OCT-GPA技术在监测原发性开角型青光眼进展中的作用

目的:探讨频域光学相干断层扫描(spectral-domain optical coherence tomography,SD-OCT)的青光眼进展引导分析(guided progression analysis,GPA)技术在判断原发性开角型青光眼(primary open angle glaucoma,POAG)进展中的作用.方法:随访36例45眼POAG患者2a,行视盘OCT、眼底照相及视野检查,至少有4次可信的OCT检查结果.根据视野结果将受试者划分为早期和中晚期.根据基线眼底照相判断视网膜神经纤维层(retinal nerve fiber layer,RNFL)情况(弥漫RNFL缺损、局限缺损、无缺损及无法判断缺损者).由两位青光眼专家根据眼底照相及视野结果将其分为进展型及非进展型.分析OCT-GPA技术同视野、眼底照相判断的一致性,计算灵敏度及特异度.结果:眼底照相或视野判断为POAG进展者18眼(40％),OCT-GPA判断POAG进展者15眼(33％).以眼底照相及视野判断为标准,OCT-GPA技术的灵敏度和特异度为38.9％和70.4％.OCT-GPA同眼底照相及视野判断结果的一致性较差(κ=0.211、-0.036).以眼底照相为标准,仅眼底照相判断进展者6眼,2眼为新的盘周出血,4眼为盘沿变窄;仅OCT-GPA判断为进展者9眼,8眼为早期,其中5眼基线眼底照相提示弥漫性RNFL缺损,2眼无明显RNFL缺损.以视野为判断标准,仅视野判断进展者7眼,5眼为中晚期;仅OCT-GPA判断进展者12眼,10眼为早期.结论:OCT-GPA在判断早期POAG进展及弥漫性RNFL缺损上有一定优势,但最好联合视野及眼底照相检查共同判断.     

合并高度近视的原发性开角型青光眼视野分析

目的探讨合并高度近视的原发性开角型青光眼（POAG）视野改变特点及其与视网膜神经纤维层（RNFL）缺损的关系。设计回顾性病例对照研究。研究对象合并高度近视的POAG组17例（21眼）、非高度近视的POAG组16例（17眼）、单纯高度近视非POAG组20例（25眼）以及正常组17例（19眼）。方法用Humphrey50型视野计进行静态中心阈值视野检查，利用相干光断层扫描术（OCT）进行视盘周围RNFL厚度检查。主要指标上方、下方、鼻侧、颞侧象限视野的平均光敏感度，MD值、PSD值；各象限RNFL厚度。结果合并高度近视的早期POAG患者总偏差概率图多表现为普遍敏感性降低，而模式偏差概率图则更多表现出POAG早期视野缺损；其平均缺损值显著高于其它各组。合并高度近视的POAG患者平均光敏感度、MD、PSD值均与其他三组有统计学意义差异（P〈0．05）；单纯高度近视组与非高度近视POAG组的PSD值及上、下象限平均光敏感度的差异均有统计学意义（P〈0．05），而鼻、颞象限平均光敏感度的差异均无统计学意义（P〉0．05）。合并高度近视的POAG组较非高度近视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厚度及上、下象限RNFL厚度的差异均有统计学意义（P〈0．05），而鼻、颞象限RNFL厚度的差异则无统计学意义（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。OCT显示的RNFL厚度与视野对应部位的缺损相关。（眼科，2007，16：24．28）     

