目的：应用磁共振扩散张量成像(DTI)技术及三维光学相干断层成像(3D-OCT)技术研究高眼压症患者(OHT)视路的微观改变。

方法：纳入我院眼科2016-01/2019-10确诊为双眼OHT的患者26例52眼作为病例组，选取同期年龄、性别均与高眼压组相匹配的健康体检者26例52眼作为对照组。所有受检眼均进行最佳矫正视力检测、中央角膜厚度(CCT)测量、非接触性眼压、视盘3D-OCT扫描检测及视神经、视交叉、视束及视放射DTI检测，OHT患者增加房角镜检查，并对比两组的差异。

结果：OHT组CCT值比正常对照组薄，眼压值较正常对照组增高(均P<0.05)。OHT视盘面积较正常对照组变大，视杯面积增大； 平均青光眼视盘旁神经纤维层(CP-RNFL)厚度、鼻侧RNFL厚度比正常对照组变薄(均P<0.05)，上方、下方及颞侧RNFL无差异(均P>0.05)。双侧视神经及视放射的FA值较正常对照组下降(均P<0.05)。两组视交叉、双侧视束FA值、双侧视路ADC值无差异(均P>0.05)。

结论：3D-OCT可以获取CP-RNFL厚度值，视盘的参数； DTI可以重建颅内视觉通路，能早期发现视神经、视交叉、视束、视放射的微观变化。联合3D-OCT及新兴的DTI技术可有效了解OHT患者视路的微观改变，为临床研究高眼压症提供新的思路和研究模式。

METHODS: Twenty-six patients with 52 eyes diagnosed as OHT in our hospital from January 2016 to October 2019 were included in the case group. Twenty-six healthy patients who were matched with age and gender in the same period were included in the control group. All eyes were examined for best corrected visual acuity, central corneal thickness(CCT), non-contact intraocular pressure, while all eyes were examined by optical disc 3D-OCT combined optic nerve, optic chiasma, optic tract, and optic radiation DTI. Compared the differences between the two groups.

RESULTS: The CCT of the OHT group was thinner than that of the normal control group; the intraocular pressure was higher than that of the normal control group, and the difference was statistically significant(all P<0.05). The optic disc area of the OHT group was larger than that of the normal control group, while the optic cup area was increased, and the average CP-RNFL thickness and nasal CP-RNFL thickness were thinner than those of the normal control group(all P<0.05). There was no statistic difference in the superior, inferior and temporal CP-RNFL(all P>0.05). The FA values of bilateral optic nerve and optic radiation decreased compared with the normal control group, and the difference was statistically significant(all P<0.05). There was no significant difference of optic chiasma, bilateral visual tract's FA value, and bilateral visual pathway ADC value between the two groups(all P>0.05).

CONCLUSION: 3D-OCT can obtain the thickness of CP-RNFL and the parameters of optic disc, DTI can reconstruct the intracranial visual pathway and can detect the microscopic changes of optic nerve, optic chiasma, optic tract, and optic radiation at early stage. Combining 3D-OCT and DTI technology can effectively understand the microscopic changes of the visual pathway and provide new models for clinical research of ocular hypertension patients.