New findings in the evaluation of the optic disc in glaucoma diagnosis

PURPOSE OF REVIEW: Ophthalmoscopical evaluation of the optic disc is a feasible and largely accessible method to diagnose glaucoma. Many qualitative parameters have been described in glaucomatous optic neuropathy. Considering individual variations in the details of topography or tissue components damaged by the glaucomatous process, however, adequate identification of glaucomatous optic disc signs requires training and experience. Without adequate guidelines of optic disc examination, the physician may miss important aspects that could lead to adequate diagnosis or identification of progression in a patient with established glaucoma. This paper presents a systematic approach for the examination of the optic disc and retinal nerve fiber layer to aid the detection of glaucoma. RECENT FINDINGS: Optic disc qualitative parameters are better than quantitative parameters in separating glaucomatous from normal eyes. The sequential evaluation of optic disc size, neuroretinal rim size and shape, retinal nerve fiber layer, presence of peripapillary atrophy, and presence of retinal or optic disc hemorrhages enhances the ability to detect glaucomatous damage and its progression. SUMMARY: Ophthalmologists should be familiar with glaucomatous optic disc signs that can be identified during clinical examination. A simple systematic approach may allow improved diagnosis and management of glaucoma.     

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

青光眼是一种进行性视神经疾病,它能引起视神经结构改变,最终导致不可逆的视功能损害。青光眼的早期诊断对保护视功能有重要意义。光学相干断层扫描仪是一种准确性和可重复性高的视网膜神经纤维层厚度和视盘参数检测技术,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。我们主要阐述该技术在青光眼早期诊断中的应用。     

Optic disc area in different types of glaucoma

AIM: To evaluate the possible relationship of optic disc area with retina nerve fiber layer in different glaucoma subtypes. METHODS: One eye each was chosen from 45 patients with ocular hypertension, 45 patients with primary open angle glaucoma, 45 patients with pseudoexfoliation glaucoma and 45 healthy controls followed in our hospital. The records of the patients were reviewed retrospectively. Optic disc area and circumpapillary retina nerve fiber layer measurements were obtained using optical coherence tomography. Central corneal thickness was measured by ultrasound pachymetry. RESULTS: The median disc area in the patients with primary open angle glaucoma was significantly higher than the patients with ocular hypertension (2.19 vs 1.90 mm2, P=0.030). The median retina nerve fiber layer was thinner in the patients with primary open angle glaucoma and pseudoexfoliation glaucoma than the patients with ocular hypertension for superior, inferior and temporal quadrants. After adjustment for age, no difference in central corneal thickness was found between the groups. Greater disc area was associated with thicker retinal nerve fiber layer for superior, inferior and nasal quadrants in the patients with primary open angle glaucoma. There was no correlation between disc area and central corneal thickness measurements of the groups. CONCLUSION: Disc size affects the retinal nerve fiber layer thickness in eyes with primary open angle glaucoma and is a possible risk factor for glaucomatous optic nerve damage.     

Influence of optic disc size on parameters of retinal nerve fiber analysis with laser scanning polarimetry

Purpose The aim of the study was to evaluate the influence of optic disc size on the variables of laser scanning polarimetry (GDx).Patients and methods One hundred and nineteen healthy controls and 161 patients with ocular hypertension (OHT) received detailed ophthalmologic investigation with respect to glaucoma including retinal nerve fiber analysis with GDx (Version 3.0.05×1; Laser Diagnostic Technologies Europe). Optic disc size was measured with planimetry using 15° optic disc photographs. With respect to frequency of optic disc size in the normal population patients were divided in quartiles of equal sample size.Results The ratio between retinal nerve fiber layer thickness in the superior and inferior areas in relation to the nasal and temporal regions decreases significantly with increasing optic disc size and the difference between the highest and lowest retinal nerve fiber layer thickness decreases significantly with increasing optic disc size. The results of multivariate neural network analysis increased with larger optic disc size in controls as well as in patients with OHT. Linear regression analysis showed an increase of 9 units (the Number) per 1 mm² of optic disc size. A Number above 30, which indicates suspected glaucoma, was detected in more than a third of the normal population investigated if the optic disc area was larger than 3.5 mm². Overall, patients with OHT had a higher Number than controls (20.5±11.5 vs. 18.1±10.4; p>0.05), but the difference between the two groups did not reach a significant level.Conclusions Retinal nerve fiber analysis in patients with an optic disc size larger than 3.5 mm² should be interpreted carefully; the Number in particular requires corrections for optic disc size.     

