高分辨率 OCT测量神经节细胞-内丛状层厚度在青光眼早期诊断中的作用

目的 探讨高分辨率相干光断层扫描（Cirrus-HD OCT）测量黄斑神经节细胞-内丛状层（GCIPL）厚度参数在青光眼早期诊断中的作用。设计 诊断技术评价。研究对象30例早期青光眼患者和56例正常对照者。方法 应用Cirrus-HD OCT进行黄斑区及其分区域GCIPL和视盘周围视网膜神经纤维层（RNFL）厚度参数测量。用受试者工作特性曲线下面积（AUC）来评价各参数区分正常眼与青光眼的能力。主要指标 GCIPL与RNFL的厚度和两者的AUC值。结果 正常人和早期青光眼GCIPL和RNFL各参数测量值之间比较,差异均有统计学意义（P均<0.01）。正常人和早期青光眼患者的平均GCIPL厚度分别为（85.43±5.27）μm和（69.30±7.71）μm;平均RNFL厚度分别为（100.98±7.98）μm和（78.80±10.38）μm（P<0.001）。GCIPL参数中诊断效能最高者是最小值（minimum）和颞上区域（superotemporal）,AUC均为0.985;其他AUC较高的参数依次为平均值（average）（0.971）、下方区域（inferior）（0.941）、颞下区域（superotemporal）（0.934）和鼻上区域（0.907）。视盘周围RNFL参数中诊断效能最高者是平均值（0.990）。结论  Cirrus-HD OCT测得的GCIPL厚度参数与视盘周围RNFL厚度参数类似,具有较好的区分正常人和早期青光眼患者的能力,可作为青光眼早期诊断的有用工具。     

神经节细胞-视网膜内丛状层复合体厚度在早期青光眼的诊断价值

目的评估神经节细胞层-视网膜内丛状层厚度(GCIPL)及GCIPL联合神经纤维层厚度(RNFL)参数在诊断青光眼中的作用。方法选择青光眼患者48例(62只眼)及健康志愿者39例(62只眼),分别测试患者每只眼视乳头周边RNFL厚度及黄斑区GCIPL分布图。评估GCIPL、RNFL及GCIPL和RNFL联合参数的敏感性、特异性,阳性似然比(PLR)和阴性似然比(NLR),并判断各参数的诊断效能。结果 GCIPL参数中,下半区域GCIPL厚度有最好的诊断效能,(敏感度88.7%,特异度为98.4%;PLR,55.4;和NLR,0.169)。下四分之一扇区,是RNFL诊断效能最好的参数(灵敏度,90.3%;特异性98.4%;PLR,56.4;和NLR,0.10)。下方区域GCIPL厚度和下四分之一扇区RNFL层厚度的或逻辑的组合具有最佳诊断性能(敏感度96.8%,特异度为98.4%;PRL,60.5;和NLR,0.033),而第6或第7点钟方位RNFL层厚度与下半区域GCIPL层厚度的或逻辑组合拥有最佳的敏感度(敏感度100%,特异度为93.5%;PRL,15.4;和NLR,0)。结论下方区域GCIPL厚度与下四分之一扇区RNFL层厚度的或逻辑的组合具有最佳诊断性能,比单独的GCIPL,RNFL参数拥有更好的诊断性能,该联合参数的使用可以减少一部分早期青光眼的漏诊。     

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.     

