频域OCT视盘形态及神经纤维层厚度参数在青光眼诊断中的作用
빈역OCT시반형태급신경섬유층후도삼수재청광안진단중적작용
Effects of optic disc topography and retinal nerve fiber layer thickness measurement by spectral-domain OCT on diagnosis of glaucoma
  • 万方数据
    中华实验眼科杂志 중화실험안과잡지
    CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
    2011年 9期 820-824 ,共5页

    王晓贞%李树宁%吴葛玮%牟大鹏

    왕효정%리수저%오갈위%모대붕

    光学相干断层扫描%青光眼%视盘%视网膜神经纤维层 光學相榦斷層掃描%青光眼%視盤%視網膜神經纖維層
    광학상간단층소묘%청광안%시반%시망막신경섬유층
    Optical coherence tomography%Glaucoma%Optic disc%Retinal nerve fiber layer
    背景 青光眼是一种可引起视神经结构改变，继而导致不可逆视功能损害的一类疾病。光学相干断层扫描(OCT)通过对视盘形态以及神经纤维层的检测，有助于青光眼的早期诊断。目的 探讨频域OCT视盘形态及神经纤维层厚度各参数在青光眼诊断中的作用。方法 非干预性、横断面研究。应用频域RTVue OCT测量62例正常人和67例青光眼患者的视盘参数，以及视网膜各区域的神经纤维层厚度。用受试者工作特性曲线下面积(ROC)评价OCT每个检测参数区分正常眼与青光眼的能力大小。结果各型青光眼组患者的年龄明显大于正常组，各型青光眼组视野平均缺损(MD)和视野模式标准化差( PSD)值均明显大于正常组，差异均有统计学意义(P＜0.01)。正常组、青光眼组、开角型青光眼组和闭角型青光眼组间视盘面积的总体差异均无统计学意义( P=0.101、0.741、0.652);正常人平均视网膜神经纤维层厚度为(109.758±9.095) μm，青光眼患者为(79.539±18.986) μm，明显低于正常人(P＜0.01)。在视盘周围8个神经纤维层区域中，正常人最厚的区域在颞下方和颞上方，分别为( 150.109±18.007) μm和(146.105±15.529) μm，而青光眼患者最厚处在颞上方和颢下方，分别为( 104.354±27.641) μm和(102.436±32.243) μm，但均较正常参数减小。正常人和青光眼患者鼻侧和颢侧视网膜神经纤维层厚度均较薄。视盘参数中，各型青光眼诊断效能最高的是盘沿容积和垂直杯盘比，二者的ROC值在总青光眼患者中分别为0.850和0.840，其特异性在80％时的敏感性分别为73.1％和76.1％，在开角型青光眼患者中分别为0.841和0.849，其特异性在80％时的敏感性分别为73.0％和81.1％，在闭角型青光眼患者中分别为0.862和0.830，其特异性在80％时的敏感性分别为73.3％和70.0％。视网膜神经纤维层厚度各参数中，诊断效能最高的是平均神经纤维层厚度，其ROC值在总青光眼、开角型青光眼、闭角型青光眼中分别为0.925、0.910和0.942，其特异性在80％时的敏感性分别为89.6％、89.2％和90.0％。视盘周围8个神经纤维层区域中，诊断效能最高的是IT区域，诊断效能最低的是TU和TL区域。结论RTVue OCT具有很好地区别正常人和青光眼患者的能力，在青光眼诊断方面是一个较实用的工具。
    배경 청광안시일충가인기시신경결구개변，계이도치불가역시공능손해적일류질병。광학상간단층소묘(OCT)통과대시반형태이급신경섬유층적검측，유조우청광안적조기진단。목적 탐토빈역OCT시반형태급신경섬유층후도각삼수재청광안진단중적작용。방법 비간예성、횡단면연구。응용빈역RTVue OCT측량62례정상인화67례청광안환자적시반삼수，이급시망막각구역적신경섬유층후도。용수시자공작특성곡선하면적(ROC)평개OCT매개검측삼수구분정상안여청광안적능력대소。결과각형청광안조환자적년령명현대우정상조，각형청광안조시야평균결손(MD)화시야모식표준화차( PSD)치균명현대우정상조，차이균유통계학의의(P＜0.01)。정상조、청광안조、개각형청광안조화폐각형청광안조간시반면적적총체차이균무통계학의의( P=0.101、0.741、0.652);정상인평균시망막신경섬유층후도위(109.758±9.095) μm，청광안환자위(79.539±18.986) μm，명현저우정상인(P＜0.01)。재시반주위8개신경섬유층구역중，정상인최후적구역재섭하방화섭상방，분별위( 150.109±18.007) μm화(146.105±15.529) μm，이청광안환자최후처재섭상방화호하방，분별위( 104.354±27.641) μm화(102.436±32.243) μm，단균교정상삼수감소。정상인화청광안환자비측화호측시망막신경섬유층후도균교박。시반삼수중，각형청광안진단효능최고적시반연용적화수직배반비，이자적ROC치재총청광안환자중분별위0.850화0.840，기특이성재80％시적민감성분별위73.1％화76.1％，재개각형청광안환자중분별위0.841화0.849，기특이성재80％시적민감성분별위73.0％화81.1％，재폐각형청광안환자중분별위0.862화0.830，기특이성재80％시적민감성분별위73.3％화70.0％。시망막신경섬유층후도각삼수중，진단효능최고적시평균신경섬유층후도，기ROC치재총청광안、개각형청광안、폐각형청광안중분별위0.925、0.910화0.942，기특이성재80％시적민감성분별위89.6％、89.2％화90.0％。시반주위8개신경섬유층구역중，진단효능최고적시IT구역，진단효능최저적시TU화TL구역。결론RTVue OCT구유흔호지구별정상인화청광안환자적능력，재청광안진단방면시일개교실용적공구。