傅立叶OCT和海德堡激光眼底扫描仪在开角型青光眼早期诊断中的应用

背景研究表明,视网膜神经纤维层（RNFL）缺损是青光眼早期损害的重要表现,如何准确地定量检测RNFL的厚度变化是青光眼早期诊断及监测青光眼病情进展的关键步骤之一。目的对傅立叶OCT、海德堡激光眼底扫描仪（HRT—Ⅲ）测量青光眼患者的RNFL厚度以及视盘的各项参数进行分析,对二者在青光眼早期诊断中的作用进行临床评价。方法收集可疑开角型青光眼（SOAG）患者26例40眼、原发性开角型青光眼（POAG）患者29例48眼以及正常对照组27例48眼。应用傅立叶OCT、HRT—Ⅲ、Humphrey 750-i型全自动视野计对所有研究对象分别进行视盘面积,视杯面积,杯盘面积比,盘沿面积,盘沿容积,视盘上方、下方、颞侧、鼻侧象限的RNFL厚度等参数测定和视野检查,对不同受检者测得的各项参数进行分析和比较,分别与视野平均缺损值做相关分析,评价不同参数对于青光眼RNFL损伤的诊断价值。结果傅立叶OCT和HTR—Ⅲ检测对正常对照组检查结果均证实RNFL从厚到薄依次为视盘下方、上方、颞侧、鼻侧象限,SOAG组和POAG组RNFL厚度变薄的顺序依次为视盘下方、上方、颞侧、鼻侧象限,各部位厚度改变的差异均有统计学意义（P〈0．05）,SOAG组和POAG组患者盘沿面积、杯盘面积比、视杯面积、盘沿容积与正常对照组比较,差异均有统计学意义（P〈0．05）。对3组患者的检测表明,傅立叶OCT与HTR-Ⅲ检测视盘上方象限、下方象限的测定之间存在着正相关关系（r=0．362、r=0．441、r=0．395,P〈0．05）;2种检查方法所测得3个组视杯容积、视杯面积、盘沿容积、杯盘面积比呈正相关（P〈0．05）。在POAG组中,傅立叶OCT测得视盘参数中的盘沿面积、盘沿容积、视杯容积、杯盘面积比与视野的平均缺损值间的相关系数分别为0．284、0．286、0．340、0．371（P〈0．05）;HRT-Ⅲ测得视盘参数中的盘沿面积、盘沿容积、杯盘面积比与视野的平均缺损值间的相关系数分别为0．339、0．859、0．422（P〈0．05）。结论傅立叶OCT和HRT-Ⅲ检测的视盘参数结果接近,且均与视野的平均缺损值有较好的相关性;所检测杯盘面积比、盘沿面积和视盘上方象限、下方象限的RNFL厚度的改变在青光眼早期诊断中均有重要价值。     

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。     

OCT检测POAG患者RNFL厚度的改变及视野缺损情况

目的:探讨OCT检测原发性开角型青光眼(POAG)患者视网膜神经纤维层厚度(RNFL)的改变及视野缺损情况.方法:回顾性病例系列研究.将POAG患者158例158眼作为POAG组,其中早期81眼,中期47眼,晚期30眼,选取同期体检无眼部相关疾病者50例50眼作为对照组.检测上方、下方、鼻侧、颞侧RNFL厚度及视野平均缺损值,POAG患者随诊3mo观察连续性变化.结果:POAG组随诊前及随诊3mo上方、下方、鼻侧、颞侧RNFL厚度均低于对照组,视野平均缺损值多于对照组,差异有统计学意义(P<0.05);早期POAG患者各部位RNFL厚度、视野平均缺损值与对照组比较差异无统计学意义(P>0.05),但各部位RNFL厚度高于中期、晚期POAG患者,视野平均缺损值少于中期、晚期POAG患者,差异有统计学意义(P<0.05);POAG组随诊前和随诊3mo各部位RNFL、视野平均缺损值比较差异无统计学意义(P>0.05).Pearson相关分析显示,上方、下方、鼻侧、颞侧RNFL厚度与视野平均缺损值均呈负相关关系(r=-0.719、-0.615、-0.681、-0.518,均P<0.05).结论:OCT可监测POAG患者RNFL厚度变化,且与视野平均缺损呈负相关关系,可用于POAG早期诊断.     

原发性开角型青光眼视盘损伤可能度分级与光学相干断层扫描一致性研究

目的　探究原发性开角型青光眼(primary open-angle glaucoma,POAG)患者眼底照相视盘损伤可能度(disc damage likelihood scale,DDLS)分级与光学相干断层扫描(optical coherence tomography,OCT)是否具有一致性。方法　采用回顾性分析,以本院2014年1月至2018年7月确诊的同时具有眼底照相和OCT检查结果的POAG患者为研究对象,由2名医师进行DDLS分级,采集患者基本信息、DDLS分级结果,Heidelberg OCT检测视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度及同期视野平均缺损值,进行统计学分析。结果　纳入患者78例（144眼）,男女比例为34∶44,年龄15~83(56.82±17.88)岁。视盘不同方向RNFL厚度的变薄程度差异有统计学意义（P<0.001）,其中视盘颞上侧与颞下侧的RNFL厚度变薄程度均显著高于其他方向（均为P<0.001）。DDLS分级与各方向RNFL厚度（P<0.05）、DDLS分级与视野缺损程度（P<0.001）、各方向RNFL厚度与视野缺损程度（P<0.001）均存在显著相关性,其中DDLS分级与整体、鼻下侧RNFL厚度的相关性最强（均为P<0.05）,视野缺损程度与整体、颞上侧RNFL厚度相关性最强（均为P<0.001）。结论　POAG的两种常用结构检查方法的结果（DDLS分级、OCT测得视盘RNFL变薄情况）具有一致性,且二者与视野缺损程度均密切相关,结果具有一致性。     

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。     

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.     