OCT测量视网膜神经纤维层厚度及视盘参数在青光眼早期诊断中的应用及意义

目的探讨光学相干断层扫描仪(optical coherence tomography,OCT)测量视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度及视盘参数在青光眼早期诊断中的应用及意义。方法青光眼患者120例(192眼)分为早期青光眼组42例(66眼)、中期青光眼组46例(76眼)和晚期青光眼组32例(50眼),另设正常对照组50例(82眼),均采用Topcon 3D OCT检测RNFL厚度和视盘参数,计算各个参数的受试者工作特征曲线下面积(are aunder the receiver operating characteristi ccurve,AROC),并对检测结果进行比较分析。结果正常对照组、早期青光眼组、中期青光眼组和晚期青光眼组的平均RNFL厚度分别为(112.31±9.34)μm、(105.45±6.74)μm、(82.19±7.28)μm、(52.48±7.85)μm;与正常对照组比较,各青光眼组的RNFL厚度差异均有显著统计学意义(均为P<0.01);各青光眼组之间两两比较差异也均有显著统计学意义(均为P<0.01)。与正常对照组相比,各青光眼组的视盘面积无明显变化,差异均无统计学意义(均为P>0.05),而视杯面积、视杯容积、杯盘比、水平杯盘比和垂直杯盘比均显著增加,差异均有显著统计学意义(均为P<0.01);盘沿面积和盘沿容积均显著降低,差异均有显著统计学意义(均为P<0.01);各青光眼组间除视盘面积外,各参数差异也均有显著统计学意义(均为P<0.01)。在正常对照组与早期青光眼组和全部青光眼组之间,对于RNFL厚度来说,平均RNFL厚度的AROC值最大;对于视盘参数来说,杯盘比的AROC值最大。结论 RNFL厚度和视盘参数是早期诊断青光眼的敏感指标,OCT检测RNFL厚度和视盘参数有助于青光眼的早期诊断。     

3D-OCT对早期原发性青光眼黄斑区视网膜神经节细胞复合体及神经纤维层结构变化的评估

背景 视网膜神经纤维层(RNFL)变薄被认为是能够检测到的青光眼最早期的改变,3D-OCT对黄斑区神经节细胞复合体(mGCC)厚度的检测使得检测黄斑区节细胞的改变成为可能,为更早发现和诊断青光眼提供思路. 目的 利用3D-OCT检查系统检测早期原发性青光眼mGCC厚度及视盘周围RNFL厚度的变化,评估早期原发性青光眼视神经损害的解剖基础. 方法 对2010年12月至2012年12月在中日友好医院眼科就诊的一眼为中晚期而对侧眼为早期的原发性青光眼的10例患者采集的3D-OCT扫描图像进行回顾性分析.所有患者均符合1987年中国青光眼学组推荐的诊断标准,临床检查资料完整.患者均接受常规眼科检查和眼底3D-OCT检查,分别采用3D-macular模式、3D-macular Wide模式和3D-disc模式对原发性青光眼黄斑区、后极部和视盘进行扫描,利用检查系统自带软件对黄斑6 mm×6 mm区域的扫描结果进行分析,由黄斑中心凹向外各方向等距离分成100个小格区,每个格区面积为0.6 mm×0.6 mm,按照mGCC的变薄程度由重到轻依次以红色、黄色和灰色标记,以每个小格中的数字与其正常值比较得到与颜色匹配的、mGCC变薄程度发生的概率值(依次为P＜1％、P＜5％、P≥5％)表示.然后分析视盘旁RNFL厚度和不同部位的厚度曲线改变,并评估视盘生理凹陷的改变. 结果 10例患者患早期青光眼的眼和对侧眼视细胞层和双极细胞层厚度均未发生改变,而患中晚期青光眼的一侧眼视盘周围RNFL厚度概率图呈红色,即视盘周围RNFL层厚度明显变薄,mGCC厚度概率和黄斑区RNFL厚度概率图呈红色,即mGCC和黄斑区RNFL层厚度明显变薄;而患早期青光眼的一侧眼视野均正常,mGCC厚度概率图和黄斑区RNFL区呈黄色,即mGCC和黄斑区RNFL厚度轻微变薄;视盘周围RNFL厚度概率图呈绿色或黄色,即视盘周围RNFL厚度正常或轻微变薄.结论 原发性青光眼mGCC层厚度变薄早于视盘周围RNFL的变薄,提示青光眼视神经结构的损害始于RGCs的细胞体并早于轴突的损伤或丢失.     

