Detection of Localized Retinal Nerve Fiber Layer Defects in Glaucoma Using Enhanced Spectral-Domain Optical Coherence Tomography
Detection of Localized Retinal Nerve Fiber Layer Defects in Glaucoma Using Enhanced Spectral-Domain Optical Coherence Tomography
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DOI：
10.1016/j.ophtha.2010.10.025
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发表时间：
2011-06-01
期刊：
影响因子：
13.7
通讯作者：
Yoshimura, Nagahisa
中科院分区：
文献类型：
--
作者：
Nukada, Masayuki;Hangai, Masanori;Yoshimura, Nagahisa
目的：比较散斑噪声抑制光谱域光学相干断层扫描(EnhancedSDOCT)、单次扫描SDOCT和单扫描时域OCT(TD OCT)图像上视网膜神经纤维层(RNFL)缺陷与周边乳头状RNFL(CpRNFL)变薄或破坏的差异。设计：回顾性对比病例序列。受试者：44例(44只眼)开角型青光眼合并局限性楔状RNFL缺陷的患者和35例(35只眼)正常人眼。方法：对35名志愿者的cpRNFL和cpRNFL的横断面图像，与用照片识别RNFL缺陷的标准数据库的可信区间进行比较，比较3种类型的OCT仪器：增强型SD OCT(SD OCT)，在相同位置跟踪和平均16幅图像以减少斑点噪声；Spectralis HRA+OCT；Heidelberg Engineering，Heidelberg，德国)，单扫描SD OCT(RTVue-100；Optovue，Fremont，CA)和单扫描TD OCT(Stratus；Carl Zeiss-Meditec，CA，Dublin)。主要观察指标：无红眼底照片上局限性RNFL缺陷的横断面图像，检测照相RNFL缺陷的敏感性，以及OCT上cpRNFL厚度图上至少有1个异常变薄扇区的青光眼的敏感性和特异性。结果：在44只青光眼患者中，65只RNFL缺陷在无红眼底照片上被发现。增强的SD OCT图像的cpRNFL边界比单扫描的SD OCT或TD OCT图像更清晰，尤其是在与RNFL缺陷相对应的区域。增强的SD OCT显示不同程度的cpRNFL变薄，在65个RNFL缺陷中，23个(35.4%)的cpRNFL反射率在与照相RNFL相同的位置被破坏。单次扫描TD OCT和SD OCT在未阻断RNFL的情况下，发现RNFL缺陷的可能性显著降低(分别为P=0.002和P=0.006)。与单扫TD OCT相比，增强SD OCT对未被破坏的RNFL缺陷的检出更敏感(P
Objective: To compare retinal nerve fiber layer (RNFL) defects on fundus photographs with circumpapillary RNFL (cpRNFL) thinning or disruption on images obtained by speckle-noise-reduced spectral-domain optical coherence tomography (enhanced SD OCT), single-scan SD OCT, and single-scan time-domain OCT (TD OCT).Design: Retrospective, comparative case series.Participants: Forty-four eyes of 44 patients with open-angle glaucoma with localized, wedge-shaped RNFL defects on red-free photographs and 35 normal eyes of 35 volunteers.Methods: Cross-sectional images of the cpRNFL and cpRNFL thinning, compared with the confidence interval limit of the normative database where the RNFL defect was photographically identified, were compared between the 3 types of OCT instruments: enhanced SD OCT (SD OCT with eye tracking and averaging of 16 images at the same location to reduce speckle noise; Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany), single-scan SD OCT (RTVue-100; Optovue, Fremont, CA), and single-scan TD OCT (Stratus; Carl Zeiss-Meditec, Dublin, CA).Main Outcome Measures: Cross-sectional images of localized RNFL defects on red-free fundus photographs, sensitivity for detecting the photographic RNFL defect, and sensitivity and specificity for detecting glaucoma as having at least 1 abnormally thinned sector on the cpRNFL thickness map on OCT.Results: Among the 44 eyes with glaucoma, 65 RNFL defects were identified on red-free fundus photographs. The cpRNFL boundaries were clearer on enhanced SD OCT images than on single-scan SD OCT or TD OCT images, particularly in regions corresponding to the RNFL defects. Enhanced SD OCT revealed various degrees of cpRNFL thinning, and disruption of cpRNFL reflectivity was seen in the same location as the photographic RNFL defect for 23 (35.4%) of the 65 RNFL defects. The RNFL defects were significantly less likely to be detected by single-scan TD OCT or SD OCT (P = 0.002 and P = 0.006, respectively) when the RNFL was not disrupted. Enhanced SD OCT was more sensitive in detecting the RNFL defects that were not disrupted compared with single-scan TD OCT (P