光学相干断层扫描在判断垂体瘤患者术后视功能预后中的应用

目的应用光学相干断层扫描（OCT）测量视网膜神经纤维层（RNFL）厚度,探讨其在判断垂体瘤患者术后视功能预后的作用。方法选取2007年1月至2008年12月经蝶窦垂体腺瘤切除术病理检查、MRI确诊的垂体瘤伴视交叉压迫患者16例（32眼）,其中男性7例,女性9例,年龄23—67岁,平均（44．4±14．71岁。在术前、术后1周、术后3个月,分别采用标准对数视力表、Stratus OCT Ⅲ和Humphrey视野分析仪．检测患者的矫正视力、平均RNFL厚度、4个象限的RNFL厚度和视野指数平均缺损（MD）。根据术前视野缺损情况及随访变化,将研究对象分为3组：A组即术前有视野缺损,术后视野缺损无改善或加重;B组即术前有视野缺损,术后视野缺损改善;C组为术前及术后均无视野缺损。对所得数据进行相关统计学分析。结果16例（32眼）患者中,A组10眼,B组11眼,C组11眼。术前有视野缺损者,平均RNFL越厚,视野缺损改善的比例越大（OR=1．189,P=0．020）;下方RNFL厚度对视野缺损改善有显著影响fOR=6．093,P=0．000）,而术前MD对术后视野缺损改善无显著影响（OR=0．955,P=0．509）。术后1周及术后3个月,B组的视力均较术前提高（t=3．893,P=0．003;t=4．310,P=0．002）,而A组和C组视力较术前差异均无统计学意义。术后3个月,A组平均RNFL厚度及颞侧RNFL厚度均较术前变薄（t=-2．378,P=0．041;（t=-2．630,P=0．025）,而上方、下方及鼻侧RNFL厚度较术前差异均无统计学意义：B组的平均RNFL厚度、鼻侧及颞侧RNn．厚度均较术前增厚（t=2．438,P=0．035;t=2．630;Pl-0．025;t=4．457,P=0．001）;C组平均RNFL厚度及4个象限RNFL厚度手术前后差异均无统计学意义。结论运用OCT检测垂体瘤患者的平均RNFL厚度及下方RNFL厚度,可作为判断患者术后短期视功能预后的较敏感指标：手术前后RNFL厚度的变化与视野缺损的变化具有较好的一致性。     

频域光学相干断层扫描（OCT）测量视盘参数及视网膜厚度在早期青光眼诊断中的作用

目的　探讨频域光学相干断层扫描（optical coherence tomography,OCT）测量视盘参数及视网膜厚度在早期青光眼诊断中的作用。方法　采用频域OCT测量40例（40眼）健康志愿者（对照组）和85例（85眼）原发性开角型青光眼（primary open angle glaucoma,POAG）患者［早期青光眼亚组（n=36）和进展期青光眼亚组（n=49）］视盘参数及视网膜神经纤维层（retinal nerve fiber layer,RNFL）厚度,比较各组RNFL厚度、视盘参数并与视野平均缺损（mean deviation,MD）值进行相关性分析,采用ROC曲线下面积评估视盘周围区RNFL厚度及视盘参数在青光眼中的诊断效果。结果　POAG组患者颞侧、上方、鼻侧及下方象限RNFL厚度和全周RNFL厚度均显著低于对照组（均为P<0.05）,且与早期青光眼组比较,进展期青光眼组患者颞侧、上方、鼻侧及下方象限RNFL厚度和全周RNFL厚度均显著降低（均为P<0.05）。各组除视盘面积外,其他视盘参数比较差异均具有统计学意义（均为P<0.05）。Pearson相关性分析显示,POAG组患者视盘颞侧、上方、下方象限RNFL厚度及全周RNFL厚度与MD均呈负相关（均为P<0.05）,而视盘参数中视杯容积和视杯/视盘面积比与MD均呈正相关（均为 P<0.05）,盘缘面积、盘缘容积和视盘容积与MD均呈负相关（均为P<0.05）。经ROC曲线分析显示,视盘周围区下方象限RNFL厚度的曲线下面积最大为0.886,其特异度和敏感度分别为0.775和0.924;视盘参数中视杯/视盘面积比曲线下面积最大,其特异度和敏感度分别为0.741和0.815。结论　OCT检测视盘结构和RNFL厚度能够用于青光眼早期诊断,且具有较高敏感度和特异度。     

New technologies for diagnosing and monitoring glaucomatous optic neuropathy.