    Background Glaucoma is an optic neuropathy caused by structural damage of the optic nerve,and its early diagnosis is critical for arresting the irreversible damage of visual function. Optical coherence tomography (OCT) allows an early diagnosis of glaucoma by the measurements of the optic disc and retinal nerve fiber parameters. Objective This study was carried out to evaluate the effects of optic disc tomography and the measurement of the retinal nerve fiber layer (RNFL) thickness by spectral-domain OCT on the diagnosis of glaucomatous eye. Methods It was a noninterventional, cross-sectional study. The optic disc topographic parameters and total and regional RNFL thickness were measured by RTVue OCT in 62 normal eyes and 67 glaucomatous eyes. The area under the receiver operating characteristic curve( ROC ) was used to assess the ability to differentiate glaucoma eyes from normal eyes of each testing parameter. This trial complied with the Helsinki Declaration and was approved by the Clinical Trial Ethic Committee of Beijing Tongren Hospital. All of the participants signed the written informed consent before any medical examination. Results In the comparison of demography ,the ages of patients, the mean deficiency( MD ) and pattern standard difference( PSD ) of perimetry were obviously larger in the glaucoma group, primary open angle glaucoma ( POAG ) group and primary closure-angle glaucoma(PACG) group than those of normal controls( P＜0. 01 ). No significant differences were found in the disc area between a total glaucoma group, POAG group or PACG group and normal group ( P =0. 101,0. 741 and 0. 652, respectively) ;however, the average RNFL thickness between normal eyes and glaucomatous eyes were significantly different( 109. 758 μm versus 79. 539 μm, P＜0. 01 ). Among the eight regions around the optic disc, the thickest RNFL located at the inferotemporal( 150. 109 μm) and superotemporal( 146. 105 μm) regions in normal eyes,and at the superotemporal( 104. 354 μm) and inferotemporal( 102. 436 μm) regions in glaucomatous eyes. Both in normal and glaucomatous eyes,the thinnest RNFL located at the nasal(NU+NL) and temporal(TU + TL) regions. For optic disc topographic parameters,the highest ROC were observed in rim volume( ROC--0. 850,0. 841 and 0. 862 in total glaucoma,POAG and PACG, respectively) and vertical cup/disc ratio( ROC =0. 840,0. 849 and 0. 830 in total glaucoma,POAG and PACG,respectively), and the sensitivities for specificity cutoff set at 80％ were 73.1％ and 76. 1％ in total glaucoma,73.0％ and 81.1％ in POAG and 73.3％ and 70.0％ in PACG, respectively. For RNFL thickness ,the highest ROC was observed in average RNFL( ROC =0. 925,0. 910 and 0. 942 in total glaucoma, POAG and PACG,respectively) ,and the sensitivities for specificity cutoff set at 80％ were 89. 6％ ,89.2％ and 90. 0％ in total glaucoma,POAG and PACG, respectively. Among the eight regions around the optic disc, RNFL thickness of region IT achieved the highest ROC, RNFL thickness of region TU and TL had the lowest ROC. Conclusions RTVue OCT appears to be of fair discriminating ability in distinguishing normal from glaucomatous eyes. RTVue OCT shows promise for the diagnosis of glaucoma.
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