用谱域OCT检测青光眼局限性视网膜神经纤维层缺损

目的评价新一代谱域OCT（SD—OCT）对青光眼局限性视网膜神经纤维层缺损（RNFLD）的识别能力。设计前瞻性病例系列。研究对象眼底立体像存在局限性RNFLD的青光眼患者44例（53眼），非青光眼对照者53例（53眼）。方法采用SD-OCT以视盘为中心环形扫描检查，扫描直径3．46mm。Kappa检验分析眼底立体像与SD—OCT两种方法对局限RNFLD部位检测一致性，并比较两种方法所检测局限RNFLD的位置及宽度对应关系。主要指标敏感性与特异性，k值，Pearson相关系数。结果自带数据库的SD-OCT显示局限性RNFLD的敏感性为92．8％，特异性为96．4％。它与眼底立体像显示局限RNFLD总体一致率94．39％（101／107），K值为0．912（P=0．000）。两种方法检测的局限性RNFLD位置Pearson相关系数r=0．987（P=0．000），宽度Pearson相关系数r=0．932（P=0．000）。结论SD—OCT具有较好的发现局限性RNFLD的能力，且与眼底立体像有很好的检测一致性。在临床上可作为青光眼RNFLD的有效检测手段，对青光跟RNFLD的进展随诊观察具有潜在价值。

The comparison of identifying the localized retinal nerve fiber layer defects using the spectral-domain OCT with fundus stereophotography

Objective To evaluate the ability of spectral-domain optical coherence tomography （SD-OCT） with its internal normative database to identify the localized retinal nerve fiber layer defects （RNFLD） in patients with glaucoma. Design Prospective case series. Participants 44 patiens （53 eyes） with localized RNFLD by fundus stereophotography, and 48 cases （48 eyes） of normal controls. Methods The subjects were scanned around the optic disc in a circle with the diameter of 3.46 mm with SD-OCT. The agreement between SD-OCT and fundus stereophotography to identify the localized RNFLD was evaluated. Correlations between the angular location and angular width of RNFLD determined by OCT （OCT-RNFLD） and by fundus stereophotography （fundus-RNFLD） were evaluated. Main Outcome Measures Sensitivity, specificity, k value for the agreement, Pearson correlation coefficient. Results The overall sensitivity and specificity of SD-OCT with its normal database to identify localized RNFLD was 92.8% and 96.4%, respectively. SD-OCT showed good diagnostic agreement with fundus stereophotography （overall k value = 0.912, P=0.000）. The angular locations and widths of RNFLD by SD-OCT were highly correlated with those of RNFLD by fundus stereophotography （Pearson correlation coefficient [r] = 0.987 and r=0.932, respectively, P=0.000）. Conelusious The SD-OCT with a normative database can detect localized RNFLD with high sensitivity and specificity, and shows good diagnostic agreement with fundus stereophotography. SD-OCT can be used for identify- ing RNFLD in patients with glaucoma, and has the potential to follow the progression of the RNFLD.