OCT检测青光眼视网膜神经纤维层局部缺损的临床研究

背景传统眼底照相的方法诊断视网膜神经纤维层（RNFL）局部缺损依赖于检查者的主观经验,而光学相干断层扫描（OCT）可以客观判断RNFL的局部缺损,新的频域OCT对RNFI,缺损的显示更直观。目的评价频域OCT、时域OCT对青光眼RNFL局部缺损的诊断价值及其与眼底彩色照相的一致性。方法由2位青光跟专家通过眼底彩色照相一致确认存在RNFL局部缺损的青光眼患者55例55眼和正常对照41名41眼纳入研究,分析眼底彩色照相、频域CirrusHD-OCT、时域Stratus OCT分别检测的RNFL局部缺损的位置和宽度,进行三者检测结果的一致性和相关性研究,评价OCT对RNFL局部缺损的诊断价值。结果确认青光眼患者55眼中共有RNFL局部缺损75处,分别位于颞上和颞下象限。CirrusHD-OCT和Stratus OCT检测RNFL损害的灵敏度分别是88．O％和69．3％,特异度分别是927％和97．6％。CirrusHD-OCT和Stratus OCT检测RNFL缺损的位置均与眼底彩色照相结果的检测值呈高度正相关（r=0．993、r=0．992,P〈0．01）;二者检测的RNFL缺损宽度与眼底彩色照相结果的检测值呈正相关（r=0．420、r=0．432,P=0．019、P=0．002）,CirrusHD-OCT和Stratus OCT检测RNFL缺损宽度与眼底彩色照相的检测值比较差异均无统计学意义（CirrusHD-OCT：P=0．114;Stratus OCT：P：0．074）。CirrusHD-OCT和Stratus-OCT检测RNFL缺损宽度值差异有统计学意义（P：0．002）。结论频域OCT和时域OCT均具有较好的诊断RNFL局部缺损的价值,与眼底彩色照相检测值有较好的一致性。     

三维OCT在开角型青光眼鉴别诊断价值

目的 探讨高分辨率三维OCT在开角型青光眼中的诊断价值.方法 采用CirrusHD-OCT对正常组94人188只眼和试验组46例92只眼进行视网膜神经纤维层厚度的检测,对比分析视盘形态和视网膜神经纤维层厚度改变.结果 正常组各部位神经纤维层厚度与性别、眼别无相关(P＞0.05).正常对照组各部位神经纤维纤维层厚度明显高于实验组,经过独立样本t检验得出差异有统计学意义(P＜0.05).根据OCT结果,并根据视野、眼压等将试验组46例92只眼诊断为青光眼的24例48只眼,大视杯22例44只眼,两个亚组各部位RNFL厚度和正常对照组相比较,视网膜神经纤维层厚度均变薄,差异有统计学意义(P＜0.05);但大视杯亚组各部RNFL厚度均高于青光眼亚组,差别有统计学意义(P＜0.05).结论 OCT可以清晰显示视网膜神经纤维层变薄的范围和区域,再配合其他检查,即可较准确、快捷鉴别原发性开角型青光眼患者,大大提高开角型青光眼的早期诊断水平,是诊断早期青光眼的不可缺少的重要检查方法之一.

Abstract：

Objective To evaluate the diagnostic value of of high-resolution three-dimensional OCT in early primary open-angle glaucoma.Methods The retinal nerve fiber layer thickness in the normal group of 94 cases (188 eyes) and experimental group (glaucoma suspect group) of 46 cases (92 eyes) were detected using the Cirrus HD-OCT,and the comparative analysis of optic disc and retinal nerve fiber layer thickness were taken.The OCT performance of normal and suspected glaucoma image features was compared.Results There was no relationship in different parts of nerve fiber layer thickness (RNFL) with gender and eyes (P ＜0.05).The thickness of nerve fiber layer of normal control group was higher than experimental group,there was statistically significant difference (P ＜0.05) by independent sample t test.Based on the measured thickness of retinal nerve fiber layer,the image features and characteristics of OCT images,vision and intraocular pressure,48 eyes of 24 patients were diagnosed with glaucoma,and 44 eyes of 22 cases were diagnosed with large cup in experimental group.RNFL thickness of different parts of the two sub-group were thinning compared with the control group,the difference was statistically significant (P ＜0.05);but large cup group showed thicker RNFL than glaucoma group,and there was the statistically significant difference (P ＜0.05).Conclusions Cirrus HD-OCT has important diagnostic value in early primary open-angle glaucoma;also can greatly increase early diagnosis in primary open-angle glaucoma.It is an important and indispensable check method.     

