Optic disk and nerve fiber layer Imaging to detect glaucoma
Optic disk and nerve fiber layer Imaging to detect glaucoma
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DOI：
10.1016/j.ajo.2007.07.010
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发表时间：
2007-11-01
影响因子：
4.2
通讯作者：
Caprioli, Joseph
中科院分区：
文献类型：
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作者：
Badala, Federico;Nouri-Mahdavi, Kouros;Caprioli, Joseph
目的：比较视盘和视网膜神经纤维层(RNFL)成像方法对早期青光眼和正常眼的鉴别诊断价值。设计：回顾性横断面研究。方法：在三级护理学术青光眼中心，对92例92只眼(46例早期周围型开角型青光眼和46例对照组)进行研究。比较了光学相干断层扫描(StratusOCT；Carl Zeiss Meditec，美国加州都柏林)、扫描激光偏振仪(GDX VCC；激光诊断技术，美国加利福尼亚州圣地亚哥)、共焦激光眼底镜(Heidelberg Retinal Tomstrator[HRT]III；Heidelberg Engineering GmbH，Heidelberg，德国)和立体光盘照片的定性评估的诊断性能。结果测量指标为受试者操作特征曲线(AUC)下的面积和固定特异度下的敏感度。结果：青光眼的视野平均偏差(+/-标准差)为-4.0+/-2.5分贝(分贝)。AUC最大(标准差)的参数有：StratusOCT的平均RNFL厚度(+/-0.96+/-0.02)，GDX VCC的神经纤维指示器(0.92+/-0.03)，HRT III的Frederick S.Mikelberg(FSM)判别函数(0.91+/-0.03)，以及椎间盘照片评价的0.97+/-0.02。在95%的特异度下，椎间盘摄影的敏感性(90%)高于GDX VCC(P=.05)和HRT III(P=.002)，但与StratusOCT(P>；.05)无显著差异。StratusOCT平均RNFL厚度和HRT III杯盘面积与CART相结合的灵敏度为91%，特异度为96%。结论：StratusOCT、GDX VCC和HRT III对早期周围性青光眼的定性评价与视盘立体摄影一样好，但不好。StratusOCT平均RNFL厚度和HRT III杯盘面积比的组合提供了较高的诊断准确率。
PURPOSE: To compare optic disk and retinal nerve fiber layer (RNFL) imaging methods to discriminate eyes with early glaucoma from normal eyes.DESIGN: Retrospective, cross-sectional study.METHODS: In a tertiary care academic glaucoma center, 92 eyes of 92 subjects (46 with early perimetric open-angle glaucoma and 46 controls) were studied. Diagnostic performance of optical coherence tomography (StratusOCT; Carl Zeiss Meditec, Dublin, California, USA), scanning laser polarimetry (GDx VCC; Laser Diagnostic Technologies, San Diego, California, USA), confocal laser ophthalmoscopy (Heidelberg Retinal Tomograph [HRT] III; Heidelberg Engineering GmbH, Heidelberg, Germany), and qualitative assessment of stereoscopic optic disk photographs were compared. Outcome measures were areas under receiver operator characteristic curves (AUCs) and sensitivities at fixed specificities. Classification and regression tree (CART) analysis was used to evaluate combinations of quantitative parameters.RESULTS: The average (+/- standard deviation) visual field mean deviation for glaucomatous eyes was -4.0 +/- 2.5 dB (decibels). Parameters with largest AUCs ( standard error) were: average RNFL thickness for StratusOCT (+/- 0.96 +/- 0.02), nerve fiber indicator for GDx VCC (0.92 +/- 0.03), Frederick S. Mikelberg (FSM) discriminant function for HRT III (0.91 +/- 0.03), and 0.97 +/- 0.02 for disk photograph evaluation. At 95% specificity, sensitivity of disk photograph evaluation (90%) was greater than GDx VCC (P = .05) and HRT III (P = .002) results, but not significantly different than those of StratusOCT (P > .05). The combination of StratusOCT average RNFL thickness and HRT III cup,to-disk area with CART produced a sensitivity of 91% and specificity of 96%.CONCLUSIONS: StratusOCT, GDx VCC, and HRT III performed as well as, but not better than, qualitative evaluation of optic disk stereophotographs for detec, tion of early perimetric glaucoma. The combination of StratusOCT average RNFL thickness and HRT III cup-to-disk area ratio provided a high diagnostic precision.