Detection of primary angle closure using anterior segment optical coherence tomography in Asian eyes
Detection of primary angle closure using anterior segment optical coherence tomography in Asian eyes
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DOI：
10.1016/j.ophtha.2006.05.073
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发表时间：
2007-01-01
期刊：
影响因子：
13.7
通讯作者：
Aung, Tin
中科院分区：
文献类型：
--
作者：
Nolan, Winifred P.;See, Jovina L.;Aung, Tin
目的：评价非接触式前房段光学相干技术（as - oct）作为一种定性成像前房角的方法，并与亚洲人的角镜检查相比较，确定其检测初级角关闭的能力。设计：前瞻性观察性病例系列。参与者：从新加坡青光眼诊所招募了2300名被诊断为原发性闭角型、原发性开角型青光眼、高眼压或白内障的患者。每个患者的双眼（如果符合条件）都被纳入研究。排除标准为假性晶状体或既往青光眼手术。方法：分别在黑暗和明亮条件下用AS-OCT获得鼻、颞、下角图像。在低光照条件下，使用Spaeth分类对每个象限的角宽度进行分级。主要观察指标：as - oct将闭合角定义为外周虹膜与巩膜刺前角壁之间的接触，角镜检查将闭合角定义为speth等级为00（后小梁网不可见）。比较两种方法检测闭角的效果。以角膜镜为参考标准，计算as - oct的灵敏度和特异性。结果：200例患者342只眼资料完整。70.9%的患者临床诊断为治疗或未治疗的原发性闭角。AS-OCT检出>= 1象限闭角142例（71%）（228例[66.7%]眼），巩膜镜检出99例（49.5%）（152例[44.4%]眼）。使用AS-OCT和角镜检查，下角比鼻象限或颞象限关闭的频率更高。当在黑暗条件下进行时，as - oct识别出98%的受试者在gonioscopy上发现有闭合角（95%置信区间[CI]， 92.2-99.6），并导致44.6%的患者在gonioscopy上发现有闭合角。以角膜镜为参考标准，as - oct在黑暗中检测闭角个体的特异性为55.4% （95% Cl, 45.2-65.2）。结论：前段OCT是一种快速、非接触的角度结构成像方法。与角镜检查相比，它在检测角闭合方面具有很高的灵敏度。AS-OCT比角镜检查发现闭合角度的人更多。
Objective: To evaluate noncontact anterior segment optical coherence technology (AS-OCT) as a qualitative method of imaging the anterior chamber angle and to determine its ability to detect primary angle closure when compared with gonioscopy in Asian subjects. Design: Prospective observational case series.Participants: Two hundred three subjects were recruited from glaucoma clinics in Singapore with diagnoses of primary angle closure, primary open-angle glaucoma, ocular hypertension, or cataract. Both eyes (if eligible) of each patient were included in the study. Exclusion criteria were pseudophakia or previous glaucoma surgery.Methods: Images of the nasal, temporal, and inferior angles were obtained with AS-OCT in dark and then light conditions. Gonioscopic angle width was graded using the Spaeth classification for each quadrant in low lighting conditions.Main Outcome Measures: Angle closure was defined by AS-OCT as contact between the peripheral iris and angle wall anterior to the scleral spur and by gonioscopy as a Spaeth grade of 00 (posterior trabecular meshwork not visible). Comparison of the 2 methods in detecting angle closure was done by eye and by individual. Sensitivities and specificities of AS-OCT were calculated using gonioscopy as the reference standard.Results: Complete data were available for 342 eyes of 200 patients. Of the patients, 70.9% had a clinical diagnosis of treated or untreated primary angle closure. Angle closure in >= 1 quadrants was detected by AS-OCT in 142 (71%) patients (228 [66.7%] eyes) and by gonioscopy in 99 (49.5%) patients (152 [44.4%] eyes). The inferior angle was closed more frequently than the nasal or temporal quadrants using both AS-OCT and gonioscopy. When performed under dark conditions, AS-OCT identified 98% of those subjects found to have angle closure on gonioscopy (95% confidence interval [CI], 92.2-99.6) and led to the characterization of 44.6% of those found to have open angles on gonioscopy to have angle closure as well. With gonioscopy as the reference standard, specificity of AS-OCT in the dark was 55.4% (95% Cl, 45.2-65.2) for detecting individuals with angle closure.Conclusion: Anterior segment OCT is a rapid noncontact method of imaging angle structures. It is highly sensitive in detecting angle closure when compared with gonioscopy. More persons are found to have closed angles with AS-OCT than with gonioscopy.