Comparison of retinal nerve fiber layer thickness between Stratus and Spectralis OCT

Purpose

To compare the peripapillary retinal nerve fiber layer (RNFL) thickness of normal patients and those with various glaucoma diseases by time domain (Stratus) and spectral domain (Spectralis) optical coherence tomography (OCT).

Methods

The RNFL thickness as measured by the Stratus and Spectral OCT was compared (paired t-test). The relationship and agreement of RNFL thickness between the two OCT modalities were evaluated by Pearson correlation, Bland-Altman plot, and area under the receiver operating characteristic curve.

Results

Two-hundred seventeen eyes of 217 patients, including twenty-four normal eyes, ninety-one glaucoma suspects, seventy-six normal tension glaucoma cases, and twenty-six primary open angle glaucoma cases (POAG) were analyzed. The peripapillary RNFL thicknesses as measured by Stratus OCT were significantly greater than those measured by Spectralis OCT. However, in quadrant comparisons, the temporal RNFL thickness obtained using Stratus OCT were significantly less than those obtained using Spectralis OCT. Correlations between RNFL parameters were strong (Pearson correlation coefficient for mean RNFL thickness = 0.88); a high degree of correlation was found in the POAG group. Bland-Altman plotting demonstrated that agreement in the temporal quadrant was greater than any other quadrant.

Conclusions

Both OCT systems were highly correlated and demonstrated strong agreement. However, absolute measurements of peripapillary RNFL thickness differed between Stratus OCT and Spectralis OCT. Thus, measurements with these instruments should not be considered interchangeable. The temporal quadrant was the only sector where RNFL thickness as measured by Spectralis OCT was greater than by Stratus OCT; this demonstrated greater agreement than other sectors.     

Comparability of retinal nerve fiber layer thickness measurements of optical coherence tomography instruments

PURPOSE: To compare retinal nerve fiber layer (RNFL) measurements between two ocular coherence tomography (OCT) instruments (OCT 2000 and Stratus OCT; Carl Zeiss Meditec, Dublin, CA) and compare their diagnostic precision. METHODS: One hundred thirty-nine consecutive subjects were imaged (3 x 3.4-mm diameter circular scans) on the same day with each instrument. Thirty-five patients were excluded due to poor-quality images. RNFL thicknesses measured by the two instruments were compared, and receiver operating characteristic (ROC) curves were used to determine diagnostic precision. RESULTS: A randomly selected eye of each of 104 participants (28 with open-angle glaucoma, 40 with suspected glaucoma, and 36 healthy subjects) was analyzed. RNFL thickness measurements generally were thicker with OCT 2000 than with Stratus OCT. The difference in global RNFL thickness between instruments was within 20 microm in 66 (65%) of subjects and within 10 microm (the instrument's limit of resolution) in 25 (25%) subjects. Application of a correction factor to OCT 2000 measurements predicted Stratus OCT RNFL thickness within 10 microm of the observed measurement in 75% of the eyes. For both instruments, highest ROC curve areas (better discrimination between glaucomatous and normal eyes) were found in the inferior sector. Discrimination using global RNFL thickness was better with Stratus OCT than OCT 2000 (P = 0.043). CONCLUSIONS: RNFL thickness measurements measured by OCT 2000 can be approximated to measurements made by Stratus OCT using correction factors calculated by this study. However, there remains considerable variability that exceeds the limits of resolution afforded by the instruments themselves. Therefore comparisons between instruments using these approximations should be interpreted with caution.     

Retinal nerve fiber layer thickness in normal, ocular hypertensive, and glaucomatous Indian eyes: an optical coherence tomography study

PURPOSE: To determine retinal nerve fiber layer (RNFL) thickness measurements in normal, ocular hypertensive (OHT), and glaucomatous Asian Indian eyes. METHODS: This prospective observational cross-sectional study included patients with OHT, primary open angle glaucoma (POAG), and age-matched normal controls. The global and 4-quadrant average RNFL thickness was measured using the Stratus OCT. The main outcome measures were differences in RNFL thickness measurements between the 3 groups. The discriminating power of each parameter was evaluated by calculating areas under receiver operating characteristic curves (AROCs). RESULTS: Twenty-three eyes of 23 POAG patients, 24 eyes of 24 OHT, and 48 eyes of 48 normal controls were analyzed. The superior, inferior, and global RNFL measurements were significantly thinner in OHTs compared with normals (P=0.031, 0.019, and 0.022, respectively). All 5 RNFL parameters were significantly thinner in the POAG group compared with OHT group (P<0.001). Parameters with largest AROCs for distinguishing glaucoma from OHT were average and inferior average RNFL measurements (0.989 and 0.979, respectively). Inferior and superior RNFL measurements had largest AROCs (0.717 and 0.700, respectively) to distinguish OHT from normal eyes. CONCLUSIONS: Stratus OCT detected significant quantitative differences in RNFL thickness between normal, OHT, and glaucomatous Asian Indian eyes.     