Optical coherence tomographic findings in optic nerve hypoplasia

We investigated a case of unilateral optic nerve hypoplasia using spectral domain optical coherence tomography (SDOCT). Optical coherence tomography was done on both eyes using 5-line Raster scan for the fovea to analyze the retinal nerve fiber layer thickness, inner retinal layer thickness, outer retinal layer thickness, and optic disc cube scan for the disc. Retinal nerve fiber layer thickness, inner retinal layer thickness, and outer retinal layer thickness were manually measured at 21-points of each five lines, and results were compared between both eyes. Retinal nerve fiber layer thickness and inner retinal layer thickness of optic nerve hypoplasia were significantly thinner than the opposite eye, but there was no significant difference in the thickness of the outer retinal layer between both eyes.     

Correlation between optic nerve head parameters and retinal nerve fibre layer thickness measured by spectral-domain optical coherence tomography in myopic eyes

Background: To evaluate the correlation between optic nerve head parameters and retinal nerve fiber layer thickness measured by Cirrus HD spectral‐domain optical coherence tomography (Cirrus HD‐OCT; Carl Zeiss Meditec) in healthy myopic eyes. Design: Cross‐sectional study. Participants: One hundred and sixty‐one right eyes from 161 healthy young myopic subjects. Methods: Optic nerve head parameters and retinal nerve fiber layer thickness were measured with the Cirrus HD‐OCT. The distance between optic disc margin and scan circle (disc margin‐to‐scan distance) was measured on the Cirrus HD‐OCT en‐face optic nerve head image with aid of National Institutes of Health ImageJ image‐analysis software (developed by Wayne Rasbands, National Institutes of Health, Bethesda, MD). Main Outcome Measures: The correlations among optic nerve head parameters, retinal nerve fibre layer thickness and the disc margin‐to‐scan distance were evaluated with and without adjustment of the magnification effect. Results: Without correction of the magnification effect, the thicker average retinal nerve fiber layer was correlated with greater rim area and lower degree of myopia (P < 0.001). When the magnification effect was corrected, thicker average retinal nerve fibre layer was associated with greater disc area and greater rim area in univariate and multivariate analyses (P ≤ 0.028); however, degrees of myopia and the disc margin‐to‐scan distance were not significantly associated with average RNFL thickness (P ≥ 0.104). Conclusions: Thicker average retinal nerve fibre layer thickness was associated with greater rim and disc areas. Disc margin‐to‐scan distance was not significantly correlated with average retinal nerve fibre layer thickness in healthy myopic eyes.     

非青光眼性大视杯临床分析

目的 探讨非青光眼性疾病引起视杯扩大的病因以及鉴别要点,为临床识别非青光眼性大视杯提供依据。设计 回顾性病例系列。研究对象 12例（19眼）非青光眼大视杯患者。方法 分析比较这些患者的病因、视盘形态学特征以及相关影像资料。主要指标 病因、视盘形态特征以及视功能改变。结果 12例患者中,4例为视神经炎,1例视神经脊髓炎,1例Leber遗传性视神经病变,2例垂体瘤,1例基底节脑出血,1例睫状视网膜动脉阻塞合并视网膜中央静脉阻塞,1例视网膜中央动脉阻塞,1例视神经损伤。所有患者视杯呈弥漫性或局限性扩大,盘沿苍白。视野表现为与原发病相应的缺损。结论 各种视神经疾病和视网膜疾病均有可能导致大视杯,它与青光眼性大视杯的鉴别点在于盘沿色泽、有无盘沿局限性缺失以及视功能异常和视盘改变的相关性。（眼科, 2012, 21: 306-309）     

同一屈光范围高度近视性弱视眼与高度近视眼眼底结构的特点

目的：探讨在同一屈光度数范围内高度近视性弱视眼与高度近视眼在EDI-OCT下视网膜、脉络膜、视盘神经纤维层的形态特征。

方法：本试验招募6～16岁的中国儿童19例26眼进行研究。将研究对象分为高度近视性弱视组(11眼)和高度近视组(15眼)。采用频域OCT深层影像扫描模式，检查黄斑中心凹及黄斑中心凹旁不同区域的视网膜、脉络膜和视盘神经纤维层厚度。

