Usefulness of axonal tract-dependent OCT macular sectors for evaluating structural change in normal-tension glaucoma
Usefulness of axonal tract-dependent OCT macular sectors for evaluating structural change in normal-tension glaucoma
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DOI：
10.1371/journal.pone.0185649
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发表时间：
2017-10-03
期刊：
影响因子：
3.7
通讯作者：
Nakazawa, Toru
中科院分区：
文献类型：
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作者：
Omodaka, Kazuko;Kikawa, Tsutomu;Nakazawa, Toru
目的确定光学相干断层扫描（OCT）黄斑图的扇区，可用于有效评估正常眼压性青光眼（NTG）患者的结构进展。方法本研究检查了117例NTG患者的117只眼，以建立轴突束依赖性黄斑扇区，并且还检查了81名NTG患者的122只眼睛的单独组，以评估这些部分揭示青光眼进展的能力。该组所有患者的纵向数据，包括至少2年内进行的至少5次OCT检查的黄斑图。用3D OCT-2000（TOP-CON）测量视乳头周围视网膜神经纤维层厚度（cpRNFLT）、颞侧顺时针扇形扫描（7 - 11点）、黄斑视网膜神经纤维层厚度（mRNFLT）和黄斑神经节细胞层加内丛状层厚度（mGCIPLT）。通过计算覆盖在黄斑图上的网格上的每个点的斯皮尔曼等级相关系数和每个顺时针扫描扇区中的cpRNFLT来识别轴突束依赖性黄斑扇区。对每个扇区的进展斜率和黄斑图进行趋势和事件分析。视野进展的黄斑被定义为存在超过2个渐进的测试点，在16个中心测试点的汉弗莱场分析仪SITA标准24-2程序，评估与Progressorsoftware.ResultsThe斜率的进展在整个黄斑区为-0.22 +/- 0.58亩米/年mRNFLT和-0.35 +/- 0.52亩米/年mGCIPLT。进展最快的mRNFLT部分（-1.00 +/-0.84 mu m/年，p < 0.001）和mGCIPLT部分（-1.16 +/-0.63 mu m/年，p < 0.001）的进展明显快于整个黄斑。根据视野进展对患者进行分类显示，进展者（22只眼）的下半视野、7点钟和8点钟扇区中的基线mRNFLT以及整体黄斑图、下半视野和8点钟扇区中的基线mGCIPLT显著低于非进展者（100只眼）。在进展者和非进展者中，8点钟扇区和进展最快扇区的mRNFLT斜率存在显著差异，但即使在进展最快的扇区中，mGCIPLT也没有差异。事件分析结果显示，NTG患者黄斑部病变进展最常见于下mRNFLT和上级mGCIPLT。此外，mRNFLT斜率与视野进展一致。该方法有望为基于OCT的青光眼进展评估开辟新的途径。
PurposeTo identify sectors of the optical coherence tomography (OCT) macular map that could be used to effectively assess structural progression in patients with normal-tension glaucoma (NTG).MethodsThis study examined 117 eyes of 117 NTG patients to establish axonal tract-dependent macular sectors, and also examined a separate group of 122 eyes of 81 NTG patients to evaluate the ability of these sectors to reveal glaucoma progression. Longitudinal data, including macular maps from at least 5 OCT examinations performed over at least 2 years, was available for all patients in this group. Circumpapillary retinal nerve fiber layer thickness (cpRNFLT), temporal clockwise sector scans (from 7 to 11 o'clock), macular retinal nerve fiber layer thickness (mRNFLT), and macular ganglion cell layer plus inner plexiform layer thickness (mGCIPLT) were measured with spectral-domain OCT (3D OCT-2000, TOP-CON). The axonal tract-dependent macular sectors were identified by calculating Spearman's rank correlation coefficient for each point on a grid overlaid on the macular map and cpRNFLT in each clockwise scan sector. Trend and event analyses for the slope of progression in each sector and macular map were performed. Visual field progression in the macula was defined by the presence of more than 2 progressive test points in the 16 central test points of the Humphrey field analyzer SITA standard 24-2 program, evaluated with Progressor software.ResultsThe slope of progression in the entire macular area was -0.22 +/- 0.58 mu m/year for mRNFLT and -0.35 +/- 0.52 mu m/year for mGCIPLT. The fastest-progressing mRNFLT sector (-1.00 +/- 0.84 mu m/year, p < 0.001) and mGCIPLT sector (-1.16 +/- 0.63 mu m/year, p < 0.001) progressed significantly faster than the overall macula. Classifying patients according to visual field progression showed that baseline mRNFLT in the inferior hemifield, 7 and 8 o'clock sectors, as well as baseline mGCIPLT in the overall macular map, inferior hemifield, and 8 o'clock sector, were significantly lower in progressors (22 eyes) than non-progressors (100 eyes). There were significant differences in mRNFLT slope in 8 o'clock sector and in the fastest progressing sector in progressors and non-progressors, but mGCIPLT did not differ, even in the fastest-progressing sector. Event analysis showed that progression occurred most frequently in inferior mRNFLT and superior mGCIPLT in this study.ConclusionAxonal tract-dependent OCT macular sectors could effectively reveal structural change in patients with NTG. Furthermore, mRNFLT slope was consistent with visual field progression. This method promises to open new avenues for the OCT-based evaluation of glaucoma progression.