Comparison of ability of time-domain and spectral-domain optical coherence tomography to detect diffuse retinal nerve fiber layer atrophy

Purpose

Our aim was to evaluate and compare diagnostic capabilities of time-domain (Stratus) and spectral-domain (Cirrus) optical coherence tomography (OCT) to detect diffuse retinal nerve fiber layer (RNFL) atrophy.

Methods

This study assessed 101 eyes from 101 glaucoma patients with diffuse RNFL atrophy and 101 eyes from 101 age-matched healthy individuals. Two experienced glaucoma specialists graded red-free RNFL photographs of eyes with diffuse RNFL atrophy using a four-level grading system. The area under the receiver operating characteristic curves (AUC) of normal eyes was compared with that of eyes with diffuse atrophy. Sensitivity and specificity of each OCT device were calculated on the basis of its internal normative database.

Results

The largest AUC for Stratus and Cirrus were obtained for average RNFL thicknesses (0.96 and 0.94, respectively). Comparison of the AUC with different RNFL atrophy grades revealed no significant difference between the two OCT devices. Using an internal normative database at a <5 % level, the overall sensitivity of Stratus ranged from 58.0 to 84.0 %, whereas that of Cirrus ranged from 75.0 to 87.0 %. According to the normative database, the highest Stratus sensitivity was obtained with the temporal–superior–nasal–inferior–temporal (TSNIT) thickness graph, and the highest Cirrus sensitivity with the TSNIT thickness graph and the deviation map.

Conclusions

The AUC obtained from Cirrus were comparable with those from Stratus. On the basis of their normative databases, these devices had similar diagnostic accuracy. Our results suggest that the diagnostic capabilities of the two instruments to detect diffuse RNFL atrophy are similar.     

Blue-on-yellow perimetry and optical coherence tomography in patients with preperimetric glaucoma

Purpose: To investigate the diagnostic ability of blue‐on‐yellow perimetry (B/YP) and Stratus optical coherence tomography (OCT) in discriminating preperimetric glaucoma from normal eyes. Methods: A total 40 eyes of 40 normal subjects, 38 eyes of 38 preperimetric glaucoma patients (normal standard automated perimetry [SAP] and retinal nerve fibre layer [RNFL] defects or localized optic disc notching and thinning) were enrolled in the study. All the patients underwent SAP and B/YP tests, and OCT measurements. The correlation between B/YP indices and OCT parameters in the eyes with preperimetric glaucoma was analysed. Receiver operating characteristic (ROC) curve area was calculated to discriminate preperimetric glaucoma from normal eyes. Results: In preperimetric glaucoma, 42% eyes (16/38) had B/YP visual field loss, and 68% eyes (26/38) had RNFL defects with OCT measurements. A mild significant correlation was found between B/YP pattern standard deviation (PSD) and average RNFL thickness (Avg.Thi) (R² = 0.112, P = 0.012), superior maximum (Smax) (R² = 0.140, P = 0.005) and maximum‐minimum (Max‐Min) (R² = 0.074, P = 0.042) in the preperimetric glaucoma group. The areas under the ROC curve for B/YP PSD and B/YP mean deviation were 0.721 and 0.665, respectively, and the three OCT parameters with the widest areas under the ROC curve were Avg.Thi (0.719), inferior average (Iavg) (0.718) and nasal average (Navg) (0.706). The highest sensitivity of the individual B/YP indices and OCT parameters for detection of preperimetric glaucoma was B/YP mean deviation (32%) and Smax/Navg (40%) at 90% specificity; the highest sensitivity of the individual B/YP indices and OCT parameters was B/YP PSD (49%) and Iavg (56%) at 80% specificity. Conclusion: The sensitivity of B/YP indices and Stratus OCT RNFL thickness parameters is low for detecting preperimetric glaucoma, suggesting that BYP and OCT as utilized in this study have limited utility in the detection of preperimetric glaucoma.     

