均較差(κ值=0.211、-0.036)。進(jìn)一步亞型分析中，單項(xiàng)檢查為判斷標(biāo)準(zhǔn)，OCT-GPA同眼底照相早期組一致性最佳(κ值=0.253)，而僅由眼底照相或視野判斷進(jìn)展的受試者基線視功能情況更差。

以眼底照相為判斷標(biāo)準(zhǔn)，僅眼底照相判斷進(jìn)展者6眼，2眼為新的盤周出血，4眼為盤沿變窄?？紤]盤周出血，OCT-GPA無法識別，同時(shí)出血引起神經(jīng)纖維層水腫，反而出現(xiàn)RNFL厚度增厚，故OCT-GPA判斷為假陰性。4眼盤沿變窄，其中3眼為中晚期，OCT-GPA均未能識別，考慮同中晚期RNFL厚度已明顯變薄，盤沿變窄，RNFL厚度變化未能讓OCT-GPA識別可能。提示OCT-GPA技術(shù)在中晚期POAG盤沿變化方面識別度較差。Jong等應(yīng)用Cirrus SD-OCT GPA發(fā)現(xiàn)其對于視盤形態(tài)改變靈敏度低，分析同其側(cè)重RNFL厚度測量相關(guān)[26]，本研究結(jié)果符合其發(fā)現(xiàn)。同時(shí)，僅OCT-GPA判斷為進(jìn)展者9眼，1眼為中晚期，其基線眼底照相為不確定RNFL缺損者，因絕對期青光眼無法判斷RNFL缺損。8眼為早期，其中5眼基線眼底照相提示為彌漫性RNFL缺損，2眼無明顯RNFL缺損。考慮可能因彌漫性RNFL缺損，眼底照相不易判斷，而OCT在測量RNFL厚度方面有定量優(yōu)勢，推測OCT-GPA在判斷早期彌漫性RNFL缺損類型的POAG進(jìn)展方面有一定優(yōu)勢，但上述病例仍需較長時(shí)間大樣本觀察，也不排除OCT-GPA假陽性可能。6眼眼底照相及OCT-GPA判斷一致，其中5眼為早期，提示OCT-GPA可能在判斷早期POAG進(jìn)展上有一定優(yōu)勢。

以視野為判斷標(biāo)準(zhǔn)，僅視野判斷進(jìn)展者7眼，5眼為中晚期，考慮可能因中晚期RNFL厚度已明顯變薄，即使出現(xiàn)陽性的視野惡化，RNFL厚度改變?nèi)圆蛔阋员籓CT-GPA識別可能，該表現(xiàn)也同OCT-GPA對中晚期POAG盤沿變化識別度欠佳相一致。同時(shí)，僅OCT-GPA判斷進(jìn)展者12眼，10眼為早期。考慮同OCT更易識別RNFL厚度，即使尚未出現(xiàn)明顯可檢測出的視野改變，而OCT-GPA提前監(jiān)測到RNFL厚度改變。同時(shí)并不排除OCT-GPA假陽性可能，尚需更長時(shí)間大樣本隨訪評估。

另有病例報(bào)道[27]，2例病例進(jìn)行OCT-GPA分析中，1例隨訪分析圖像中出現(xiàn)了對側(cè)眼圖像，另1例出現(xiàn)了其他患者的眼底圖像，而這2例均未發(fā)現(xiàn)明顯硬件及操作問題。本組研究中未出現(xiàn)眼別匹配錯(cuò)誤。本研究的局限在于受試者數(shù)量較少，隨訪時(shí)間短，許多推斷尚需大樣本和長期臨床研究的評價(jià)結(jié)果。

綜上所述，本研究提示OCT-GPA技術(shù)更易判斷早期POAG進(jìn)展，對中晚期POAG進(jìn)展識別欠佳。判斷彌漫性RNFL缺損、不確定RNFL缺損變化上有一定優(yōu)勢，對新的盤周出血及盤沿變窄識別欠佳。OCT-GPA在判斷早期POAG進(jìn)展有一定優(yōu)勢，但最好聯(lián)合視野及眼底照相檢查共同判斷。

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Clinical role of Cirrus optical coherence tomography-guided progression analysis in detecting glaucomatous progression

Xin-Hui Guan, Li Li, Yong Liang

Special Scientific Research Foundation for Young Scientific and Technological Talents of Health and Family Planning Commission of Xinjiang Uygur Autonomous Region (No.2014Y10)

2016-05-23Accepted：2016-08-08

?spectral-domain optical coherence tomography; primary open angle glaucoma; guided progression analysis; optic disc photography

2014年度新疆維吾爾自治區(qū)衛(wèi)生廳青年科技人才專項(xiàng)科研項(xiàng)目(No.2014Y10)

(830054)中國新疆維吾爾自治區(qū)烏魯木齊市，新疆醫(yī)科大學(xué)第五附屬醫(yī)院眼科

關(guān)新輝,女，畢業(yè)于新疆醫(yī)科大學(xué)，碩士，副主任醫(yī)師，研究方向：白內(nèi)障、青光眼。

梁勇，男，碩士，主任醫(yī)師，主任.iohey@163.com

2016-05-23

2016-08-08

Guan XH, Li L, Liang Y. Clinical role of Cirrus optical coherence tomography-guided progression analysis in detecting glaucomatous progression.GuojiYankeZazhi(IntEyeSci) 2016;16(9):1687-1691

10.3980/j.issn.1672-5123.2016.9.22