BACKGROUND: Recently, instruments have been developed to provide real-time, quantitative measurements of the optic disc and retinal nerve fiber layer (RNFL) for use in glaucoma management. Our objective is to (1) provide an overview of two of these instruments, the confocal scanning laser ophthalmoscope (Heidelberg Retina Tomograph, HRT) and scanning laser polarimeter (Nerve Fiber Analyzer, NFA) and (2) compare measurements obtained with these instruments to clinical features used in the diagnosis of glaucoma. METHODS: Twenty glaucoma patients, 4 normal subjects and 20 glaucoma subjects were included. All subjects had images obtained with the HRT and NFA, and RNFL and optic disc photography completed within 5 weeks of each other. The HRT results were compared with qualitative evaluation of stereophotographs of the optic disc, and NFA results were compared against a semi-quantitative RNFL photograph severity score. RESULTS: Twenty-five (57%) subjects had thinning of the neuroretinal rim identified by evaluation of stereoscopic optic disc photographs. Despite overlap, HRT measurements of rim volume, rim area, and rim/disc ratio were significantly smaller in eyes with evidence of rim thinning than in eyes with no evidence of rim thinning. Moderate to severe RNFL damage was detected by evaluation of photographs in 25 (57%) of subjects. NFA RNFL thickness measures were smaller in eyes with moderate to severe RNFL damage than in relatively healthy eyes. CONCLUSIONS: Previous studies have documented the reproducibility of these instruments and suggested analytic techniques for improving their ability to differentiate between normal and glaucoma eyes. Our results indicate that despite overlap in values, these instruments provide measurements that reflect clinically relevant features of the optic disc and RNFL. Whether these technologies can improve our ability to detect glaucomatous progression over time needs to be determined with well-designed longitudinal studies and comparison with established diagnostic techniques for evaluating glaucomatous optic neuropathy.     

Comparison of glaucomatous parameters in normal, ocular hypertensive and glaucomatous eyes using optical coherence tomography 3000

This study was performed to evaluate optic disc appearance, retinal nerve fiber layer (RNFL) thickness, and macular thickness in normal, ocular hypertensive (OHT) and glaucomatous eyes using optical coherence tomography (OCT) 3000. One hundred fifty-eight eyes of 167 consecutive subjects were enrolled: 60 normal, 53 OHT, and 54 glaucomatous. OCT topographic parameters of cup diameter, cup area, rim area, and cup/disc area ratio were significantly less in OHT eyes than in normal eyes and were significantly less in glaucomatous eyes than in normal and OHT eyes. RNFL was significantly thinner in OHT eyes than in normal eyes in the inferior quadrant, and in glaucomatous eyes than in OHT and normal eyes in the mean and for all four quadrants. Macular thickness was significantly thinner in glaucomatous eyes than in OHT and normal eyes throughout all subdivisions. Optic disc parameters, and RNFL and macular thickness measurements made with OCT may be useful in the clinical assessment of glaucoma.     

Polarimetric measurement of retinal nerve fiber layer thickness in glaucoma diagnosis

