光学相干断层扫描在视网膜神经纤维层检测中的应用

光学相干断层扫描术是一种新的光学诊断技术,可进行活体眼组织显微结构的非接触式、非侵入性断层成像。首先开发运用于眼后节,现已广泛应用于临床。其在视网膜神经纤维层检测中的应用有助于对青光眼。高度近视及糖尿病视网膜病变等疾病的诊治。现就光学相干断层扫描在视网膜神经纤维层检测中的应用作一综述。     

Retinal sensitivity and retinal nerve fiber layer thickness measured by optical coherence tomography in glaucoma

PURPOSE: To define the relationship between retinal light sensitivity and peripapillary retinal nerve fiber layer (RNFL) thickness as measured using the Stratus optical coherence tomograph (OCT). DESIGN: Prospective study. METHODS: SETTING: Institutional. STUDY POPULATION: A total of 126 healthy subjects, 42 patients with ocular hypertension (OHT) and 64 patients with primary open-angle glaucoma (POAG) were examined by the 24/II program of the Humphrey Field Analyzer (Carl Zeiss Meditec, Inc, Dublin, California, USA), and the Fast RNFL Thickness examination of the OCT. Individual visual field (VF) test scores and peripapillary RNFL thickness measurements were grouped into six topographically corresponding sectors whose mean values were then calculated. One eye per patient was randomly chosen. MAIN OUTCOME MEASURES: The correlations between mean retinal sensitivity (expressed both in decibel and unlogged scales) and RNFL thickness were described with linear and logarithmic regression analyses. RESULTS: With reference to all 232 individuals, the equation that best explained the model was logarithmic when using the decibel scale, and either linear or logarithmic when using the unlogged scale. A statistically significant, age-adjusted correlation between function and structure was found in most sectors both using the decibel (logarithmic regression analysis r(2) 0.24 to 0.61, P < .001), and the unlogged scale (r(2) 0.37 to 0.53, P < .001 in both linear and logarithmic regression analyses). CONCLUSIONS: When using the decibel scale, the logarithmic equation may better explain the function/structure relationship between retinal sensitivity and OCT-measured RNFL thickness along a wide spectrum of glaucoma continuum. These results support the need to combine functional and structural tests in the detection of early glaucoma.     

Reproducibility of retinal nerve fiber layer measurements across the glaucoma spectrum using optical coherence tomography

Purpose:

The purpose was to determine intra-session and inter-session reproducibility of retinal nerve fiber layer (RNFL) thickness measurements with the spectral-domain Cirrus optical coherence tomography (OCT)^® (SD-OCT) in normal and glaucomatous eyes, including a subset of advanced glaucoma.

Materials and Methods:

RNFL measurements of 40 eyes of 40 normal subjects and 40 eyes of 40 glaucomatous patients including 14 with advanced glaucoma were obtained on the Cirrus OCT^® (Carl Zeiss Meditec, Dublin, CA, USA) five times on 1-day (intra-session) and on five separate days (inter-session). Intraclass correlation coefficient (ICC), coefficient of variation (COV), and test-retest variability (TRT) values were calculated for mean and quadrant RNFL in each group separately. Reproducibility values were correlated with age and stage of glaucoma.

Results:

For intra-session reproducibility, the ICC, COV, and TRT values for mean RNFL thickness in normal eyes were 0.993, 1.96%, and 4.02 µm, respectively, 0.996, 2.39%, and 3.84 µm in glaucomatous eyes, and 0.996, 2.41%, and 3.70 µm in advanced glaucoma. The corresponding inter-session values in normal eyes were 0.992, 2.16%, and 4.09 µm, 0.995, 2.62%, and 3.98 µm in glaucoma and 0.990, 2.70%, and 4.16 µm in advanced glaucoma. The mean RNFL thickness measurements were the most reproducible while the temporal quadrant had the lowest reproducibility values in all groups. There was no correlation between reproducibility and age or mean deviation on visual fields.

