Mastropasqua Leonardo, Brusini Paolo, Carpineto Paolo, Ciancaglini Marco, Di Antonio Luca, Zeppieri Marco W, Parisi Lucia
Ophthalmology Clinic, University G. d'Annunzio, Chieti-Pescara, via dei Vestini, 66013 Chieti, Italy.
J Glaucoma. 2006 Aug;15(4):328-35. doi: 10.1097/01.ijg.0000212230.65545.d3.
The purpose of this study was to determine by means of the Humphrey Matrix frequency doubling technology (FDT) perimetry and the optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness measurement whether functional and/or structural differences exist between normal and ocular hypertensive (OHT) subjects.
One eye of 60 consecutive normal individuals and 60 OHT subjects was enrolled in this prospective observational comparative case series study. All subjects were examined at either the Ophthalmology Clinic, University of Chieti-Pescara, Chieti, Italy or the Department of Ophthalmology, S. Maria della Misericordia Hospital, Udine, Italy. All subjects underwent a full ophthalmic examination, including visual acuity, slit-lamp biomicroscopy, central corneal thickness ultrasound pachymetry measurement, achromatic automated perimetry, Matrix FDT perimetry, stereoscopic optic nerve head photography, and OCT. Matrix FDT perimetry mean deviation (MD), pattern standard deviation, glaucoma hemifield test, and 12 OCT RNFL thickness parameters were examined. Student t test, Bonferroni correction for multiple comparisons and receiver operator characteristics curve areas (AUROCs) were used to find any discrimination function between healthy and OHT eyes. Sensitivities at 83% and 92% specificities were reported.
The FDT MD scores ranged from -1.10 to +3.80 decibels (db) in normal individuals and from -4.75 to +3.20 db in OHT subjects. The comparison between the average MD in the 2 groups showed a statistically significant difference (P=0.024). OCT showed a statistically significant difference between the 2 groups when examining the ratio between the inferior and the superior mean RNFL thickness (P=0.004). For OCT, the parameter with the largest AUROC for discriminating between healthy and hypertensive eyes was the ratio between the mean inferior and superior RNFL thickness (AUROC=0.85, sensitivity=75% at specificity=83%, sensitivity=67% at specificity=92%). For Matrix FDT perimetry, the parameter with the largest AUROC was MD (AUROC=0.78, sensitivity=67% at specificity=83%, sensitivity=58% at specificity=92%).
Our results suggest that OHT eyes having a normal achromatic automated perimetry and a normal clinical disc appearance cannot be differentiated from normal eyes using conventional OCT parameters. When analyzing the ratio between inferior and superior average RNFL thickness, however, a significant difference is evident between healthy and hypertensive eyes. Using Matrix FDT perimetry, a significant difference in MD seems to exist between these 2 groups of eyes. The AUROCs confirm that OCT Iavg/Savg and Matrix FDT MD show the greatest sensitivity and specificity among the examined OCT and Matrix FDT parameters.
本研究旨在通过 Humphrey 矩阵频率加倍技术（FDT）视野检查和光学相干断层扫描（OCT）测量视网膜神经纤维层（RNFL）厚度，确定正常人和高眼压（OHT）受试者之间是否存在功能和/或结构差异。
本前瞻性观察性对比病例系列研究纳入了 60 名连续正常个体和 60 名 OHT 受试者的一只眼睛。所有受试者均在意大利基耶蒂 - 佩斯卡拉大学眼科诊所或意大利乌迪内慈悲圣母医院眼科进行检查。所有受试者均接受了全面的眼科检查，包括视力、裂隙灯生物显微镜检查、中央角膜厚度超声测厚、无色自动视野检查、矩阵 FDT 视野检查、立体视盘照相和 OCT。检查了矩阵 FDT 视野检查的平均偏差（MD）、模式标准差、青光眼半视野检查以及 12 个 OCT RNFL 厚度参数。采用 Student t 检验、多重比较的 Bonferroni 校正以及受试者操作特征曲线面积（AUROCs）来寻找健康眼和 OHT 眼之间的任何鉴别功能。报告了特异性为 83%和 92%时的敏感度。
正常个体的 FDT MD 评分范围为 -1.10 至 +3.80 分贝（dB），OHT 受试者的范围为 -4.75 至 +3.20 dB。两组平均 MD 的比较显示出统计学显著差异（P = 0.024）。在检查下方和上方平均 RNFL 厚度之比时，OCT 显示两组之间存在统计学显著差异（P = 0.004）。对于 OCT，用于区分健康眼和高血压眼的 AUROC 最大的参数是下方和上方平均 RNFL 厚度之比（AUROC = 0.85，特异性为 83%时敏感度 = 75%，特异性为 92%时敏感度 = 67%）。对于矩阵 FDT 视野检查，AUROC 最大的参数是 MD（AUROC = 0.78，特异性为 83%时敏感度 = 67%，特异性为 92%时敏感度 = 58%）。
我们的结果表明，对于色觉正常且临床视盘外观正常的 OHT 眼，使用传统 OCT 参数无法与正常眼区分开来。然而，在分析下方和上方平均 RNFL 厚度之比时，健康眼和高血压眼之间存在明显差异。使用矩阵 FDT 视野检查时，这两组眼之间的 MD 似乎存在显著差异。AUROCs 证实，在检查的 OCT 和矩阵 FDT 参数中，OCT 的 Iavg/Savg 和矩阵 FDT 的 MD 显示出最大的敏感度和特异性。
