Diagnostic Ability of Individual Macular Layers by Spectral-Domain OCT in Different Stages of Glaucoma
Diagnostic Ability of Individual Macular Layers by Spectral-Domain OCT in Different Stages of Glaucoma
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DOI：
10.1016/j.ogla.2020.04.003
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发表时间：
2020-09-01
影响因子：
2.9
通讯作者：
Schmetterer, Leopold
中科院分区：
文献类型：
--
作者：
Chua, Jacqueline;Tan, Bingyao;Schmetterer, Leopold
目的：比较黄斑视网膜内层厚度与乳头周围视网膜神经纤维层（cpRNFL）厚度单独使用或联合cpRNFL对早期、中度和晚期青光眼的诊断能力。设计：横断面研究。参与者：共有423名青光眼参与者和423名年龄和性别匹配的正常参与者。方法：参与者使用视盘和黄斑扫描方案进行卷云光谱域OCT （SD-OCT）成像（Carl Zeiss Meditec, Dublin， CA）。使用Iowa Reference Algorithms （version 3.8.0）进行视网膜内层分割，利用轴向长度值进行放大校正，重新缩放视网膜内层的平均厚度。获得了各层/扇形的厚度测量值及其在接收机工作特性曲线（auc）下对应的面积。青光眼根据其视野严重程度细分（早期，n = 234；中度，n = 107；晚期，n = 82）。主要观察指标：视网膜内层。结果：67%的参与者为男性，平均年龄±标准差为65±9岁。青光眼组视网膜乳头周围神经纤维层、黄斑神经节细胞层（mGCL）、黄斑内丛状层（mIPL）明显变薄（P < 0.0005）。正常眼早期青光眼的最佳检测参数为cpRNFL （AUC = 0.861）和mGCL (AUC = 0.842)，中度青光眼的最佳检测参数为mGCL联合内丛状层（IPL） （AUC = 0.915）和cpRNFL （AUC = 0）。914)，晚期青光眼为mGCL-IPL （AUC = 0.984）和cpRNFL （AUC = 0.977）。各严重程度黄斑参数auc与cpRNFL厚度测量差异无统计学意义（P < 0.05）。结合黄斑和cpRNFL参数提高了早期青光眼（AUC = 0.908; P = 0.002）和中度青光眼（AUC = 0.944; P = 0.031）的诊断效能，但对晚期青光眼（AUC = 0.991; P = 0.05）的诊断效能没有提高。结论：单层mGCL厚度与传统的cpRNFL厚度相当，用于诊断早期/中度青光眼，而cpRNFL厚度仍然是晚期青光眼最有效的。联合黄斑测量（GCL和GCL- ipl）和cpRNFL提高了早期/中度青光眼的识别，但没有提高晚期青光眼的识别。对于早期青光眼的诊断，应同时使用黄斑和视盘扫描。(C) 2020年美国眼科学会。
Purpose: To compare the diagnostic ability of macular intraretinal layer thickness with circumpapillary retinal nerve fiber layer (cpRNFL) thickness, either when used individually or in combination with cpRNFL for detecting early, moderate, and advanced glaucoma.Design: Cross-sectional study.Participants: A total of 423 glaucoma participants and 423 age- and gender-matched normal participants.Methods: Participants underwent Cirrus spectral-domain OCT (SD-OCT) imaging (Carl Zeiss Meditec, Dublin, CA) using the optic disc and macular scanning protocols. Iowa Reference Algorithms (version 3.8.0) were used for intraretinal layer segmentation, and mean thickness of intraretinal layers was rescaled with magnification correction using axial length value. Thickness measurements of each layer/sector and their corresponding areas under the receiver operating characteristic curve (AUCs) were obtained. Glaucoma eyes were subdivided based on of their visual field severity (early, n = 234; moderate, n = 107; advanced, n = 82).Main Outcome Measures: Intraretinal layers.Results: Some 67% of participants were male, their average +/- standard deviation age was 65 +/- 9 years. Circumpapillary retinal nerve fiber layer, macular ganglion cell layer (mGCL), and macular inner plexiform layer (mIPL) were significantly thinner in the glaucoma groups (P < 0.0005). The 2 best parameters for detecting normal eyes from early glaucoma was cpRNFL (AUC = 0.861) and mGCL (AUC = 0.842), from moderate glaucoma was mGCL combined with inner plexiform layer (IPL) (AUC = 0.915) and cpRNFL (AUC = 0 .914), and from advanced glaucoma was mGCL-IPL (AUC = 0.984) and cpRNFL (AUC = 0.977). There was no statistical significance between AUCs for the macular parameter and cpRNFL thickness measurement at any of the severities (P > 0.05). Combining macular and cpRNFL parameters improved the diagnostic performance for early glaucoma (AUC = 0.908; P = 0.002) and moderate glaucoma (AUC = 0.944; P = 0.031) but not for advanced glaucoma (AUC = 0.991; P > 0.05).Conclusions: Single-layer mGCL thickness is comparable to the traditional cpRNFL thickness for the diagnosis of early/moderate glaucoma, whereas cpRNFL thickness remains the most efficient for advanced glaucoma. Combining macular measurements (GCL and GCL-IPL) and cpRNFL improved the discrimination of early/moderate glaucoma but not of advanced glaucoma. For the diagnosis of early glaucoma, both macular and optic disc scans should be used. (C) 2020 by the American Academy of Ophthalmology.