Elbendary Amal M, Mohamed Helal Randa
Mansoura Ophthalmic Center, Mansoura University, Egypt.
Saudi J Ophthalmol. 2013 Jan;27(1):19-24. doi: 10.1016/j.sjopt.2012.09.001. Epub 2012 Oct 11.
To determine the discriminating ability of retinal nerve fiber layer (RNFL) thickness measured with spectral-domain optical coherence tomography (SD-OCT) in different stages of glaucoma.
Thirty normal, 150 glaucomatous eyes were included. Glaucomatous eyes were graded into early, moderate and severe stages according to one of the global indices called visual field index (VFI). Complete ophthalmic examination, white on white perimetry and SD-OCT were done for all patients. RNFL thickness of quadrants and average thickness were recorded. Area under receiver operating characteristic curves (AUCs) were used to assess the performance of OCT parameters.
AVERAGE, INFERIOR AND SUPERIOR RNFL THICKNESS WERE THE BEST PARAMETERS TO DISCRIMINATE NORMAL FROM EARLY GLAUCOMA (AUC: 0.91-86), early from moderate (AUC: 0.77-0.70) and moderate from severe (AUC: 0.85-83). Average RNFL loss was 18% in early glaucoma, 28% in moderate glaucoma and 41% in severe glaucoma. Early damage tends to be focal and in the lower quadrant. A significant correlation was detected between mean VFI and mean RNFL loss. Glaucoma was restaged according to average RNFL loss into early: ⩾97.5 μ, moderate: <97.5-72.5 μ and severe: <72.5 μ.
RNFL thickness measured with SD-OCT could discriminate the three stages of glaucoma. RNFL loss can be correlated to visual field loss. Future OCT-based staging of glaucoma, adjunctive to perimetry is possible.
确定使用光谱域光学相干断层扫描（SD-OCT）测量的视网膜神经纤维层（RNFL）厚度在青光眼不同阶段的鉴别能力。
纳入30只正常眼和150只青光眼患眼。根据一种称为视野指数（VFI）的整体指标之一，将青光眼患眼分为早期、中期和晚期。对所有患者进行了全面的眼科检查、白对白视野检查和SD-OCT检查。记录象限的RNFL厚度和平均厚度。使用受试者操作特征曲线下面积（AUC）来评估OCT参数的性能。
平均、下方和上方RNFL厚度是区分正常与早期青光眼（AUC：0.91-0.86）、早期与中期（AUC：0.77-0.70）以及中期与晚期（AUC：0.85-0.83）的最佳参数。早期青光眼的平均RNFL损失为18%，中期青光眼为28%，晚期青光眼为41%。早期损伤往往是局灶性的且位于下方象限。检测到平均VFI与平均RNFL损失之间存在显著相关性。根据平均RNFL损失将青光眼重新分期为：早期：⩾97.5 μ，中期：<97.5-72.5 μ，晚期：<72.5 μ。
用SD-OCT测量的RNFL厚度可区分青光眼的三个阶段。RNFL损失与视野损失相关。未来基于OCT的青光眼分期，辅助视野检查是可行的。