Stratus OCT与GDxVCC测量正常人与青光眼患者视网膜神经纤维层厚度比较研究

目的 比较相干光断层扫描仪StratusOCT与激光偏振光视网膜扫描仪GDxVCC测量视网膜神经纤维层(RNFL)厚度的相关性及差异,探讨两者测量值与视野的相关性及其对青光眼的诊断效能.方法 84例原发性开角型青光眼(POAG)患者及50名正常人,随机选取一眼进行StratusOCT和GDxVCCRNFL厚度测量及Humphery自动视野计检查.相关分析比较两种仪器测量的全周、上方、下方RNFL厚度;回归分析研究视野的平均偏差与两种仪器测量的RNFL厚度值之间的关系;ROC曲线下面积分析两种仪器诊断青光眼的效能.结果 Stratus OCT测量正常人及POAG患者的全周RNFL厚度分别为(100.00±7.36)μm和(75.12±17.11)μm,GDxVCC对应测量值(57.16±5.05)μm和(48.00.4±8.46)μm.两种仪器测量的RNFL厚度呈线性相关(r>0.75).两种仪器测量的RNFL厚度值与视野的平均偏差呈正相关,三次曲线拟合度较直线相关的拟合度好.对于青光眼诊断,Stratus OCT的最大ROC曲线下面积为0.908,GDxVCC最大ROC曲线下面积为0.842.结论 Stratus OCT与GDxVCC测量RNFL厚度值存在差异,但两者呈线性相关,均与视野的平均偏差呈曲线相关.两种仪器诊断青光眼的效能均较好.     

Comparison of the influence of cataract and pupil size on retinal nerve fibre layer thickness measurements with time-domain and spectral-domain optical coherence tomography

Background: To investigate and compare the effect of cataract and pupil size on retinal nerve fibre layer (RNFL) thickness measurements using spectral‐domain optical coherence tomography (Cirrus OCT) and time‐domain OCT (Stratus OCT). Design: Prospective, hospital‐based study. Participants: Twenty‐five eyes from 25 normal subjects undergoing cataract surgery. Methods: Three retinal nerve fibre layer (RNFL) thickness measurements were taken before and after dilation, preoperatively and postoperatively, using Cirrus 200 × 200 Optic Disc Scan and Stratus Fast RNFL Scan. Main Outcome Measures: Linear regression, intraclass correlation coefficient (ICC) and coefficient of variation analysis. Results: Cataract removal caused significant increase in RNFL measurements in both modalities (Cirrus P < 0.02; Stratus P < 0.001). There was no significant difference in the increase in measurements between the two machines. Pupil dilation had variable and non‐statistically significant effect in both (P > 0.05). ICC showed excellent reproducibility with Cirrus OCT after mydriasis, preoperatively (ICC = 0.78–0.90) and postoperatively (ICC = 0.90–0.97), but poor reproducibility before mydriasis (P < 0.75). Stratus OCT achieved excellent reproducibility after cataract removal both before (ICC = 0.86–0.96) and after mydriasis (ICC = 0.92–0.95), but poor reproducibility before cataract surgery (P < 0.75). Conclusions: Cataracts, not pupil size, cause significant underestimation of RNFL measurements in both Cirrus and Stratus OCT. The extent of influence exerted does not appear different between the two instruments. Reproducibility of each machine appears to be affected differently. Mydriasis is required to achieve excellent reproducibility with Cirrus OCT, and media clarity is required with Stratus OCT.     

Retinal Nerve Fiber Layer Thickness Reproducibility Using Seven Different OCT Instruments

Purpose. The clinical utility of new optical coherence tomography (OCT) instruments strongly depends on measurements reproducibility. The aim of this study was to assess retinal nerve fiber layer (RNFL) thickness reproducibility using six different spectral-domain OCTs (SD-OCTs) and one time-domain OCT. Methods. RNFL thickness (average and four quadrant) from six SD-OCTs (Spectral OCT/SLO OPKO/OTI, 3D-OCT 2000 Topcon, RS-3000 NIDEK, Cirrus HD-OCT Zeiss, RTVue-100 Optovue, and Spectralis Heidelberg) and one time-domain OCT (Stratus OCT Zeiss) was measured twice in 38 right eyes of 38 randomly chosen healthy volunteers by two masked operators. Inter- and intraoperator reproducibility was evaluated by the intraclass correlation coefficient (ICC), coefficient of variation (CV), and Bland-Altman test analysis. Instrument-to-instrument reproducibility was determined by ANOVA for repeated measures. We also tested how the devices disagree in terms of systemic bias and random error using a structural equation model. Results. Mean RNFL average thickness ranged from 90.08 μm to 106.51 μm. Cirrus and Heidelberg showed the thinnest RNFL values in all measurements, Topcon the highest. ICC, CV, and Bland-Altman plots showed variable inter- and intraoperator agreement depending on the instrument. Heidelberg demonstrated the best interoperator (ICC, 0.92; CV, 1.56%) and intraoperator (ICC, 0.94 and 0.95; CV, 1.28% and 1.26%, respectively, for operator A and operator B) agreement for average RNFL thickness. Conclusions. Heidelberg demonstrated the higher agreement in inter- and intraoperator reproducibility, Optovue the worst. In light of our error analysis results, we found that a scale bias among instruments could interfere with a thorough RNFL monitoring, suggesting that best monitoring is obtained with the same operator and the same device.     

