Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Am J Ophthalmol. 2013 Dec;156(6):1297-1307.e2. doi: 10.1016/j.ajo.2013.08.001. Epub 2013 Sep 25.
To evaluate the performance of ganglion cell layer/inner plexiform layer (GCL/IPL) measurements with spectral-domain optical coherence tomography (Cirrus HD-OCT) for detection of early glaucoma and to compare results to retinal nerve fiber layer (RNFL) measurements.
Cross-sectional prospective diagnostic study.
We enrolled 99 subjects, including 59 eyes with glaucoma (47 subjects) (mean deviation >-6.0 dB) and 91 normal eyes (52 subjects). Patients underwent biometry and peripapillary and macular OCT imaging. Performance of the GCL/IPL and RNFL algorithms was evaluated with area under receiver operating characteristic curves (AUC), likelihood ratios, and sensitivities/specificities adjusting for covariates. Combination of best parameters was explored.
Average (SD) mean deviation in the glaucoma group was -2.5 (1.9) dB. On multivariate analyses, age (P < 0.001) and axial length (P = 0.03) predicted GC/IPL measurements in normal subjects. No significant correlation was found between average or regional GC/IPL thickness and respective outer retina (OR) thickness measurements (P > 0.05). Average RNFL thickness performed better than average GCL/IPL measurements for detection of glaucoma (AUC = 0.964 vs 0.937; P = 0.04). The best regional measures from each algorithm (inferior quadrant RNFL vs minimum GCL/IPL) had comparable performances (P = 0.78). Entering the GC/IPL to OR ratio into prediction models did not enhance the performance of the GCL/IPL measures. Combining the best parameters from each algorithm improved detection of glaucoma (P = 0.04).
Regional GCL/IPL measures derived from Cirrus HD-OCT performed as well as regional RNFL outcomes for detection of early glaucoma. Using the GC/IPL to OR ratio did not enhance the performance of GCL/IPL parameters. Combining the best measures from the 2 algorithms improved detection of glaucoma.
评估应用频域光学相干断层扫描仪（Cirrus HD-OCT）对神经节细胞层/内丛状层（GCL/ IPL）进行测量，以发现早期青光眼的性能，并将其结果与视网膜神经纤维层（RNFL）的测量值进行比较。
横断面前瞻性诊断研究。
共纳入 99 例受试者，其中包括 59 只青光眼眼（47 例）（平均偏差>-6.0dB）和 91 只正常眼（52 例）。患者接受眼生物测量和视盘及黄斑 OCT 成像。应用受试者工作特征曲线（ROC）下面积（AUC）、似然比和调整协变量后的敏感度/特异度评估 GCL/ IPL 和 RNFL 算法的性能。还探讨了最佳参数的组合。
青光眼组的平均（标准差）平均偏差为-2.5（1.9）dB。在多变量分析中，年龄（P<0.001）和眼轴长度（P=0.03）可预测正常受试者的 GC/ IPL 测量值。未发现平均或区域性 GCL/ IPL 厚度与相应的外视网膜（OR）厚度测量值之间存在显著相关性（P>0.05）。平均 RNFL 厚度比平均 GCL/ IPL 测量值更能检测青光眼（AUC=0.964 与 0.937；P=0.04）。来自每个算法的最佳区域测量值（下方象限的 RNFL 与最小 GCL/ IPL）具有相当的性能（P=0.78）。将 GCL/ IPL 与 OR 的比值输入预测模型并不会增强 GCL/ IPL 测量值的性能。将每个算法的最佳参数结合起来可以提高青光眼的检出率（P=0.04）。
Cirrus HD-OCT 得出的区域性 GCL/ IPL 测量值与区域性 RNFL 结果一样，可用于检测早期青光眼。使用 GCL/ IPL 与 OR 的比值并不能提高 GCL/ IPL 参数的性能。将两种算法的最佳测量值结合起来可以提高青光眼的检出率。