视网膜神经节细胞复合体厚度检测对原发性开角型青光眼的诊断意义

目的比较视网膜黄斑区神经节细胞复合体(GCC)厚度和视盘周围视网膜神经纤维层(p RNFL)厚度各单项指标及两者联合后指标对原发性开角型青光眼(POAG)的诊断价值。设计诊断方法评价。研究对象挪威特罗姆瑟眼病中心2013年10月至2014年3月就诊者的正常人40眼,POAG 66眼。其中早期青光眼(EG)34眼、中晚期青光眼(AG)32眼。方法所有受试眼均进行频域相干光断层扫描(i Vue 100 SD-OCT)GCC模式及ONH模式扫描检测。通过比较各参数受试者曲线下面积(AUCs)来评估其诊断能力。主要指标黄斑区GCC厚度及p RNFL厚度的AUCs值。结果所有眼全周GCC厚度与全周p RNFL厚度具有强相关性。青光眼组全周GCC厚度(EG 81.03±6.37μm,AG 76.28±9.39μm)和p RNFL厚度(EG 80.47±9.02μm,AG 69.84±11.74μm)较正常组(GCC 92.90±6.07μm,p RNFL 96.98±8.09μm)显著变薄(P均<0.05)。校正年龄后,具有最高诊断能力的指标在EG组是上方GCC厚度(AUC=0.929),AG组是全周p RNFL厚度(AUC=0.988)。以全周p RNFL厚度为参照,EG组中全周GCC厚度及全周p RNFL厚度回归联合后诊断能力提高,但无统计学意义;AG组中,全周GCC厚度及全周p RNFL厚度并联后灵敏度显著提高(P<0.05)。结论采用SD-OCT测量法,GCC厚度在各期POAG中均具有与p RNFL厚度相当的、较高的诊断能力。AG组中,全周GCC厚度及全周p RNFL厚度联合可能提高诊断灵敏度。     

应用OCT观察早期糖尿病视网膜病变患者视网膜神经纤维层的厚度变化

目的：研究和分析早期糖尿病视网膜病变患者视盘周围视网膜神经纤维层和黄斑部视网膜厚度的变化,揭示不同程度的早期糖尿病视网膜病变患者视网膜神经纤维层( RNFL)及黄斑部视网膜厚度变化的趋势。
　　方法：临床病例对照研究。选取我院2012-09/2013-01确诊的早期2型糖尿病视网膜病变患者60例120眼,分为无视网膜病变组( NDR)20例40眼及合并轻、中度非增殖性糖尿病视网膜病变组( NPDR)40例80眼,对照组为正常人20例40眼,应用光学相干断层成相分别以RNFL扫描模式(视盘中点为中心,直径为3.45 mm环形扫描)和黄斑部视网膜厚度扫描模式(黄斑中心凹为中心。直径1000μm的区域);测量正常人与早期糖尿病视网膜病变患者视盘周围RNFL厚度和黄斑区视网膜厚度。
　　结果：与正常对照组相比, NDR组除下象限RNFL变薄差异有统计学意义( P<0.05);视盘周围RNFL厚度及其它各象限差异无统计学意义( P>0.05),轻度NPDR组视盘周围平均值、下象限 RNFL 厚度差异有统计学意义( P<0.05);中度 NPDR 组视盘周围平均值、上象限、下象限RNFL厚度下降差异均有统计学意义( P<0.05)。 NPDR组,NDR组和对照组三组比较各象限 RNFL 厚度下降;NDR组、轻度NPDR与中度NPDR组相比,黄斑部视网膜厚度差异有统计学意义(P<0.05),后者视网膜厚度逐渐增加。
　　结论：在早期糖尿病视网膜病变,视盘周围RNFL厚度随病变程度逐渐降低,而黄斑部视网膜厚度却逐渐增加, OCT能定性、定量地观察早期糖尿病视网膜病变的程度。     