PURPOSE: To evaluate reliability and diagnostic value of polarimetric measurements of the retinal nerve fiber layer (RNFL) thickness in the diagnosis of glaucoma. METHODS: The study included 81 eyes with perimetric glaucoma with glaucomatous changes of the optic disc and visual field defects; 52 eyes with preperimetric glaucoma with glaucomatous optic disc abnormalities and normal achromatic visual fields; and 70 normal eyes. For determination of reliability, four examiners repeated polarimetric measurements five times in ten normal subjects. RESULTS: The polarimetric variables were significantly correlated with increasing mean visual field defect and decreasing neuroretinal rim area. In correlation analyses with visual field defects, correlation coefficients were highest for the variable "superior/nasal ratio" and "the Number," a variable calculated by the neural network of the device. In correlations with neuroretinal rim area, correlation coefficients were highest for measurements of the inferior nerve fiber layer thickness. The preperimetric glaucoma group and the control group differed significantly in the variables "superior/nasal ratio" and "the Number" and, to a smaller degree, in the variables "superior/temporal ratio" and "superior/inferior ratio." The Number variable had a sensitivity of 82% and 58% at a predefined specificity of 80% in separating perimetric glaucoma patients and preperimetric glaucoma patients, respectively, from control subjects. Reproducibility of the polarimetric measurements ranged between 70% and 89%. CONCLUSION: Polarimetric measurements of the RNFL thickness can detect glaucomatous optic nerve damage in patients with visual field loss, and in some patients with preperimetric glaucomatous optic nerve damage. Considering the fast performance, easy handling, and low maintenance costs, RNFL polarimetry may be helpful in glaucoma diagnosis.     

Structure-function relationships using confocal scanning laser ophthalmoscopy, optical coherence tomography, and scanning laser polarimetry

PURPOSE: To assess the strength of the association between retinal nerve fiber layer (RNFL) thickness and optic disc topography measured with confocal retinal tomography (HRT II; Heidelberg Engineering, Dossenheim, Germany), optical coherence tomography (StratusOCT; Carl Zeiss Meditec, Inc., Dublin, CA), and scanning laser polarimetry (GDx with variable corneal compensator, VCC; Carl Zeiss Meditec, Inc.), and visual field (VF) sensitivity and to determine whether this association is better expressed as a linear or nonlinear function. METHODS: One hundred twenty-seven patients with glaucoma or suspected glaucoma and 127 healthy eyes from enrollees in the Diagnostic Innovations in Glaucoma Study (DIGS) were tested on HRT II, StratusOCT, GDx VCC, and standard automated perimetry (SAP, with the Swedish Interactive Thresholding Algorithm [SITA]) within 3 months of each other. Linear and logarithmic associations between RNFL thickness (HRT II, StratusOCT, and GDx VCC) and neuroretinal rim area (HRT II) and SAP sensitivity expressed in decibels were determined globally and for six RNFL/optic disc regions (inferonasal, inferotemporal, temporal, superotemporal, superonasal, and nasal) and six corresponding VF regions (superior, superonasal, nasal, inferonasal, inferior, and temporal). RESULTS: The associations (R2) between global and regional RNFL/optic disc measurements and VF sensitivity ranged from <0.01 (temporal RNFL, nasal VF, and nasal RNFL, temporal VF; linear and logarithmic associations) to 0.26 (inferotemporal RNFL, superonasal VF; logarithmic association) for HRT II; from 0.02 (temporal RNFL, nasal VF; linear association) to 0.38 (inferotemporal RNFL, superonasal VF; logarithmic association) for OCT; and from 0.03 (temporal RNFL, nasal VF; linear association) to 0.21 (inferotemporal RNFL, superonasal VF; logarithmic association) for GDx. Structure-function relationships generally were strongest between the inferotemporal RNFL-optic disc sector and the superonasal visual field and were significantly stronger for StratusOCT RNFL thickness than for other instruments in this region. Global associations (linear and logarithmic) were significantly stronger using OCT compared with HRT. In most cases, logarithmic fits were not significantly better than linear fits when visual sensitivity was expressed in log units (i.e., decibels). CONCLUSIONS: These results suggest that structure-function associations are strongest with StratusOCT measurements and are similar between HRT II and GDx VCC and these associations are generally no better expressed logarithmically than linearly when healthy, suspect, and glaucomatous eyes are considered.     

