傅立叶OCT在早期原发性开角型青光眼中的诊断能力

目的：评价傅立叶域相干光断层成像术Fourier-Domain Optical Coherence Tomography,FD-OCT, using the RTVue -100 (Optovue Inc, Fremont, California,USA）]在鉴别正常眼及早期原发性开角型青光眼（POAG）中的能力。 方法：横断面研究。对符合入选标准的早期原发性开角型青光眼组及正常组的所有受试者行FD-OCT及Humphrey视野（Humphrey Field Analyzer model 740, Carl Zeiss Meditec, Dublin, CA, USA）检查。比较早期POAG患者及正常人各视盘测量参数、神经纤维层厚度及后极部神经节细胞复合体(GCC)厚度；对早期POAG患者及正常人各测量参数绘制受试者操作特征曲线（ROC），计算ROC曲线下面积（AROC），敏感性、特异性及阳性和阴性似然比评估各参数的诊断性能。 结果：分析34例早期POAG患者及42例正常人结果。在特定特异度（95% and 85%）下垂直杯盘比（C/D vertical ratio）的灵敏度和阳性似然比最高，分别为79.4%和88.2%，33.4和7.4。在所有单一参数中，垂直杯盘比的AROC最大，为0.930。使用logistical诊断模型联合垂直杯盘比、RNFL AT on 3.45mm和盘沿面积，AROC为0.949。 结论：FD-OCT所测得的视盘、神经纤维层厚度及GCC厚度改变在早期POAG患者及正常人差异有显著性。以AROC、敏感性、特异性及阳性和阴性似然比为评价指标，位居前三位的指标为：垂直杯盘比、RNFL AT on 3.45mm和盘沿面积。

Diagnostic Capability of Fourier-Domain Optical Coherence Tomography in early Primary Open Angle Glaucoma

Background: To evaluate the diagnostic capability of parameters of the optic disc, retinal nerve fiber layer thickness, and ganglion cell complex (GCC) using Fourier-domain optical coherence tomography (FD-OCT) for early primary open angle glaucoma (POAG) patients. Design and Methods: Observational cross-sectional study. Two groups of patients, early perimetric damage POAG and normal subjects were included in this study. All patients underwent FD-OCT and visual field examination in addition to full ophthalmic examinations. Receiver operating characteristic curves (ROC) were studied for all parameters. The sensitivity and specificity for distinguishing between normal and early glaucomatous eyes, the areas under the receiver operating characteristic curves (AROC) and positive, negative likelihood ratios were evaluated for all the single parameters and selected combined parameters using arbitrary cutoffs. Results: 34 eyes of 34 early POAG patients and 42 eyes of 42 normal subjects were analyzed. Cup/Disc vertical ratio presented the best sensitivity and positive likelihood ratio for selected specificities (95% and 85%) which were 79.4% and 88.2%, 33.4 and 7.4, respectively. Among all single parameters, the C/D vertical ratio demonstrated the highest AROC which was at 0.930. The RNFL AT on 3.45mm shows the highest AROC among all of the peripapillary RNFL parameters. The sensitivity at selected specificity and AROC of GCC was not as high as C/D vertical ratio and RNFL AT on 3.45mm. When the C/D vertical ratio, RNFL AT on 3.45mm, and rim area were combined using a logistical diagnostic model, the AROC was raised to 0.949 but not significantly different from the top single parameter, C/D vertical ratio. Conclusions: The key parameters obtained by FD-OCT were able to show the significant differences of optic discs, thickness of RNFL and GCC between POAG patients and normal subjects. According to sensitivity, specificity, likelihood ratio and AROC, the top three parameters from FD-OCT for early diagnosis of POAG were C/D vertical ratio, RNFL AT on 3.45mm, and the rim area.