本期导读

本期以远程眼科学及青光眼诊疗为重点报道内容。刘杏等在频域OCT测量黄斑区节细胞-内丛状层（GCIPL）厚度在青光眼早期诊断中的应用述评一文中,从中国人GCIPL厚度的测量可重复性与分布规律、正常人GCIPL厚度的影响因素、青光眼患者GCIPL厚度与视网膜神经纤维层（RNFL）厚度及视野的相关性、黄斑区GCIPL厚度对早期青光眼的诊断效能等几个方面阐述了黄斑区GCIPL厚度在青光眼早期诊断的应用价值,GCIPL厚度检测有可能较视盘周围RNFL厚度、黄斑区节细胞复合体（GCC）更早地发现青光眼性结构损害,指出了采用SD-OCT检测GCIPL厚度与视野、RNFL厚度、视盘参数等检测相互整合,是提高青光眼早期检出率的关键。本期刊登了2篇有关远程眼科方面的论著,在远程眼科视频会诊疾病构成比初步分析一文中,作者回顾了2014-2015年远程眼科视频会诊患者354例的疾病病种构成比,其结果显示,在目前的远程眼科视频会诊中,单眼视盘水肿性疾病、继发性青光眼、视网膜静脉阻塞以及增生性糖尿病视网膜病变是基层医院最具诊治需求的眼病。远程眼科视频会诊是在远程眼科阅片的基础上,远程会诊中心的医师与基层医院医师及患者视频沟通的一种诊疗方式,在某种程度上解决了边远地区部分患者的眼病诊疗需求。在另一篇远程眼科阅片及时性及阅片报告详细性的初步研究一文中,作者对2015年12月远程眼科阅片患者7713例的阅片完成时间以及影像描述、阅片建议的字数进行统计分析,结果显示目前的远程眼科阅片服务中绝大多数患者的阅片报告可在半天内完成,但阅片报告中影像描述及阅片建议的详细性尚参差不齐。在青光眼研究方面,本期刊登了局部使用前列腺素滴眼剂导致中央角膜厚度轻微变薄,但尚未发现对矫正眼压产生影响的论著,以及可疑原发性房角关闭患者激光周边虹膜切开术后5年房角生物测量分析结果、可视化角膜生物力学分析仪评估青光眼患者角膜生物力学特征以及曲伏前列素治疗抗青光眼术后眼压失控的原发性闭角型青光眼的短期疗效等文章,均值得读者关注。     

基于视网膜神经纤维层厚度及神经节细胞复合体诊断POAG的效能分析

目的：比较原发性开角型青光眼( primary open angle glaucoma,POAG)与正常对照组盘周视网膜神经纤维层厚度( retinal nerve fiber layer thickness,RNFL)及黄斑区神经节细胞复合体( ganglion cell complex,GCC)厚度差异,并评价盘周 RNFL 厚度及黄斑 GCC 厚度在 POAG 中的诊断价值。
　　方法：采用横断面研究。连续的POAG患者56例纳入研究。选择同期年龄、性别、屈光度及眼轴匹配的正常人60名60眼作为正常对照组。用RTVue-100光学相干断层扫描技术( optical coherence tomography,OCT)检测并比较POAG组及对照组盘周RNFL厚度及黄斑GCC厚度。采用受试者工作特征曲线( receiver operating characteristic curve,ROC)及ROC曲线下面积( area under curve,AUC)评价盘周 RNFL 厚度及黄斑 GCC 厚度对青光眼的诊断价值。
　　结果：POAG组患者盘周所有象限RNFL均薄于正常对照组,差异有统计学意义( P<0.001)。 POAG组患者黄斑所有区域GCC厚度均小于正常对照组,差异有统计学意义(P<0.001)。多因素线性回归分析结果,PAOG诊断是盘周RNFL厚度与黄斑GCC厚度的独立相关因素。 ROC及AUC分析提示：杯盘比AUC值最大( AUC=0.936;95%CI=0.903~0.964),其次为上方 RNFL 厚度( AUC=0.910;95%CI=0.889~9.455),诊断价值高,盘周鼻侧,下方,颞侧RNFL厚度以及黄斑上方,下方平均GCC厚度AUC值均大于0.8,具有较好的诊断价值。
　　结论：POAG患者盘周RNFL厚度与黄斑GCC厚度均明显变薄,变薄的盘周RNFL厚度与黄斑GCC厚度与POAG诊断存在相关性。盘周RNFL厚度与黄斑GCC厚度均有较好的诊断价值。     