频域OCT检测视乳头形态及视网膜神经纤维层厚度在青光眼诊断中的作用

目的 探讨频域相干光断层扫描(OCT)检测视乳头形态及视网膜神经纤维层(RNFL)厚度在青光眼诊断中的作用.方法 为非干预性、观察性研究.应用RTVue OCT检测60例正常人和97例青光眼患者的视乳头各参数,以及平均和各个区域的RNFL厚度.采用单因素方差分析对以上各参数组间进行比较.用受试者工作特性曲线下面积(AUC)和特异性≥80%的敏感性来评价每一个检测参数区分正常与各期青光眼的能力大小.结果 除视乳头面积外,正常人和各期青光眼患者各参数测量值之间差异均有统计学意义(F=1.024,P=0.596;F=36.519,54.464,27.659,36.176,20.562,63.833,30.031, 54.652,98.146,78.705,99.839,43.728,75.720,45.709,39.380, 33.590,66.887,78.335,45.485;P=0.000).其中,平均RNFL厚度正常人为109.950μm,早期青光眼患者为93.313 μm,中期青光眼患者为80.374μm,晚期青光眼患者为65.570 μm.在视乳头周围8个RNFL区域中,正常人最厚的为颞下150.066μm和颞上146.285μm.各期青光眼患者最厚的均为颞上,分别为早期108.569 μm,中期103.420μm,晚期88.708μm,其次为颞下,分别为早期108.201μm,中期102.830 μm,晚期86.369 μm.而鼻侧(NU+NL)和颞侧(TU+TL)无论在正常人还是青光眼患者中均较薄.在视乳头形态各参数中,各期青光眼诊断效能最高的均为垂直杯盘比,其AUC值在早、中、晚期青光眼患者中分别为0.762,0.946和0.988,它们特异性在80%时的敏感性分别为62.2%,76.5%和99.2%.在RNFL厚度参数中,早期青光眼诊断效能最高的是颞上区域RNFL厚度,其AUC值为0.915,特异性在80%时的敏感性为89.5%;中期青光眼诊断效能最高的是下方平均RNFL厚度,其AUC值为0.967,特异性在80%时的敏感性为94.1%;晚期青光眼诊断效能最高的是平均RNFL厚度,其AUC值为0.985,特异性在80%时的敏感性为99.2%.在视乳头周围8个RNFL区域中,诊断效能最高的是颞上区域(ST),其AUC值在早、中、晚期青光眼患者中分别为0.915,0.926和0.966,它们特异性在80%时的敏感性分别为89.5%,88.2%和92.9%.诊断效能较低的是颞侧(TU+TL)和鼻侧(NU+NL).结论 RTVue OCT具有较好的区别正常人和各期青光眼患者的能力,在青光眼诊断方面是一个有用的工具.     

Retinal nerve fiber layer measurements using laser scanning polarimetry in different stages of glaucomatous optic nerve damage

PURPOSE: To evaluate the diagnostic value of polarimetric measurements of the retinal nerve fiber layer (RNFL) thickness in different stages of glaucomatous optic nerve damage. METHODS: The study included 92 eyes of 46 controls (age 41.0+/-13.7 years) and a heterogeneous group of 232 eyes of 135 patients with different stages of glaucomatous optic nerve damage (age 54.0+/-10.2 years; 68 patients with primary open-angle glaucoma, 56 with normal-pressure glaucoma and 11 patients with secondary glaucoma due to primary dispersion syndrome or pseudoexfoliation syndrome). All control subjects and patients underwent complete ophthalmological examinations including scanning laser polarimetry of the RNFL using the GDx (Laser Diagnostic Technologies, San Diego, Calif.) and 15 degrees color stereo optic disc photographs. Only subjects and patients with disc area less than 3.4 mm(2) were included in the study. The total glaucoma group were divided into four subgroups according to the morphological criteria of the neuroretinal rim. RESULTS: The stage of morphological glaucomatous optic nerve damage was classified as follows: stage 0: n=92, stage 1: n=103, stage 2: n=65, stage 3: n=40, and stage 4: n=19. Differences in mean polarimetric retardation between controls and eyes with glaucoma were significant for all parameters except the variable symmetry. The most significant differences between controls and eyes with glaucomatous optic nerve damage were found with the "number" variable assigned by the neural network analysis ( P<0.001). With increasing stage of glaucomatous optic nerve damage, separation of the variable "the number" increased significantly. At a predetermined specificity of 90% the sensitivity of the groups with different stages of morphological glaucomatous optic nerve damage increased from 32% for stage 1 to 90% for stage 4. CONCLUSION: Polarimetric measurement of the RNFL thickness is significantly associated with morphological glaucomatous optic nerve damage. The fast performance, easy handling, and low cost of RNFL polarimetry mean that it can be included in the routine examination of glaucoma patients. Further study and refinement of this technique are indicated to improve its usefulness in both clinical diagnosis and in population-based case identification.     