Conclusions:

Peripapillary RNFL thickness measurements using Cirrus OCT^® demonstrated excellent reproducibility in normal and glaucomatous eyes, including eyes with advanced glaucoma. Mean RNFL thickness measurements appear to be the most reproducible and probably represent the best parameter to use for longitudinal follow-up.     

Evaluation of retinal nerve fiber layer, optic nerve head, and macular thickness measurements for glaucoma detection using optical coherence tomography

PURPOSE: To compare the ability of optical coherence tomography retinal nerve fiber layer (RNFL), optic nerve head, and macular thickness parameters to differentiate between healthy eyes and eyes with glaucomatous visual field loss. DESIGN: Observational case-control study. METHODS: Eighty-eight patients with glaucoma and 78 healthy subjects were included. All patients underwent ONH, RNFL thickness, and macular thickness scans with Stratus OCT during the same visit. ROC curves and sensitivities at fixed specificities were calculated for each parameter. A discriminant analysis was performed to develop a linear discriminant function designed to identify and combine the best parameters. This LDF was subsequently tested on an independent sample consisting of 63 eyes of 63 subjects (27 glaucomatous and 36 healthy individuals) from a different geographic area. RESULTS: No statistically significant difference was found between the areas under the ROC curves (AUC) for the RNFL thickness parameter with the largest AUC (inferior thickness, AUC = 0.91) and the ONH parameter with largest AUC (cup/disk area ratio, AUC = 0.88) (P = .28). The RNFL parameter inferior thickness had a significantly larger AUC than the macular thickness parameter with largest AUC (inferior outer macular thickness, AUC = 0.81) (P = .004). A combination of selected RNFL and ONH parameters resulted in the best classification function for glaucoma detection with an AUC of 0.97 when applied to the independent sample. CONCLUSIONS: RNFL and ONH measurements had the best discriminating performance among the several Stratus OCT parameters. A combination of ONH and RNFL parameters improved the diagnostic accuracy for glaucoma detection using this instrument.     

Measurement of retinal nerve fiber layer in primary acute angle closure glaucoma by optical coherence tomography

PURPOSE: To detect the objective structure changes of the retinal nerve fiber layer (RNFL) in primary acute angle closure glaucoma (PAACG) and to evaluate the efficacy of quantitative assessment of RNFL thickness with optical coherence tomography (OCT). PATIENTS AND METHODS: Forty patients who had unilateral PAACG attack in the first 4 months after remission and 40 single eyes from 40 normal controls were enrolled in this cross-sectional study. For all cases, PAACG had resolved after treatment. Using the Stratus OCT, the RNFL was assessed in both eyes within 2 weeks after PAACG, and again after 4 months. The OCT parameters were compared among normal controls, the unaffected fellow eyes, and the attacked eyes within 2 weeks and at 4 months after remission. Of the 40 patients, 14 PAACG patients underwent 5 times measurements, respectively, within 2 weeks and at 1, 2, 3, and 4 months after intraocular pressure was controlled. Differences between affected eyes and fellow eyes for the mean RNFL thickness at various periods after remission were also compared. RESULTS: RNFL of the PAACG eyes became thicker (average: 142.6+/-22.9 microm) within 2 weeks and thinner (average: 83.6+/-19.8 microm) at 4 months after acute strike compared with the fellow unaffected and normal eyes. Significant differences were demonstrated comparing the average and 4-quadrant RNFL thicknesses for the attacked eyes with those of the normal controls (P<0.001 to 0.001) and fellow eyes (P<0.001 to 0.002) using 1-way analysis both within 2 weeks and at 4 months after remission. There was significant difference in the RNFL thickness among the 5 time points after intraocular pressure controlled in the acute strike group (P<0.001). CONCLUSIONS: Using OCT, RNFL thickness was found to increase in eyes immediately after an episode of PAACG followed by a decrease in RNFL thickness over time (up to 3 mo). This detection can aid in better understanding the pathologic retinal changes involved in PAACG, and help in the assessment and management of these patients.     