Comparación de tres instrumentos de tomografía de coherencia óptica,un time-domain y dos Fourier-domain,en la estimación del grosor de la capa de fibras nerviosas de la retina

PurposeTo assess agreement between one system of time-domain optical coherence tomography (OCT) (Stratus) and two systems of fourier-domain OCT (Cirrus and 3D OCT1000) for the measurement of the retinal nerve fibre layer thickness (RNFL).MethodsFifty eyes from 25 patients with neuro-ophthalmological disorders of the afferent visual pathway were included. A triple RNFL thickness OCT examination with Stratus, Cirrus and 3D OCT-1000 was performed on both eyes of every patient, on the same day and by the same technician. The average RNFL thickness by quadrants and clock sectors were compared with the Lin's concordance correlation coefficient (CCC) and Bland-Altman plots.ResultsThe average RNFL thickness, the temporal and nasal quadrants and corresponding clock sectors, was higher by 3D OCT-1000 (mean 90.02 microns), nevertheless, RNFL thickness of the superior and inferior quadrants and corresponding clock hours was higher when measured by Stratus device. The CCC agreement between Stratus and Cirrus was high (0.820), between Stratus and 3D OCT-1000 was moderate (mean 0.573) and between Cirrus and 3D OCT-1000 was moderate with a mean of 0.564 but too low in the nasal and temporal quadrants (0.362 and 0.347 respectively).ConclusionsThe RNFL thickness measurements by Stratus, Cirrus and 3D OCT-1000 OCT are not equivalent. Although the agreement between Stratus and Cirrus was high, it was too low between 3D OCT-1000 and Stratus or Cirrus.© 2009 Sociedad Española de Oftalmología. Published by Elsevier España, S.L. All rights reserved.     

Comparison between GDx VCC scanning laser polarimetry and Stratus OCT optical coherence tomography in the diagnosis of chronic glaucoma

PURPOSE: To compare the abilities of scanning laser polarimetry with the variable corneal compensator (GDx VCC) with those of optical coherence tomography (Stratus OCT) in discriminating between healthy and early-to-moderate perimetric glaucomatous eyes. METHODS: A total of 95 glaucomatous patients (mean deviation - 3.7 +/- 3.0 dB, pattern standard deviation 4.5 +/- 2.7 dB) and 62 control subjects underwent imaging by the GDx VCC and Stratus OCT using both optic nerve head (ONH) and retinal nerve fibre layer (RNFL) scan protocols. One eye per patient was considered. Sensitivity at > or = 90% specificity and area under the receiver operating characteristic curve (AROC) were calculated for each GDx VCC and Stratus OCT index. RESULTS: The largest AROCs with Stratus OCT were associated with cup : disc area ratio (0.88) for ONH scan indices, and with average thickness (0.84) for RNFL scan indices. The nerve fibre indicator provided the greatest AROC for the GDx VCC indices (0.85). CONCLUSIONS: Both the GDx VCC and Stratus OCT instruments were shown to be useful in the detection of glaucomatous damage. The best performing indices for the GDx VCC and Stratus OCT with both ONH and RNFL scans gave similar AROCs, showing a moderate sensitivity in early-to-moderate glaucoma patients.     

Comparisons of ganglion cell-inner plexiform layer loss patterns and its diagnostic performance between normal tension glaucoma and primary open angle glaucoma: a detailed, severity-based study

AIM: To evaluate the patterns of macular ganglion cell-inner plexiform layer (GCIPL) loss in normal tension glaucoma (NTG) and primary open angle glaucoma (POAG) in a detailed, disease severity-matched way; and to assess the diagnostic capabilities of GCIPL thickness parameters in discriminating NTG or POAG from normal subjects. METHODS: A total of 157 eyes of 157 subjects, including 57 normal eyes, 51 eyes with POAG and 49 eyes with NTG were enrolled and strictly matched in age, refraction, and disease severity between POAG and NTG groups. The average, minimum, superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal GCIPL thickness, and the average, superior, temporal, inferior, and nasal retinal nerve fiber layer (RNFL) thickness were obtained by Cirrus optical coherence tomography (OCT). The diagnostic capabilities of OCT parameters were assessed by area under receiver operating characteristic (AUROC) curves. RESULTS: Among all the OCT thickness parameters, no statistical significant difference between NTG group and POAG group was found (all P>0.05). In discriminating NTG or POAG from normal subjects, the average and inferior RNFL thickness, and the minimum GCIPL thickness had better diagnostic capabilities. There was no significant difference in AUROC curve between the best GCIPL thickness parameter (minimum GCIPL) and the best RNFL thickness parameter in discriminating NTG (inferior RNFL; P=0.076) and indiscriminating POAG (average RNFL; P=0.913) from normal eyes. CONCLUSION: Localized GCIPL loss, especially in the inferior and inferotemporal sectors, is more common in NTG than in POAG. Among all the GCIPL thickness parameters, the minimum GCIPL thickness has the best diagnostic performance in differentiating NTG or POAG from normal subjects, which is comparable to that of the average and inferior RNFL thickness.     

