目的：应用光学相干断层扫描仪(optical coherence tomography，OCT)定量检测老年白内障患者视网膜神经纤维层(retinal nerve fiber layer，RNFL)厚度的变化，分析年龄相关性白内障患者实施超声乳化吸除手术后盘周RNFL的变化特点以及与视力的相关性。

方法：临床纳入实施超声乳化吸除手术的老年年龄相关性白内障患者51例70眼，根据患者有无糖尿病分为糖尿病组与非糖尿病组。其中，非糖尿病组30例38眼，糖尿病组21例32眼。所有患者术后均采用OCT定量测量不同时间(术后3、14d，1、3、6mo)眼底盘周RNFL的厚度，比较不同时间RNFL厚度的变化，分析其与术眼最佳矫正视力(BCVA)的相关性。

结果：非糖尿病组术后3、14d盘周RNFL厚度与糖尿病组对比无统计学差异(P>0.05)，术后3、6mo盘周RNFL厚度明显小于糖尿病组(P<0.05)； 两组患者术前和术后3、14d，1mo裸眼视力差异均无统计学意义(P>0.05)； 糖尿病组术后3、6mo裸眼视力明显低于非糖尿病组，差异有统计学意义(P<0.05)。非糖尿病组术后14d，1、3mo盘周RNFL厚度与视力呈现负相关(P<0.05)； 糖尿病组术后14d，1、3、6mo盘周RNFL厚度与视力呈现负相关(P<0.05)。

结论：光学相干断层扫描仪对老年白内障患者术后盘周RNFL的改变具有良好的检测作用，RNFL的改变是导致视力变化的一个重要原因。

AIM: To apply optical coherence tomography(OCT)in the detection of retinal nerve fiber layer(RNFL)thickness in senile cataract patients and to analyze the changes of RNFL and the correlation with the patient's visual acuity after phacoemulsification.

METHODS: Fifty-one senile cataract patients(70 eyes)received the phacoemulsification. The patients were divided into diabetes mellitus(DM)group and non-DM group. There were 30 cases(38 eyes)in non-DM group and 21 cases(32 eyes)in DM group. After treatments, OCT was applied to detect the patients' RNFL thickness at different time periods(at 3, 14d, 1, 3 and 6mo after treatments). At different time periods, RNFL thickness was detected to analyze its correlation with the best corrected visual acuity(BCVA).

RESULTS: At 3 and 14d after treatments, RNFL thickness of non-DM group was not different from that of DM group(P>0.05); at 3 and 6mo after treatments, RNFL thickness of non-DM group was smaller than that of DM group(P<0.05); the uncorrected visual acuity of the two groups before treatments had no statistical significant differences compared with those at 3,14d and 1mo postoperatively(P>0.05); the uncorrected visual acuity of DM group at 3, 6mo postoperatively was significantly lower than those of non-DM group(P<0.05); at 14d, 1 and 3mo after treatments, the RNFL thickness of non-DM group was negatively correlated with the patient's visual acuity(P<0.05); at 14d, 1, 3 and 6mo after treatments, RNFL thickness of DM group was negatively correlated with the patient's visual acuity(P<0.05).

CONCLUSION: OCT is a good detecting parameter for the change of RNFL thickness and the change of RNFL thickness is an important cause of the changes of the patient's visual acuity.