Analysis of peripapillary retinal nerve fiber layer and inner macular layers by spectral-domain optical coherence tomography for detection of early glaucoma

AIM: To analyze the diagnostic capabilities of peripapillary retinal nerve fiber layer (pRNFL) thickness and segmented inner macular layer (IML) thickness measured by spectral-domain optical coherence tomography for detection of early glaucoma. METHODS: Fifty-three patients with primary open angle glaucoma (POAG), 60 patients with normal tension glaucoma (NTG) and 32 normal control subjects were enrolled. Thicknesses of pRNFL, total macular layers (TML), and the IML, including macular RNFL (mRNFL) and macular ganglion cell layer (mGCL) were assessed. The areas under the receiver operating characteristic curves (AROC) were calculated to compare the diagnostic power of different parameters. RESULTS: There were no differences in the parameters of pRNFL, TML, and IML between POAG and NTG groups. The thicknesses of superior and inferior mGCL showed significant correlation with mean deviation of visual field (R2=0.071, P=0.004; R2=0.08, P=0.002). The mGCL thickness significantly correlated with the pRNFL thickness in the superior and inferior quadrants (R2=0.156, P<0.001; R2=0.407, P<0.001). The thickness of the inferior-outer sector of macula had greater AROCs than those in the inferior-inner sector of macula. The AROCs for superior (0.894) and inferior (0.879) pRNFL thicknesses were similar with the AROCs for superior (0.839) and inferior mGCL (0.864) thicknesses. Sensitivities at 80% specificity for global pRNFL, inferior-outer mGCL and inferior-outer mRNFL thicknesses were 0.938, 0.867, and 0.725, respectively. CONCLUSION: The diagnostic capability of the mGCL thickness is comparable to that of the pRNFL thickness in patients with early glaucoma. The inferior-outer sector of IML has a better diagnostic capability than the inferior-inner sector of IML for detection of early glaucoma.     

Evaluation of optic nerve head and retinal nerve fiber layer in early and advance glaucoma using frequency-domain optical coherence tomography

Background  

Recent research has suggested that structural significant damage in the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) may precede visual field loss. Optical coherence tomography (OCT) has become an important tool which has contributed to earlier and more accurate diagnosis of glaucoma over the past decade. RTVue OCT was the first frequency-domain OCT (FD-OCT) device to offer comprehensive glaucoma analysis including an RNFL thickness map and optic disc morphology. The aim of this study was to evaluate and compare the performance of FD-OCT for the detection of early and advanced glaucoma from normal eyes.     

光学相干断层成像术对原发性开角型青光眼视网膜神经纤维层的定性和定量检测

OBJECTIVE: To study the characteristics of optical coherence tomography (OCT) of primary open angle glaucoma (POAG), the difference of retinal nerve fiber layer (RNFL) thickness between normal persons and patients with POAG and the correlation between RNLF and visual field index. METHODS: Eighty-three cases (149 eyes) with POAG and 83 normal persons (150 eyes) were tested by OCT with circular scans around the optic nerve head (diameter = 3.46 mm) to observe the features of OCT. Statistic analysis was taken to compare the difference of RNFL thickness in quadrants and means between normal and glaucomatous group, and the difference of the thickness among the stages in POAG. Linear correlation and regression analysis was used to show the correlation between RNFL thickness and visual field index of 115 eyes of glaucomatous patients. RESULTS: The RNFL thickness measured by OCT in normal subjects is the thickest in superior and inferior quadrants, less in thickness in temporal and the thinnest in nasal quadrant. The curve showed double peaks. The RNFL of glaucomatous patients showed local thinness or defect, diffuse thinness or combination of the above two types. The mean RNFL thickness of normal group was (90.1 +/- 10.8) microm, (140.4 +/- 10.5) microm, (85.2 +/- 14.0) microm, (140.4 +/- 9.7) microm and (114.2 +/- 6.0) microm, of glaucomatous group was (56.0 +/- 31.0) microm, (81.0 +/- 36.3) microm, (47.1 +/- 27.5) microm, (73.4 +/- 38.4) microm and (64.6 +/- 28.8) microm in temporal, superior, nasal, inferior quadrant and the whole area, respectively. There is significant difference of RNFL thickness between the normal and glaucomatous group (P < 0.000), and there are significant differences among the three stages (early, developing and late) of glaucomatous group (P < 0.000). There is a close negative relationship between RNFL thickness and visual field index (r = -0.796, P < 0.0001). The sensitivity and specificity of RNFL thickness measured by OCT were 93.3% and 92.0%, respectively. CONCLUSION: OCT can quantitatively measure the RNFL thickness and show the difference of RNFL between normal persons and glaucomatous patients. The RNFL thickness gradually decreases while visual field defect increases with the development of POAG.     