结果：中心凹外1.0、1.5、2.0、2.5、3.0mm区域的视网膜厚度在绝大多数方位上，两组比较有差异(P<0.05)。下方3.0mm处，高度近视性弱视组脉络膜厚度显著薄于高度近视组(P=0.012)。两组各方位视盘神经纤维层厚度比较均无差异(P>0.05)。

结论：在同一屈光度数范围内，中心凹周围的视网膜厚度，高度近视性弱视眼明显薄于高度近视眼，弱视的发生发展可能参与其变化过程。     

光学相干断层扫描技术在原发性开角型青光眼早期诊断中的应用

目的：探讨利用光学相干断层扫描技术(optical coherence tomography, OCT)测量视乳头旁视网膜神经纤维层(retinal nerve fiber layer, RNFL)厚度、视盘形态和黄斑区视网膜厚度在原发性开角型青光眼(primary open angle glaucoma, POAG)早期诊断中的应用价值。

方法：选取2016-01/2017-06本院收治的POAG 患者65例85眼作为研究组, 随机选取同期在本院进行身体检查的健康者52例78眼作为对照组,采用OCT测量视乳头旁RNFL厚度、黄斑区视网膜厚度和视盘参数包括杯/盘比(C/D)、视杯面积(cup area, CA)、视杯容积(cup volume, CV)、视盘面积(disc area, DA)、盘沿面积(rim area, RA)和盘沿容积(rim volume, RV),并对检测结果进行比较分析。

结果：研究组视乳头旁RNFL厚度在上方、下方、颞侧、鼻侧和均值均明显小于对照组,差异有统计学意义(P<0.001); 研究组CA、CV、C/D明显高于正常对照组,差异有统计学意义(P<0.001),而DA、RV明显小于正常对照组,差异有统计学意义(P<0.001),DA则略小于正常对照组,差异无统计学意义(P>0.05)。研究组黄斑区视网膜厚度在上方、下方、颞侧、鼻侧均明显小于对照组,差异有统计学意义(P<0.001)。

结论：OCT能够定量客观检测RNFL厚度、黄斑区视网膜厚度和视盘参数,这有助于POAG的早期诊断。     

Relation between size of optic disc and thickness of retinal nerve fibre layer in normal subjects

AIMS—To evaluate the relation between the optic disc size and the thickness of the peripapillary retinal nerve fibre layer (RNFL) in normal Japanese subjects by means of scanning laser polarimetry.
METHODS—Scanning laser polarimetry was performed in 60 normal subjects. One eye of each subject was randomly selected for study. Using a scanning laser polarimeter, the integral of RNFL thickness was measured totally and regionally within a circular band located 1.75 disc diameters from the centre of the optic disc. The correlation between the optic disc size and the integral of RNFL thickness was examined.
RESULTS—The optic disc size showed a significant correlation with the integral of RNFL thickness (R = 0.497, p <0.001). A significant negative correlation was observed between the optic disc size and the ratio of inferior integral to total integral of RNFL thickness (R = −0.274, p = 0.034).
CONCLUSIONS—The cross sectional area occupied by the RNF, measured by scanning laser polarimetry increased significantly with an increase in optic disc size while the ratio of inferior to total cross sectional area decreased significantly. These facts should be considered when one evaluates the RNFL thickness in patients with progressive optic neuropathies such as glaucoma.

Keywords: scanning laser polarimeter; normal subjects; optic disc; retinal nerve fibre layer     

病理性近视视盘及其相关结构的形态学改变

病理性近视眼的视盘及其相关结构的形态学改变,包括视网膜神经纤维层厚度改变、视盘形态改变等,由此可引起相应的视功能改变.病理性近视眼因后巩膜葡萄肿的形成及生物力学特性的改变,可能导致视神经的结构和功能发生异常.这其中一些变化可能与青光眼的发生密切相关,或者对青光眼诊断造成困扰.     