OCT检测视网膜神经纤维层厚度及视盘参数在青光眼早期诊断应用

目的 通过光学相干断层成像术(OCT)检测视网膜神经纤维层(RNFL)厚度及视盘结构参数,结合视野改变,探讨OCT在青光眼早期诊断中的应用价值.方法 采用OCT对34只眼疑似闭角型青光眼(SG)患者、36只眼慢性闭角型青光眼(CACG)早中期患者、10只眼正常人行RNFL及视盘扫描,观察各组的RNFL厚度及视盘结构的图像特征;将各象限RNFL厚度和平均RNFL厚度的均数进行总体比较及任意两组间比较;将视乳头水平、垂直杯盘比及杯/盘面积比的均数进行比较;将平均RNFL厚度与视野指数进行相关分析.结果 三组间各象限RNFL厚度、平均RNFL厚度、视盘参数差异有统计学意义(P<0.05);正常人与SG组下方、上方及平均RNFL厚度差异有统计学意义(P<0.05);正常人与CACG早中期组各象限RNFL厚度及平均RNFL厚度差异均有统计学意义(P<0.05);CACG早中期组与SG组上方、下方、鼻侧及平均RNFL厚度差异有统计学意义(P相似文献   

比较应用SD-OCT检测青光眼患者黄斑区节细胞与视盘周围视网膜神经纤维层的改变

目的:通过节细胞内网状层(GCIPL)评估中度和重度青光眼的损伤程度并比较其与视盘周围视网膜神经纤维层(PRNFL)的诊断效能,包括敏感性与特异性及ROC曲线下面积(AUC).方法:前瞻性研究.共210眼(包括中度青光眼患者30例54眼,重度青光眼患者34例59眼和正常人50例97眼)纳入本研究.所有参与者均接受全面眼科检查,包括视野检查、3D-OCT视盘检查和3D-OCT黄斑部垂直扫描.记录并比较所有参与者的GCIPL和PRNFL的AUC、敏感性与特异性.结果:在中度和重度青光眼组中,上部、下部及整体GCIPL和PRNFL厚度明显变薄(P＜0.001).在中度青光眼组中,GCIPL的敏感度与特异性高于PRNFL(仅上半部分敏感性相同).重度青光眼组,上部、下部及整体GCIPL的敏感度均低于PRNFL.整体GCIPL的特异性低于PRNFL.上部GCIPL的特异性高于PRNFL.下部GCIPL的特异性与PRNFL相同.结论:对于区分中度和重度青光眼,黄斑GCIPL参数的功能远高于PRNFL.两者联合在病情分析中效果最优,能够提供更准确的损伤程度评估.     

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.     

