Interpreting Retinal Nerve Fiber Layer Reflectance Defects Based on Presence of Retinal Nerve Fiber Bundles.
Interpreting Retinal Nerve Fiber Layer Reflectance Defects Based on Presence of Retinal Nerve Fiber Bundles.
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DOI：
10.1097/opx.0000000000001690
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发表时间：
2021-05-01
期刊：
影响因子：
--
通讯作者：
Burns SA
中科院分区：
文献类型：
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作者：
Swanson WH;King BJ;Burns SA
自适应光学扫描激光检眼镜检查（AOSLO）视网膜神经纤维层（RNFL）的视网膜成像有助于预测周边损伤的严重程度，基于纤维的缺失和来自光谱域光学相干断层扫描（SD-OCT）的RNFL正面图像中缺陷的投影。RNFL的正面图像揭示青光眼患者的反射缺陷，并预测周边缺陷的位置。这些缺陷可能是由于视网膜神经纤维束的丢失或束反射率降低引起的。本研究使用AOSLO评估SD-OCT上RNFL反射缺陷区域中是否存在束。使用自适应光学扫描激光检眼镜成像视盘和中央凹之间约30 × 3°的垂直RNFL条带。选择了15例通过该区域的SD-OCT反射缺陷的青光眼患者。4名患者在上级和低级半野都有反射缺陷，因此对19个半野进行了AOSLO上的束存在评估。如果存在束，则对半野进行评分，以确定束是否异常（低对比度和/或低密度）。当灵敏度低于15 dB时，认为周边缺损较深。10个半野在AOSLO上有一个没有纤维的区域;所有半野都有相应的深周边缺损。其他9个半野在AOSLO图像中没有无纤维的区域：4个有正常纤维，5个有异常纤维。这9个半野中唯一一个有深周边缺损的半野是低对比度纤维和整体薄RNFL。视网膜神经纤维层反射率缺陷，这是与深周边缺陷，通常有一个区域，没有纤维的AOSLO图像的RNFL。从正面SD-OCT RNFL反射图像预测外周损伤严重程度的能力可以受益于区分纤维缺失和异常纤维的量化。
Adaptive-optics scanning-laser-ophthalmoscopy (AOSLO) retinal imaging of the retinal nerve fiber layer (RNFL) helps predict the severity of perimetric damage based on absence of fibers and projection of the defects in en face images of the RNFL from spectral-domain optical coherence tomography (SD-OCT). En face images of the RNFL reveal reflectance defects in patients with glaucoma and predict locations of perimetric defects. These defects could arise from either loss of retinal nerve fiber bundles or reduced bundle reflectance. This study used AOSLO to assess presence of bundles in areas with RNFL reflectance defects on SD-OCT. Adaptive-optics scanning laser ophthalmoscopy was used to image a vertical strip of RNFL measuring approximately 30 × 3° between the optic disc and the fovea. Fifteen patients with glaucoma who had SD-OCT reflectance defects that passed through this region were chosen. Four patients had reflectance defects in both superior and inferior hemifields, so presence of bundles on AOSLO was assessed for 19 hemifields. Where bundles were present, the hemifield was scored for whether bundles seemed unusual (low contrast and/or low density). Perimetric defects were considered deep when sensitivity was below 15 dB. Ten hemifields had a region with no fibers present on AOSLO; all had a corresponding deep perimetric defect. The other nine hemifields had no region in the AOSLO image without fibers: four with normal fibers and five with unusual fibers. The only one of these nine hemifields with a deep perimetric defect was one with low-contrast fibers and overall thin RNFL. Retinal nerve fiber layer reflectance defects, which were associated with deep perimetric defects, usually had a region with absence of fibers on AOSLO images of RNFL. Ability to predict severity of perimetric damage from en face SD-OCT RNFL reflectance images could benefit from quantification that differentiated between absence of fibers and unusual fibers.