Retinal detachment associated with optic disc colobomas and morning glory syndrome

We report the diagnosis and treatment of patients with retinal detachment and/or retinoschisis associated with optic nerve coloboma or morning glory syndrome. A retrospective review of patients with optic nerve coloboma or morning glory syndrome with associated retinal detachment or retinoschisis was conducted. For five patients (six eyes), we report the clinical findings, spectral domain optical coherence tomography (OCT) imaging, intraoperative findings, and treatment outcomes. OCT scans demonstrate a bilaminar structure of maculopathy, consisting of inner schisis-like changes and outer layer retinal detachment. In most cases, a retinal break was demonstrated within the optic disc defect with three-dimensional OCT imaging. Glial tissue was sometimes observed within the anomalous defect. Vitrectomy and resection of the tractional tissue in these cases produced good anatomical and visual outcomes. Retinal detachment spontaneously resolved in cases where traction was not present. Traction may contribute to the pathogenesis of retinal detachment associated with colobomatous optic disc anomalies, either directly or by creating a secondary retinal break. OCT imaging assists with understanding the contributing factors to retinal detachment in individual cases of colobomatous optic disc anomalies and can thereby assist with determining the most effective approach to management.     

视盘出血在正常眼压青光眼中的形态学分析

目的 对正常眼压性青光眼（NTG）患者，前瞻性评估视盘出血和视网膜神经纤维层缺损及盘周萎缩弧之间的形态学关系。 方法 患者行每月1次眼底照相，眼底立体照相和计算机图像分析系统定性及定量评估视盘出血与神经纤维层缺损及萎缩弧的关系。 结果 NTG出血组37位患者42只眼有50处眼底视盘出血，出血眼中有35只有神经纤维层缺损，发生率83.3%（35/42）。非出血组35位患者40只眼中神经纤维层局限缺损为21个，发生率52.5%（21/40），两组间神经纤维缺损发生率无统计学意义（χ2=1.403, P=0.236，P＞0.05）。出血组和非出血组两组间β区萎缩弧的发生率差异有统计学意义（χ2=7.008, P=0.008，P＜0.01)，出血组β区萎缩弧面积(2.05±0.88) mm2，非出血组β区面积(1.42±0.53) mm2，两组比较有统计学意义（t=-2.785, P=0.008）。β区萎缩弧范围在出血组：(164.00±49.87)°，非出血组(128.42±40.04)°，两组间比较有统计学意义（t=-2.618, P=0.012，P＜0.05)。随诊中出血组和非出血组盘沿丢失发生率组间比较有统计学意义（χ2=5.802, P=0.016，P＜0.01），但组间比较随诊视野损害的发生率则无统计学意义。 结论 NTG中视盘出血和神经纤维层缺损及萎缩弧之间有密切的关系。随诊中发现出血组较非出血组有更多的盘沿丢失和萎缩弧面积改变，提示NTG视盘出血是疾病进展的危险因素。 (中华眼底病杂志, 2006, 22: 232-235)     

原发性闭角型青光眼视神经盘结构和视野的改变

原发性闭角型青光眼已成为不可逆性致盲的最常见病因之一。对原发性闭角型青光眼的研究,除了关注眼前节,特别是房角的情况外,也有必要对其视神经损害模式进行研究。本文通过文献回顾,总结了原发性闭角型青光眼特别是急性闭角型青光眼眼底形态和视功能的改变,希望能更好地了解早期原发性闭角型青光眼的疾病特征,为临床治疗和研究提供帮助。     

海德堡视网膜断层扫描仪测量正常人视盘参数

目的 :建立正常人群海德堡视网膜断层扫描仪 (Heidelbergretinatomograph ,HRT)视盘参数的正常值 ,明确哪些因素对正常人HRT视盘参数有影响。方法 :选用 10 2例 (13 2只眼 )正常人 ,用HRT进行视盘扫描 ,视盘参数包括视盘面积、视杯面积和容积、盘沿面积和容积、视杯形态、视杯平均深度和最大深度、杯 /盘面积比、沿 /盘面积比、平均视网膜神经纤维层(retinalnervefiberlayer,RNFL)厚度和横截面积、水平C/D和垂直C/D。计算正常人视盘参数范围 ,用直线回归的方法判断视盘大小和年龄对视盘参数的影响。结果 :正常人左右眼和男女间视盘各参数差异无显著意义 (P >0 0 5)。年龄与RNFL厚度及横截面积呈负相关 ,相关系数分别为 -0 2 3 4和 -0 2 3 5,其余各参数与年龄无关。盘沿容积和视杯最大深度不受视盘大小的影响 ,其余各参数均与视盘大小呈线性相关。结论 :HRT可定量检测正常人视盘参数 ;正常人视盘参数变异很大 ,盘沿容积不受视盘大小的影响 ,是一个区分正常与早期青光眼的很好的参数     