OCT测量视网膜神经纤维层厚度在青光眼诊断中的研究进展

青光眼是一种进展性视神经疾病,它能引起视神经结构改变,最终导致不可逆视功能损害。青光眼的早期诊断对保护视功能有重要的意义。光学相关断层扫描仪可以定量检测视网膜神经纤维层厚度,为早期诊断青光眼,监测视神经损害及指导青光眼的治疗提供了新的思路。本文主要反映该技术在青光眼诊断中的研究进展。许多研究都发现光学相关断层扫描仪检测的视网膜神经纤维层厚度在有视野改变的青光眼中有明显改变,且与视野损害在位置和严重程度上有很好的相关性,但仍缺乏有力的纵向研究来评价其在无视野改变青光眼中的诊断价值。     

Evaluation of the glaucomatous damage on retinal nerve fiber layer thickness measured by optical coherence tomography

PURPOSE: To evaluate the relationship between visual field and retinal nerve fiber layer (RNFL) thickness measured by optical coherent tomography (OCT) and to assess the diagnostic ability of OCT to distinguish between early glaucomatous or glaucoma-suspect eyes from normal eyes. DESIGN: Retrospective, non-randomized, cross-sectional study. METHODS: A total of 160 eyes of 120 normal Japanese adults, 23 eyes of 16 patients with ocular hypertension, 38 eyes of 35 glaucoma-suspect patients, and 237 glaucomatous eyes of 140 glaucoma patients were enrolled in the study. The glaucoma group included 89 early glaucomatous eyes. Thickness of the RNFL around the optic disk was determined with three 3.4-mm diameter circle OCT scans. Average and segmental RNFL thickness values were compared among all groups. The correlation between mean deviation and RNFL thickness in glaucomatous eyes was also analyzed. Receiver operating characteristic (ROC) curve area was calculated to discriminate normal eyes from early glaucomatous or glaucoma-suspect eyes. RESULTS: A significant relationship existed between the mean deviation and RNFL thickness in all parameters excluding the 3-o'clock area. The average RNFL thickness had the strongest correlation in all parameters (r = -0.729, P <.001). Retinal nerve fiber layer thickness at the 7-o'clock inferotemporal segment had the widest areas under the ROC curves in all parameters for early glaucomatous eyes (0.873). CONCLUSIONS: Measurement of RNFL thickness by OCT is useful in detecting early RNFL damage. Furthermore, OCT measurements of RNFL thickness may provide clinically relevant information in monitoring glaucomatous changes.     

