Mardin C Y, Horn F, Viestenz A, Lämmer R, Jünemann A
Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Erlangen.
Klin Monbl Augenheilkd. 2006 Apr;223(4):308-14. doi: 10.1055/s-2005-858855.
Healthy optic discs with large cups are often characterised to be glaucomatous in automated, morphometric analysis. The aim of this study was to investigate the variables of laser scanning tomography (LST) and nerve fibre polarimetry of these disks in comparison to small and normal sized disks.
117 eyes (age 49.3 +/- 14.6 years) with healthy, non-atrophic disks (md = 0.8 dB, Tensio 14.3 +/- 2.5 mmHg) of the Erlangen Glaucoma Registry were clinically examined. Morphometry was performed both by planimetry and the HRT I (Heidelberg Engineering, Dossenheim, version 2.01) and with the GDx FCC (Laser Diagnostics, San Diego). 63 eyes initially referred for a large cup were compared to 54 normal eyes. All measurements were analysed globally and in four sectors according to Jonas.
The disc area of discs with large cups was significantly larger than that for the normals (3.1 +/- 5.3 vs. 2.2 +/- 4.2 mm (2)). Both the multivariate analysis of the HRT and the GDx revealed a significant correlation with total disk area (R = 0.34, p = 0.0001), with a high percentage of false positive glaucoma eyes among large disks. Cup area and volume showed, in contrast to rim volume and rim area, a significant correlation (R = 0.76, p = 0.0001) with the disc size. Thickness of retinal nerve fibre layer measurements both in HRT and GDx showed higher values for larger disc size with steeper cup measurements. The vertical diameter of the cup increased in comparison to the horizontal to a higher extent with increasing disc size.
By the pronounced enlargement of cup measurements, decreasing nerve fibre thickness values and decreasing ratio of temporal-to-inferior width of the neuroretinal rim, large disks may easily be detected as false glaucomatous by morphometric analysis systems. A better presentation of large discs in a normative database and integration of sectors and disc area in a multivariate analysis may improve the diagnostic abilities of automated morphometric disk analysis.
在自动形态测量分析中，杯盘比大的健康视盘常被判定为青光眼性视盘。本研究旨在对比杯盘比大的视盘与小视盘及正常大小视盘，研究激光扫描断层扫描（LST）和神经纤维偏振测量法的相关变量。
对埃尔朗根青光眼登记处的117只眼（年龄49.3±14.6岁）进行临床检查，这些眼睛具有健康、非萎缩性视盘（平均偏差=0.8 dB，眼压14.3±2.5 mmHg）。通过面积测量法以及HRT I（海德堡工程公司，多森海姆，版本2.01）和GDx FCC（激光诊断公司，圣地亚哥）进行形态测量。将最初因杯盘比大而转诊的63只眼与54只正常眼进行比较。所有测量结果均根据约纳斯法进行整体分析和四个象限分析。
杯盘比大的视盘面积显著大于正常视盘（3.1±5.3 vs. 2.2±4.2 mm²）。HRT和GDx的多变量分析均显示与视盘总面积存在显著相关性（R = 0.34，p = 0.0001），杯盘比大的视盘中青光眼假阳性眼的比例较高。与盘沿体积和盘沿面积相比，杯盘面积和体积与视盘大小存在显著相关性（R = 0.76，p = 0.0001）。HRT和GDx测量的视网膜神经纤维层厚度在视盘较大且杯盘比测量值更陡时显示出更高的值。随着视盘大小增加，杯盘的垂直直径相对于水平直径增加的幅度更大。
通过杯盘测量值的显著增大、神经纤维厚度值的降低以及神经视网膜盘沿颞侧与下方宽度比值的降低，形态测量分析系统可能容易将大视盘误判为青光眼性视盘。在标准数据库中更好地呈现大视盘，并在多变量分析中纳入象限和视盘面积，可能会提高自动形态测量视盘分析的诊断能力。