Central Retinal Vein Occlusion in a Childhood Optic Nerve Tumour

The authors describe the first paediatric patient with an aggressive optic nerve tumour of uncertain histology causing a central retinal vein occlusion, retinochoroidal collaterals, arteriovenous anastomoses, and peripheral retinal non-perfusion. He first presented with pale optic nerve head, followed by development of optic disc oedema a year later. Certain optic nerve tumours can present with central retinal vein occlusion in the paediatric age group.     

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。     

Glaucoma diagnosis of the optic disc using photography and planimetry

Ophthalmoscopically and on clinical optic disc photographs, the optic nerve head can be described by the following parameters: size and shape of the optic disc, size and shape of the neuroretinal rim, size and shape of the optic cup, size and shape of the alpha and beta zones of parapapillary chorioretinal atrophy, visibility of the retinal nerve fiber layer, diameter of the retinal arteries, presence and location of optic disc hemorrhages.     

Retinal tomographic measurements in optic disc pit

Background: The aim was to assess the Heidelberg Retina Tomograph II measurements in optic disc pit. Methods: The study included 10 patients with a unilateral optic disc pit. The patients had no other ocular conditions except refractive errors. Normal fellow eyes of the patients were used as a control group. Optic nerve head topographic analyses were performed using a confocal scanning laser ophthalmoscope, Heidelberg Retina Tomograph II (HRT II). Results: The topographic parameters of the eyes with optic disc pit and normal fellow eyes were as follows, respectively: disc area (3.77 ± 1.50 and 3.07 ± 0.83 mm²), cup area (1.99 ± 1.71 and 1.09 ± 0.54 mm²), rim area (1.67 ± 0.55 and 1.87 ± 0.75 mm²), cup volume (0.94 ± 1.24 and 0.34 ± 0.27 mm³), rim volume (0.51 ± 0.40 and 0.55 ± 0.19 mm³), mean cup depth (0.44 ± 0.20 and 0.31 ± 0.11 mm) and mean retinal nerve fibre layer thickness (0.25 ± 0.20 and 0.28 ± 0.59 mm). Eyes with an optic disc pit were found to have significantly larger disc area compared to fellow eyes (p = 0.038). All the other parameters showed no statistically significant interocular differences (p > 0.05). Conclusion: Our study demonstrates that the optic disc pit affects only the disc area measurement in HRT II. Other changes in optic nerve head morphometric parameters were insignificant. The clinician must be careful in the evaluation of HRT II results with respect to optic disc area in a disc with a pit.     

23G玻璃体视网膜手术后视网膜血管直径与神经纤维层厚度及视盘的变化

目的：调查接受睫状体平坦部玻璃体切割术及术中辅助治疗患者的视网膜血管直径,视网膜神经纤维层厚度和视盘改变。
　　方法：共40例(40眼)接受单侧睫状体平坦部玻璃体切割术及术中辅助治疗患者纳入研究,分别于术前、术后3 lo及6 lo行视网膜照相检测视网膜中央动脉和静脉的直径,应用修正Parr-Hubbard公式计算视网膜中央动脉当量和视网膜中央静脉当量。运用Stratus OCT检测视神经纤维层厚度。立体视盘摄影检测视盘的垂直杯盘比。
　　结果：术前患者的双眼视网膜血管直径与神经纤维层厚度及视盘检查无统计学差异。垂直杯盘比在3 lo和6 lo较术前明显增加(P<0.01, P<0.01),且手术眼与对侧眼显著不同(P<0.01, P<0.01)。术后6lo术眼视网膜中央动脉当量与视网膜中央静脉当量的改变明显大于对侧眼(P<0.01, P<0.01)。视神经纤维层厚度无显著变化。
　　结论：玻璃体切割术及术中辅助治疗在术后6 lo会引起视盘的垂直杯盘比及视网膜血管直径的改变,而视网膜神经纤维层厚度变化不明显。