CAJ | 학술논문

背景青光眼早期视野结果存在很大的可变性,实践中不得不反复测试以确定准确的视野缺损情况.基于视网膜神经纤维层(RNFL)与视野结构-功能对应关系的评价方法较传统诊断方法可能更为高效和客观. 目的评价RNFL与视野的结构-功能对应关系在开角型青光眼早期诊断中的应用价值. 方法纳入2007年1-6月于中南大学湘雅医院眼科确诊的早期开角型青光眼患者64例64眼为早期开角型青光眼组,纳入同期正常志愿者50人50眼作为正常对照组,2个组患者年龄和性别构成比均匹配.所有受检者进行偏振激光扫描仪联合个体化角膜补偿技术(GDxVCC)、标准自动视野(SAP)、短波视野计(SWAP)检查,将3种检查的不同标准归纳为总体诊断标准:即传统的诊断指标[GDxVCC为神经纤维指数(NFI),视野为青光眼半视野检测(GHT)]及局部诊断标准(GDxVCC及视野的模式偏差地图中异常缺损“点”的量化指标),评价两种标准下3种检查的独立诊断以及运用RNFL与视野的对应关系图、局部诊断标准下三者联合应用对青光眼诊断的敏感性和特异性.结果采用总体诊断标准,GDxVCC、SWAP、SAP对早期开角型青光眼诊断的敏感性分别为70％、63％、61％,特异性分别为84％、80％、78％.采用局部诊断标准,GDxVCC、SWAP、SAP对早期开角型青光眼诊断的敏感性分别为78％、86％、78％,特异性分别为54％、40％、50％；而采用该标准、运用RNFL与视野的对应关系图、三者联合诊断的特异性提高至90％,敏感性为86％,阳性似然比为8.59,阴性似然比为0.16. 结论 RNFL与视野的分布对应图可提供早期青光眼患者青光眼半视野簇与RNFL分布的结构-功能对应联系,提供有价值的个体化诊断信息,GDxVCC、SWAP、SAP的联合应用有助于甄别单次检查造成的假阳性率,提高开角型青光眼的早期诊断效能.
배경 청광안조기시야결과존재흔대적가변성,실천중불득불반복측시이학정준학적시야결손정황.기우시망막신경섬유층(RNFL)여시야결구-공능대응관계적평개방법교전통진단방법가능경위고효화객관. 목적 평개RNFL여시야적결구-공능대응관계재개각형청광안조기진단중적응용개치. 방법 납입2007년1-6월우중남대학상아의원안과학진적조기개각형청광안환자64례64안위조기개각형청광안조,납입동기정상지원자50인50안작위정상대조조,2개조환자년령화성별구성비균필배.소유수검자진행편진격광소묘의연합개체화각막보상기술(GDxVCC)、표준자동시야(SAP)、단파시야계(SWAP)검사,장3충검사적불동표준귀납위총체진단표준:즉전통적진단지표[GDxVCC위신경섬유지수(NFI),시야위청광안반시야검측(GHT)]급국부진단표준(GDxVCC급시야적모식편차지도중이상결손“점”적양화지표),평개량충표준하3충검사적독립진단이급운용RNFL여시야적대응관계도、국부진단표준하삼자연합응용대청광안진단적민감성화특이성.결과 채용총체진단표준,GDxVCC、SWAP、SAP대조기개각형청광안진단적민감성분별위70％、63％、61％,특이성분별위84％、80％、78％.채용국부진단표준,GDxVCC、SWAP、SAP대조기개각형청광안진단적민감성분별위78％、86％、78％,특이성분별위54％、40％、50％；이채용해표준、운용RNFL여시야적대응관계도、삼자연합진단적특이성제고지90％,민감성위86％,양성사연비위8.59,음성사연비위0.16. 결론 RNFL여시야적분포대응도가제공조기청광안환자청광안반시야족여RNFL분포적결구-공능대응련계,제공유개치적개체화진단신식,GDxVCC、SWAP、SAP적연합응용유조우견별단차검사조성적가양성솔,제고개각형청광안적조기진단효능.
Background One of the difficulties in identifying early glaucoma is the variability of perimetry performance.For this reason,a field defect have to be reproduced more than two consecutive examinations before it is confirmed.The relationship between visual field sensitivity and retinal nerve fiber layer (RNFL) thickness may give us a more efficient and objective assessment to the early diagnosis of glaucoma.Objective This diagnostic test was to evaluate the application of functional-structural relationship between automated perimetry and RNFL in the early diagnosis of open-angle glaucoma.Methods Sixty-four eyes of 64 patients with early open-angle glaucoma and 50 eyes of 50 normal volunteers with the matched age and gender were enrolled in Xiangya Hospital January to June 2007.Visual field examinations,including standard automated perimetry (SAP),short wave automated perimetry (SWAP),and imaging of scanning laser polarimetry with variable corneal compensation(GDxVCC),were performed on the subjects with the informed consent.The sensitivity and specificity of the joint or single measurement of GDxVCC,SAP and SWAP under the local diagnostic criteria,and overall diagnostic criteria were calculated.Results According to the overall diagnostic criteria,the sensitivity of GDxVCC,SWAP and SAP were 70％,63％,61％ respectively,and the specificity were 84％,80％,78％,respectively.According to the local diagnostic criteria,the sensitivity of GDxVCC,SWAP and SAP were 78％,86％,78％,respectively,and the specificity were 54％,40％,50％,respectively.With the local diagnostic criteria,the sensitivity and specificity of serial test of GDxVCC,SWAP and SAP were 86％ and 90％ respectively,and the positive likelihood ratio and negative likelihood ratio were 8.59 and O.16,respectively.Conclusions The functional-structural relationship between automated perimetry and RNFL which can provide valuable individual diagnostic information for patients,and serial test of GDxVCC,SWAP and SAP can reduce the false positive rate and improve the diagnostic performance significantly.