频域OCT检测青光眼视乳头及黄斑区容积改变的初步研究

目的通过比较青光眼和正常人视乳头旁神经纤维层容积及黄斑区神经上皮层容积的差异,分析青光眼患者视乳头和黄斑立体结构特征,探讨频域光学相干断层成像术（ED-OCT）对青光眼的诊断价值。方法采用FD-OCT对33例青光眼患者和33例正常人行视乳头及黄斑区视网膜三维立体扫描,比较青光眼患者和正常人视乳头旁和黄斑区立体结构参数差异;采用直线回归分析各参数与视野平均缺损值的相关性;计算各参数诊断青光眼的受试者工作特征曲线下面积及灵敏度、特异度。结果青光眼组和正常对照组黄斑区容积比较除黄斑中心凹直径1 mm范围内的容积差异无统计学意义外,其余8个区域差异均有统计学意义;视乳头旁神经纤维层容积（mm3）比较颞（青光眼组0.29±0.02,对照组0.32±0.04）、上（青光眼组0.49±0.28,对照组0.55±0.06）、鼻（青光眼组0.34±0.17,对照组0.35±0.05）、下（青光眼组0.47±0.29,对照组0.56±0.06）四个区域差异均有统计学意义。各参数与视野平均缺损的相关性均有统计学意义,相关系数最高的是黄斑区内环下象限的视网膜神经上皮层容积（r=0.58,P〈0.01）;受试者工作特征曲线分析结果显示黄斑区外环下象限视网膜神经上皮层容积（AROC 0.79;敏感度82%）与视乳头旁下象限神经纤维层容积（AROC 0.81;敏感度81%）具有最大面积及最佳敏感度。结论 FD-OCT检测黄斑区及视乳头旁神经纤维层立体结构特征和容积等参数的改变,有助于临床青光眼的诊断。     

糖尿病患者视网膜神经纤维层OCT测量的形态学观察

背景 传统的观点认为,糖尿病视网膜病变（DR）的主要病理机制是视网膜的微血管病变,但近年来发现糖尿病患者的视功能改变发生于DR的微血管病变发生之前,传统的观点无法解释糖尿病患者在出现可辨认的血管改变之前已有视功能改变的现象. 目的 应用频域光学相干断层扫描（OCT）观察无视网膜血管改变的糖尿病患者、非增生性糖尿病视网膜病变（NPDR）患者视网膜神经纤维层（RNFL）厚度的改变,分析糖尿病患者RNFL厚度与DR的关系. 方法 收集2012年10月至2013年9月于山西省眼科医院就诊且确诊的2型糖尿病患者56例60眼,按DR国际临床分型标准分为非糖尿病视网膜病变（NDR）组26例30眼和NPDR组（轻中度NPDR）30例30眼,同期纳入年龄和性别匹配的健康志愿者30人30眼作为对照.应用OCT对受试者行RNFL厚度测量,包括视盘周围及中心凹周围视网膜360°平均RNFL厚度及鼻上、颞上、颞侧、颞下、鼻下、鼻侧区域的RNFL厚度,比较各组患者RNFL厚度的变化. 结果 NDR组、NPDR组和正常对照组受试者视盘周围平均RNFL厚度分别为（97.46±8.65）、（100.69±16.35）和（109.22±8.69）μm,其中NDR组、NPDR组受试者视盘周围平均RNFL厚度值均低于正常对照组,差异均有统计学意义（P=0.001、0.006）;NDR组视盘周围各象限RNFL厚度均较正常对照组变薄,颞上、颞侧、颞下和鼻下象限RNFL厚度的差异均有统计学意义（P=0.001、0.001、0.001、0.010）;NPDR组视盘周围各象限RNFL厚度均较正常对照组变薄,其中颞上、鼻侧区域RNFL厚度的差异均有统计学意义（P=0.001、0.046）.NDR组、NPDR组和正常对照组平均黄斑区RNFL厚度分别为（33.47±3.39）、（36.81±3.21）、（38.18±2.16）μm,NDR组、NPDR组受试者黄斑区平均RNFL厚度值均低于正常对照组,其中NDR组与正常对照组比较差异有统计学意义（P=0.001）;NDR组黄斑区各区域RNFL厚度较正常     

Retinal nerve fiber layer defect patterns in primary angle-closure and open-angle glaucoma: A comparison using optical coherence tomography

Purpose  

To compare the patterns of retinal nerve fiber layer (RNFL) thickness loss in primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) using optical coherence tomography (OCT).