Evaluation of spectral domain optical coherence tomography parameters in discriminating preperimetric glaucoma from high myopia

AIM: To evaluate the diagnostic ability of macular ganglion cell-inner plexiform layer (GCIPL) thickness obtained by spectral-domain optical coherence tomography (SD-OCT) in discriminating non-highly myopic eyes with preperimetric glaucoma (PPG) from highly myopic healthy eyes. METHODS: A total of 254 eyes, including 76 normal controls (NC), 116 eyes with high myopia (HM) and 62 non-highly myopic eyes with PPG were enrolled. The diagnostic ability of OCT parameters was accessed by the areas under the receiver operating characteristic (AUROC) curve in two distinguishing groups: PPG eyes with non-glaucomatous eyes including NC and HM (Group 1), and PPG eyes with HM eyes (Group 2). Differences in diagnostic performance between GCIPL and RNFL parameters were evaluated. RESULTS: The minimum (AUROC curve of 0.782), inferotemporal (0.758) and inferior (0.705) GCIPL thickness were the top three GCIPL parameters in discriminating PPG from non-glaucomatous eyes, all of which had statistically significant lower diagnostic ability than average RNFL thickness (0.847). In discriminating PPG from HM, the best GCIPL parameter was minimum (0.689), statistically significant lower in diagnostic ability than average RNFL thickness (0.789) and three other RNFL thickness parameters of temporal and inferotemporal clock-hour sectors. CONCLUSION: The minimum GCIPL thickness is the best GCIPL parameter to detect non-highly myopic PPG from highly myopic eyes, whose diagnostic ability is inferior to that of average RNFL thickness and RNFL thickness of several temporal and inferotemporal clock-hour sectors. The average RNFL thickness is recommended for discriminating PPG from highly myopic healthy eyes in current clinical practice in a Chinese population.     

Structural measurements and vessel density of spectral-domain optic coherence tomography in early, moderate, and severe primary angle-closure glaucoma

AIM: To compare the macular ganglion cell-inner plexiform layer (GCIPL) thickness, retinal nerve fiber layer (RNFL) thickness, optic nerve head (ONH) parameters, and retinal vessel density (VD) measured by spectral-domain optical coherence tomography (SD-OCT) and analyze the correlations between them in the early, moderate, severe primary angle-closure glaucoma (PACG) and normal eyes. METHODS: Totally 70 PACG eyes and 20 normal eyes were recruited for this retrospective analysis. PACG eyes were further separated into early, moderate, or severe PACG eyes using the Enhanced Glaucoma Staging System (GSS2). The GCIPL thickness, RNFL thickness, ONH parameters, and retinal VD were measured by SD-OCT, differences among the groups and correlations within the same group were calculated. RESULTS: The inferior and superotemporal sectors of the GCIPL thickness, rim area of ONH, average and inferior sector of the retinal VD were significantly reduced (all P<0.05) in the early PACG eyes compared to the normal and the optic disc area, cup to disc ratio (C/D), and cup volume were significantly higher (all P<0.05); but the RNFL was not significant changes in early and moderate PACG. In severe group, the GCIPL and RNFL thickness were obvious thinning with retinal VD were decreasing as well as C/D and cup volume increasing than other three groups (all P<0.01). In the early PACG subgroup, there were significant positive correlations between retinal VD and GCIPL thickness (except superonasal and inferonasal sectors, r=0.573 to 0.641, all P<0.05), superior sectors of RNFL thickness (r=0.055, P=0.049). More obvious significant positive correlations were existed in moderate PACG eyes between retinal VD and superior sectors of RNFL thickness (r=0.650, P=0.022), and temporal sectors of RNFL thickness (r=0.740, P=0.006). In the severe PACG eyes, neither GCIPL nor RNFL thickness was associated with retinal VD. CONCLUSION: The ONH damage and retinal VD loss appears earlier than RNFL thickness loss in PACG eyes. As the PACG disease progressed from the early to the moderate stage, the correlations between the retinal VD and RNFL thickness increases.     