神经节细胞复合体厚度检测在原发性开角型青光眼中的诊断价值

背景 青光眼以损害视网膜神经节细胞(RGCs)继而出现视野缺损为特征,高分辨率频域OCT(SD-OCT)可以准确可靠地定量分析黄斑区视网膜神经节细胞复合体(GCC)厚度. 目的 探讨黄斑区GCC厚度对原发性开角型青光眼(POAG)的诊断意义.方法 采用前瞻性诊断试验研究设计.于2015年11月至2016年4月在北京同仁医院连续纳入POAG患者70例和30名健康志愿者,应用RTVue SD-OCT对70例POAG患者和30名正常对照者进行黄斑区GCC厚度和视盘周围视网膜神经纤维层(RNFL)厚度检测,并行Humphrey视野检查,均纳入受检者的右眼进行统计.根据视野检查的平均缺损(MD)值将POAG分为早期、进展期和晚期,对各组受检眼平均GCC、上方GCC和下方GCC、平均RNFL、上方RNFL、下方RNFL、局部丢失体积(FLV)和整体丢失体积(GLV)进行比较;评估POAG患者GCC厚度、RNFL厚度与视野MD值的关系,采用曲线下面积(AUC)和受试者工作特征ROC曲线评价GCC厚度和RNFL厚度对POAG的诊断效率. 结果 与正常对照组比较,早期POAG组、进展期POAG组和晚期POAG组的平均GCC、上方GCC、下方GCC、平均RNFL、上方RNFL和下方RNFL均明显降低,FLV和GLV均明显升高,各组间总体比较差异均有统计学意义(均P＜0.001);与早期POAG组比较,进展期POAG组和晚期POAG组受检眼平均GCC值和平均RNFL厚度值均明显下降,GLV值明显增加,差异均有统计学意义(均P＜0.05);晚期POAG组受检眼上方RNFL厚度值明显低于早期POAG组,差异有统计学意义(P=0.003);晚期POAG组受检眼上方GCC值明显低于早期POAG组和进展期POAG组,差异均有统计学意义(均P＜0.001);与早期POAG组比较,进展期POAG组和晚期POAG组受检眼下方GCC和下方RNFL厚度值明显下降,FLV明显增加,差异均有统计学意义(均P≤0.01).POAG患者平均GCC、上方GCC和下方GCC、平均RNFL、上方RNFL和下方RNFL与MD值均呈线性正相关(r=0.624、0.583、0.601、0.571、0.447、0.537,均P＜0.001);POAG患者平均GCC与平均RNFL、上方GCC与上方RNFL以及下方GCC与下方RNFL均呈线性正相关(r=0.648、0.630、0.602,均P＜0.001).平均GCC、上方GCC、下方GCC、FLV、GLV、平均RNFL、上方RNFL和下方RNFL的AUC值分别为0.965、0.924、0.979、0.985、0.980、0.990、0.979和0.992(均P＜O.001).GCC参数中FLV与下方RNFL的AUC值比较,差异无统计学意义(P＞0.05). 结论 POAG患者下方GCC厚度更容易受到损伤,GCC参数中FLV和GLV是诊断POAG的敏感指标,GCC厚度可以作为诊断和判断POAG病情进展的有效指标.     

Ability of Stratus OCT to identify localized retinal nerve fiber layer defects in patients with normal standard automated perimetry results

PURPOSE: To evaluate the ability of Stratus optical coherence tomography (OCT; Carl Zeiss Meditec, Dublin, CA) with its internal normative database to discriminate between healthy eyes and eyes with a localized retinal nerve fiber layer (RNFL) defect not accompanied by a perimetric defect according to standard automated perimetry (SAP) (i.e., a preperimetric localized RNFL defect). METHODS: Data were retrospectively reviewed from 49 eyes of 49 subjects with preperimetric localized RNFL defects, and 49 healthy control eyes of 49 age-matched subjects, with classification into each group based primarily on red-free fundus photography RESULTS: The sensitivity and specificity of various OCT RNFL thickness parameters for identifying subjects with preperimetric localized RNFL defects was determined. In addition, the topographic relationship between the OCT-measured RNFL thickness and the localized RNFL defect location according to red-free fundus photography (i.e., the red-free RNFL defect) was examined. results. The sensitivity of the Stratus OCT RNFL thickness parameters ranged from 2.0% to 40.8%. The highest sensitivity was yielded using a criterion of > or =1 clock hour that were abnormal at the 5% level, which had a specificity of 85.7%. The OCT-measured RNFL thickness showed excellent topographic agreement with the red-free RNFL defect location. CONCLUSIONS: Although the sensitivity of current Stratus OCT RNFL thickness parameters is low for preperimetric localized RNFL defects, it appears that OCT has the potential to recognize such defects. Further study is needed to develop new analytical methods that will increase OCT sensitivity for identifying preperimetric localized RNFL damage.     

