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目的 探讨视网膜及黄斑后极部不对称参数在早期原发性开角型青光眼(primary open-angle glaucoma,POAG)中的诊断意义.设计诊断技术评价.研究对象50例(100眼)早期POAG患者和50例(100眼)正常对照者.方法 应用高分辨率相干光断层扫描(Cirrus HD-OCT)进行黄斑模块和视盘模块扫描,测量视盘周围视网膜神经纤维层(RNFL)厚度、黄斑厚度、黄斑神经节细胞-内丛状层(GCIPL)厚度,并进行双眼和同一眼内不对称参数分析;Humphrey视野计检查视野平均缺损(MD)和模式标准差(PSD).用受试者工作特性下曲线下面积(AUC)评价各参数诊断早期POAG的能力.主要指标RNFL厚度、黄斑厚度、GCIPL厚度及不对称性分析和AUC值.结果 早期POAG组,上方、下方及总体的视盘RNFL厚度、黄斑厚度、GCIPL厚度均较正常对照组明显变薄(P＜0.05).除眼内视盘RNFL厚度的差值(P=0.128),其余组间各测量参数的不对称性分析即绝对差比较均具有统计学差异(P＜0.05).GCIPL诊断效能最高者是双眼上方GCIPL厚度差值,AUC值为0.933,其次是GCIPL总体厚度(AUC=0.922).视盘周围RNFL参数中诊断效能最高者是双眼视盘RNFL总体厚度差值(AUC=0.894).黄斑厚度参数中诊断效能最高者是黄斑总体厚度(AUC=0.85).特异性在95％时,总体GCIPL厚度的敏感度最高(85％);其次为总体GCIPL厚度差值(80％).结论 Cirrus-HD OCT测量视盘RNFL厚度及GCIPL厚度并进行双眼不对称参数分析对早期POAG的诊断价值比黄斑厚度参数大.但同一眼内不对称参数分析的诊断能力最差.“,”Objective To investigate the diagnostic value of asymmetry parameters in retina and macular posterior pole in early primary open angle glaucoma (POAG).Design Diagnostic technique evaluation.Participants 50 eyes of 100 patients with early POAG and 100 eyes of 50 cases in normal control.Methods All eyes underwent Cirrus HD-OCT for thickness of total,inferior,superior retinal nerve fiber layer (RNFL) around the optic disc 、macular and ganglion cell-inner plexiform layer (GCIPL),and then calculated intereye and intraeye difference (posterior pole asymmetry parameters analysis).The mean field defect (MD) and pattern standard deviation (PSD) were recorded using a Humphrey perimeter.The area under the curve (AUC) was used to evaluate the ability of the paraneters to diagnose early POAG.Main Outcome Measures RNFL thickness,macular thickness and GCIPL thickness of two groups,asymmetric analysis for intereye and intraeye difference of RNFL thickness,macular thickness and GCIPL thickness.The AUC value of each parameter,the sensitivity of the fixed specificity.Results The RNFL thickness,macular thickness and GCIPL thickness in the early POAG group were significantly thinner than those in the normal control group (P＜O.05).In addition to the difference in the intraocular RNFL thickness (P=0.128),there were significant difference (P＜0.05) in the absolute difference between the two groups in the asymmetry of other measurement parameters.The highest GCIPL diagnostic efficacy was the intereye difference of the superior GCIPL thickness,AUC was 0.933,followed by the total GCIPL thickness (AUC=0.922).The highest RNFL around the optic disc diagnostic efficacy is intereye difference of the total RNFL thickness (AUC=0.894).The highest macular diagnostic efficacy was total macular thickness (AUC=0.85).The sensitivity of total GCIPL thickness was the highest,with a 95％ specificity of 85％,followed by intereye total GCIPL thickness difference of 80％.Conclusion The diagnostic value of RNFL thickness around optic disc and GCIPL thickness,especially their intereyeasymmetric parameters respectively were worth more than macular thickness in early diagnosis of POAG measured by Cirrus-HD OCT.But the analysis of intraocular asymmetric parameters showed the lowest diagnostic ability and the lowest AUC.