Discriminating performance of macular ganglion cell-inner plexiform layer thicknesses at different stages of glaucoma

AIM: To determine the discriminating performance of the macular ganglion cell-inner plexiform layer (GC-IPL) parameters between all the consecutive stages of glaucoma (from healthy to moderate-to-severe glaucoma), and to compare it with the discriminating performances of the peripapillary retinal nerve fiber layer (RNFL) parameters and optic nerve head (ONH) parameters. METHODS: Totally 147 eyes (40 healthy, 40 glaucoma suspects, 40 early glaucoma, and 27 moderate-to-severe glaucoma) of 133 subjects were included. Optical coherence tomography (OCT) was obtained using Cirrus HD-OCT 5000. The diagnostic performances of GC-IPL, RNFL, and ONH parameters were evaluated by determining the area under the curve (AUC) of the receiver operating characteristics. RESULTS: All GC-IPL parameters discriminated glaucoma suspect patients from subjects with healthy eyes and moderate-to-severe glaucoma from early glaucoma patients (P<0.017, for all). Also, minimum, inferotemporal and inferonasal GC-IPL parameters discriminated early glaucoma patients from glaucoma suspects, whereas no RNFL or ONH parameter could discriminate between the two. The best parameters to discriminate glaucoma suspects from subjects with healthy eyes were superonasal GC-IPL, superior RNFL and average c/d ratio (AUC=0.746, 0.810 and 0.746, respectively). Discriminating performances of all the parameters for early glaucoma vs glaucoma suspect comparison were lower than that of the other consecutive group comparisons, with the best GC-IPL parameters being minimum and inferotemporal (AUC=0.669 and 0.662, respectively). Moreover, minimum GC-IPL, average RNFL, and rim area (AUC=0.900, 0.858, 0.768, respectively) were the best parameters for discriminating moderate-to-severe glaucoma patients from early glaucoma patients. CONCLUSION: GC-IPL parameters can discriminate glaucoma suspect patients from subjects with healthy eyes, and also all the consecutive stages of glaucoma from each other (from glaucoma suspect to moderate-to-severe glaucoma). Further, the discriminating performance of GC-IPL thicknesses is comparable to that.     

Discriminating ability of spectral domain optical coherence tomography in different stages of glaucoma

Purpose

To determine the discriminating ability of retinal nerve fiber layer (RNFL) thickness measured with spectral-domain optical coherence tomography (SD-OCT) in different stages of glaucoma.

Patients and methods

Thirty normal, 150 glaucomatous eyes were included. Glaucomatous eyes were graded into early, moderate and severe stages according to one of the global indices called visual field index (VFI). Complete ophthalmic examination, white on white perimetry and SD-OCT were done for all patients. RNFL thickness of quadrants and average thickness were recorded. Area under receiver operating characteristic curves (AUCs) were used to assess the performance of OCT parameters.

Results

Average, inferior and superior RNFL thickness were the best parameters to discriminate normal from early glaucoma (AUC: 0.91–86), early from moderate (AUC: 0.77–0.70) and moderate from severe (AUC: 0.85–83). Average RNFL loss was 18% in early glaucoma, 28% in moderate glaucoma and 41% in severe glaucoma. Early damage tends to be focal and in the lower quadrant. A significant correlation was detected between mean VFI and mean RNFL loss. Glaucoma was restaged according to average RNFL loss into early: ⩾97.5 μ, moderate: <97.5–72.5 μ and severe: <72.5 μ.

Conclusion

RNFL thickness measured with SD-OCT could discriminate the three stages of glaucoma. RNFL loss can be correlated to visual field loss. Future OCT-based staging of glaucoma, adjunctive to perimetry is possible.     