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。     

Reproducibility of retinal nerve fiber thickness measurements using the stratus OCT in normal and glaucomatous eyes

PURPOSE: To determine the reproducibility of Stratus Optical Coherence Tomography (OCT) retinal nerve fiber layer (RNFL) measurements around the optic nerve in normal and glaucomatous eyes. METHODS: One eye was chosen at random from 88 normal subjects and 59 glaucomatous subjects distributed among mild, moderate, and severe glaucoma, determined by visual field testing. Subjects underwent six RNFL thickness measurements performed by a single operator over a 30-minute period with a brief rest between sessions. Three scans were taken with the high-density Standard RNFL protocol, and three were taken with the Fast RNFL protocol, alternating between scan protocols. RESULTS: Reliability, as measured by intraclass correlation coefficient (ICC), was calculated for the overall mean RNFL thickness and for each quadrant. The ICC for the mean Standard RNFL thickness (and lower 95% confidence interval [CI]) in normal and glaucomatous eyes was 0.97 (0.96 CI) and 0.98 (0.97 CI), respectively. The ICC for the mean Fast RNFL thickness in normal and glaucomatous eyes was 0.95 (0.93 CI) and 0.97 (0.95 CI), respectively. Quadrant ICCs ranged between 0.79 and 0.97, with the nasal quadrant being the least reproducible of all four quadrants, using either the Standard or Fast RNFL program. The test-retest variability ranged from 3.5 microm for the average RNFL thickness measurements in normal eyes to 13.8 microm for the nasal quadrant measurements in glaucomatous eyes, which appeared to be the most variable. CONCLUSIONS: Reproducibility of RNFL measurements using the Stratus OCT is excellent in normal and glaucomatous eyes. The nasal quadrant appears to be the most variable measurement. Standard RNFL and Fast RNFL scans are equally reproducible and yield comparable measurements. These findings have implications for the diagnosis of glaucoma and glaucomatous progression.     

Usefulness of optical coherence tomography parameters of the optic disc and the retinal nerve fiber layer to differentiate glaucomatous, ocular hypertensive, and normal eyes

PURPOSE: To assess Stratus optical coherence tomography (OCT) original parameters for identifying glaucomatous damage and to evaluate differences among glaucomatous, ocular hypertensive, and normal eyes. DESIGN: Cross-sectional prospective study. SUBJECTS AND METHODS: The study was conducted at 2 centers. The study population consisted of 55 normal individuals, 95 patients with ocular hypertension (OHT), and 79 patients with glaucoma. Retinal nerve fiber layer (RNFL) and optic nerve head OCT protocols were used to evaluate all study participants. Measurements taken were RNFL thickness, several ratios, RNFL asymmetry between both eyes, rim volume, rim width, disc area, cup area, rim area, cup/disc (C/D) area ratio, and horizontal and vertical C/D ratios. The main outcome measures were the differences in OCT parameters among groups and the areas under the receiver operating characteristic curves (AROC). RESULTS: Mean RNFL thickness around the disc, and superior and inferior RNFL thickness, were significantly thinner in glaucomatous eyes than in OHT or normal eyes (P<0.001). Rim parameters were significantly smaller in glaucomatous eyes than in normal (P<0.001) and OHT eyes (P=0.01). C/D ratios were significantly greater in glaucomatous eyes than in OHT (P<0.001) and normal (P<0.001) eyes. Significant differences were found between normal and OHT eyes in 7 disc parameters. No difference was found among groups in parameters describing RNFL asymmetry between both eyes. The AROC curves of the other RNFL and disk parameters ranged from 0.741 to 0.85. CONCLUSIONS: Almost all RNFL and disc parameters showed significant differences and discriminated between glaucomatous and normal eyes. There were significant differences in some optic nerve parameters, but no RNFL parameters, between normal and OHT eyes.     

A comparison of structural measurements using 2 Stratus optical coherence tomography instruments

PURPOSE: To compare measures of peripapillary retinal nerve fiber layer (RNFL) thickness, optic disc topography, and central foveal thickness generated using 2 different Stratus optical coherence tomography (OCT) instruments. METHODS: Ten normal subjects and 10 glaucoma subjects were included. One randomly selected eye per subject was scanned consecutively using a fast RNFL thickness protocol, fast macular thickness map, and fast optic disc protocol by 2 experienced operators on 2 instruments. The order of the machines and operators were randomized. The output power of each machine was measured using an optical power meter. For each OCT measurement 2 factor fixed effects analyses of variance were performed and a restricted maximum likelihood variance component analysis of the proportion of variance due to subject, operator, and machine was calculated. RESULTS: Significant differences (P相似文献