Reduction of posterior pole retinal thickness in glaucoma detected using the Retinal Thickness Analyzer

OBJECTIVES: To report evidence of changes in posterior pole retinal thickness in glaucoma and preperimetric glaucoma. DESIGN: Cross-sectional study. PARTICIPANTS: One hundred forty participants (140 eyes): 31 normal subjects, 33 with ocular hypertension, 43 with primary open-angle glaucoma (POAG), and 33 with preperimetric glaucoma. INTERVENTION: Posterior pole retinal thickness measurements using the Retinal Thickness Analyzer (RTA; Talia Technology Ltd., Neve-Ilan, Israel). MAIN OUTCOME MEASURES: The mean foveola average thickness (VAV), foveola minimum thickness (VMI), perifoveal average thickness (PFAV), perifoveal minimum thickness (PFMI), posterior pole average thickness (PPAV), and posterior pole minimum thickness (PPMI) were compared among the groups. The correlation between RTA values and visual field values was evaluated. The area under the receiver operator characteristic (AROC) curve, the optimal cut values, and the predictability values were estimated statistically between normal and the other groups using RTA values. RESULTS: Results from 91 eyes (65%) were included. Perifoveal average thickness values in preperimetric glaucoma (190.4+/-15.6 microm; mean+/-standard deviation) and POAG (185.7+/-16.8 microm) were significantly less than in normal controls (211.4+/-16.8 microm) and in eyes with ocular hypertension (211.6+/-15.9 microm). Perifoveal minimum thickness, PPAV, and PPMI were significantly less in preperimetric glaucoma and in POAG than in normal controls; VAV and VMI were not significantly different among groups. Perifoveal average thickness, PFMI, PPAV, and PPMI significantly correlated with visual field mean defect (R = -0.38, -0.42, -0.36, and -0.41, respectively) and loss of variance (R = -0.29, -0.30, -0.26, and -0.17, respectively). The AROC using PFAV, PFMI, PPAV, and PPMI was significantly larger than 0.5 between normal and preperimetric glaucoma (0.83, 0.92, 0.82, and 0.87, respectively) and between normal and POAG eyes (0.86, 0.97, 0.83, and 0.93, respectively). When using the PFMI, the sensitivities at the minimum specificity cutoffs of 90% were highest in comparisons between normal and preperimetric glaucoma (sensitivity, 75%) and between normal and POAG eyes (sensitivity, 95%). By the logistic regression analysis, PFAV, PFMI, PPAV, and PPMI distinguished between normal and preperimetric glaucoma (R(2) = 0.30, 0.49, 0.27, and 0.37, respectively) and between normal and POAG (R(2) = 0.37, 0.59, 0.31, and 0.51, respectively). CONCLUSIONS: Posterior pole retinal thickness decreases in early- and moderate-stage glaucoma. Reduction of perifoveal retinal thickness is correlated with visual field loss. In vivo measurements of posterior pole retinal thickness may help distinguish between normal and glaucomatous eyes.     

合并高度近视的原发性开角型青光眼视野分析(英文)