频域OCT检测视野前青光眼黄斑区视网膜神经节细胞复合体厚度的初步研究

Objective To evaluate the diagnostic capabilities of ganglion cell complex (GCC) thickness in preperimetric glaucoma (PPG) with spectral domain optical coherence tomography (SD-OCT). Design Self control study and case control study. Participants Primary open-angle glaucoma (POAG) patients were 20 cases(40 eyes), of which 20 eyes without visual field defects as PPG, and healthy controls were 30 cases(30 eyes). Methods All subjects were underwent macular scanning and peripapillary retinal nerve fiber layer (RNFL) scanning using the RTvue SD-OCT. The area under the receiver operating characteristic curve (AUC) was used to assess the ability to discriminate PPG from normal control. Main Outcome Measures The thickness of GCC and RNFL, and their AUCs. Results Compared with normal eyes, the thickness of average GCC, superior GCC, inferior GCC, average RNFL, superior RNFL, and inferior RNFL in PPG eyes decreased (P<0.001). However, these parameters were thicker than POAG eyes (P≤0.002). The values of GCC-GLV and GCC-FLV increased compared with normal eyes (P<0.001, P=0.021), but decreased compared with POAG eyes (P<0.001). GCC-GLV had highest AUC for detecting PPG (0.983) from normal eyes, followed by average RNFL (0.930). However, the difference between the two parameters was not statistically significant (P>0.05). Conclusions In addition to RNFL, the GCC could be a structural parameter for detecting PPG. (Ophthalmol CHN, 2017, 26: 10-14)     

Three dimensional neuro-retinal rim thickness and retinal nerve fiber layer thickness using high-definition optical coherence tomography for open-angle glaucoma

Purpose

To compare the diagnostic capability of three-dimensional (3D) neuro-retinal rim thickness (NRR) with existing optic nerve head and retinal nerve fiber layer (RNFL) scan parameters using high-definition optical coherence tomography (HD-OCT).

Design

Retrospective study.

Methods

Based on the mean deviation (MD) of the Humphrey Field Analyzer (HFA), the 152 subjects were categorized into mild (MD >???6 dB, 100), moderate (MD ??6 to ??12 dB, 26), and severe (MD <???12 dB, 26) glaucoma. The HD-OCT values of NRR, RNFL and ganglion cell inner plexiform layer (GCIPL) thicknesses, along with those of other parameters (rim area, disc area) were obtained, and the average NRR thickness was calculated.

Results

For all of the HD-OCT parameters, RNFL thickness showed a higher area under the ROC (AUROC) curve (range: 0.937–1.000) than did NRR thickness (range: 0.827–1.000). There were significant RNFL, NRR, and GCIPL AUROC curve differences among the mild, moderate and severe glaucoma groups. RNFL thickness for mild glaucoma showed a significantly larger area than did NRR thickness [area difference: 0.110 (±?0.025); p value <?0.0001). Furthermore, RNFL relative to NRR thickness yielded higher sensitivity (85–100% vs. 72–100%) and specificity (89–100% vs. 84–100%) for diagnosis of glaucoma.

Conclusion

RNFL thickness remains significantly better than 3D NRR thickness in terms of glaucoma-diagnostic capability in HD-OCT.

     

Diagnostic ability of ganglion cell complex thickness to detect glaucoma in high myopia eyes by Fourier domain optical coherence tomography

AIM: To evaluate the ability of macular ganglion cell complex (GCC) thickness using Fourier domain optical coherence tomography (FD-OCT) to detect glaucoma in highly myopic eyes. METHODS: Cross-sectional study. A total of 114 participants, consecutively were enrolled. Macular GCC thickness and peripapillary retinal nerve fiber layer (RNFL) thickness were obtained with RTVue FD-OCT. Receiver operating characteristics curves were constructed for each measurement parameter, and areas under the curves (AUCs) were compared. RESULTS: Both the average GCC and average RNFL thickness showed negative correlations with axial length (rGCC=-0.404, P=0.001; rRNFL=-0.561, P<0.001). The largest AUCs from GCC, and RNFL parameters were 0.968 [global loss volume (GLV)], and 0.855 (average RNFL), respectively. GLV was significantly better for detecting high myopic glaucoma than average RNFL (P<0.001). CONCLUSION: Macular GCC thickness has higher diagnostic power than peripapillary RNFL thickness to discriminate glaucoma patients from non-glaucoma subjects in high myopia.