目的:探讨合并高度近视和非高度近视的原发性开角型青光眼早期视野改变特点及其与视网膜神经纤维层缺损的关系。方法:利用Humphrey750型计算机自动视野计对17例(21眼)合并高度近视的POAG和16例(17眼)非高度近视的POAG及20例(25眼)单纯高度近视以及17例(19眼)正常组进行静态中心阈值视野检查,利用OCT进行视盘周围RNFL厚度检查。比较正常组、合并高度近视POAG组、非高度近视POAG组、单纯高度近视组视野缺损的总偏差概率图;比较正常组、合并高度近视的POAG组、非高度近视的POAG组以及单纯高度近视组的MD值、PSD值、上方、下方、鼻侧、颞侧平均光敏感度;比较正常组、合并高度近视的POAG组、非高度近视的POAG组以及单纯高度近视组的平均、上方、下方、鼻侧、颞侧RNFL厚度;分别分析合并高度近视的POAG组、非高度近视的POAG组以及单纯高度近视组各组内上方、下方、鼻侧、颞侧各象限RNFL厚度与视野对应部位的缺损之间的关系以及各组视野特点。结果:合并高度近视的早期POAG患者在总偏差概率图中多表现为普遍敏感性降低,而在模式偏差概率图则更多表现出POAG早期视野缺损;平均缺损值显著高于其它各组。合并高度近视的POAG患者无论平均光敏感度还是MD、PSD值均与其他三组有显著差异(P<0.05);单纯高度近视组与非高度近视的POAG组的各象限平均光敏感度的差异均有显著性(P<0.05)。合并高度近视的POAG组较非高度近视的POAG组以及单纯高度近视组RNFL厚度明显变薄;此三组较正常组RNFL厚度变薄;单纯高度近视组与非高度近视的POAG组的平均RNFL厚度及各象限RNFL厚度的差异均有显著性(P<0.05);各组四个象限RNFL厚度与视野对应部位的缺损相关。结论:在进行合并高度近视的POAG视野结果判定时要依靠模式偏差概率图,其特点是伴有生理盲点扩大和外移。OCT能够反映合并高度近视的POAG的RNFL厚度的改变,及RNFL厚度与视野缺损的相关性有助于在合并高度近视POAG中的临床诊断。     

视网膜神经纤维层及黄斑厚度不对称参数在POAG早期诊断中的应用

目的:研究视网膜神经纤维层及黄斑厚度不对称参数在原发性开角型青光眼(primary open angle glaucoma,POAG)早期诊断中的应用.方法:临床研究对象包括正常受试者50例100眼和单侧早期POAG的患者50例100眼,使用Humphrey视野计记录视野平均缺损(MD)和模式标准差(PSD)、Cirrus HD-OCT扫描视网膜神经纤维层(RNFL)厚度、黄斑厚度,并进行后极部不对称参数分析,后者主要为双眼RNFL厚度及黄斑厚度的比较、眼内上/下方RNFL厚度的比较,眼内上/下方黄斑厚度的比较,并计算所有OCT参数的曲线下面积(AUC).结果:除眼内上/下方视盘RNFL厚度差值比较无统计学意义(P=0.265),两组研究对象视盘RNFL厚度、黄斑厚度、双眼上方/下方/总体RNFL厚度或黄斑厚度的不对称性差异、眼内上/下方黄斑厚度的差值均有统计学意义(P<0.05).视盘RNFL总体厚度的AUC值为0.827.视盘RNFL总体厚度差值的敏感性最高,95%特异性的敏感度为67%.黄斑总体厚度平均值的AUC值为0.822.黄斑厚度差值的AUC值为0.777.结论:后极部视网膜厚度不对称参数分析对早期POAG患者提供了良好的诊断效能,且与RNFL厚度的诊断精度相似.然而,眼内不对称分析参数表现不佳,需要在其用于早期单侧青光眼诊断之前进一步细化.     

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μ

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颞下方,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颞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．O％。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RTVueOCT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。     

Retinal nerve fiber layer analysis: relationship between optical coherence tomography and red-free photography.

PURPOSE: Comparison of retinal nerve fiber layer (RNFL) thickness measurements using optical coherence tomography (OCT) to the clinical standard red-free photography (evaluated semiquantitatively), in relation to functional visual field damage in primary open-angle glaucoma (POAG) patients, ocular hypertensives, and POAG suspects. METHODS: Concurrent, cross-sectional study. In four age-matched groups (42 patients with early to moderate POAG, 34 ocular hypertensives, 22 POAG suspects, and 25 normal controls), RNFL was assessed with OCT, standardized red-free photographic scoring method and standard achromatic perimetry. RESULTS: OCT RNFL thickness decreases with increased RNFL damage (detected with red-free photography). The global average OCT RNFL thickness correlated significantly with the photographic total RNFL score (r = .650, P = .0001). Both OCT and photographic scoring system were able to find significantly thinner RNFL in the glaucoma group as compared with normals (P = .0001 for both), ocular hypertensives (P = .0001 for both), and suspects (P = .0001 for both). However, neither OCT nor photography could significantly differentiate between ocular hypertensives, suspects, and normals. Both OCT and photography were significantly correlated with VF loss. For the percentage of VF points depressed <5%, the correlation was highest for OCT (r = -0.615 for OCT and r = -0.476 for photography). OCT had a higher diagnostic accuracy than photography (86% and 77%, respectively). CONCLUSION: For RNFL thickness measurements, the presence of high correlations between OCT, photographic scores, and functional visual field loss suggest the validity of OCT measurements. The higher diagnostic accuracy of OCT RNFL measurements suggests its potential advantage for detection of early cases of glaucoma.