Amini Navid, Miraftabi Arezoo, Henry Sharon, Chung Norman, Nowroozizadeh Sarah, Caprioli Joseph, Nouri-Mahdavi Kouros
Invest Ophthalmol Vis Sci. 2016 Mar;57(3):1468-75. doi: 10.1167/iovs.15-18382.
We tested the hypotheses that the mismatch between the clinical disc margin (CDM) and Bruch's membrane opening (BMO) is a function of BMO area (BMOA) and is affected by the presence of glaucoma.
A total of 45 normal eyes (45 subjects) and 53 glaucomatous eyes (53 patients) were enrolled and underwent radial optic nerve head (ONH) imaging with spectral domain optical coherence tomography. The inner tip of the Bruch's membrane (BM) and the clinical disc margin were marked on radial scans and optic disc photographs, and were coregistered with custom software. The main outcome measure was the difference between the clinical disc area (CDA) and BMOA, or CDA-BMOA mismatch, as a function of BMOA and diagnosis. Multivariate regression analyses were used to explore the influence of glaucoma and BMOA on the mismatch.
Global CDA was larger than BMOA in both groups but the difference was statistically significant only in the normal group (1.98 ± 0.37 vs. 1.85 ± 0.45 mm2, P = 0.02 in the normal group; 1.96 ± 0.38 vs. 1.89 ± 0.56 mm2, P = 0.08 in the glaucoma group). The sectoral CDA-BMOA mismatch was smaller in superotemporal (P = 0.04) and superonasal (P = 0.05) sectors in the glaucoma group. The normalized CDA-BMOA difference decreased with increasing BMOA in both groups (P < 0.001). Presence or severity of glaucoma did not affect the CDA-BMOA difference (P > 0.14).
Clinical disc area was larger than BMOA in normal and glaucoma eyes but reached statistical significance only in the former group. The CDA-BMOA mismatch diminished with increasing BMOA but was not affected by presence of glaucoma. These findings have important clinical implications regarding clinical evaluation of the ONH.
我们检验了以下假设，即临床视盘边缘（CDM）与布鲁赫膜开口（BMO）之间的不匹配是BMO面积（BMOA）的函数，并且受青光眼的存在影响。
共纳入45只正常眼（45名受试者）和53只青光眼患眼（53名患者），并采用光谱域光学相干断层扫描对视神经乳头（ONH）进行放射状成像。在放射状扫描和视盘照片上标记布鲁赫膜（BM）的内端和临床视盘边缘，并使用定制软件进行配准。主要观察指标是临床视盘面积（CDA）与BMOA之间的差异，即CDA - BMOA不匹配，作为BMOA和诊断的函数。采用多变量回归分析来探讨青光眼和BMOA对不匹配的影响。
两组的整体CDA均大于BMOA，但差异仅在正常组具有统计学意义（正常组：1.98±0.37 vs. 1.85±0.45 mm²，P = 0.02；青光眼组：1.96±0.38 vs. 1.89±0.56 mm²，P = 0.08）。青光眼组颞上象限（P = 0.04）和鼻上象限（P = 0.05）的扇形CDA - BMOA不匹配较小。两组中，标准化的CDA - BMOA差异均随BMOA增加而减小（P < 0.001）。青光眼的存在或严重程度不影响CDA - BMOA差异（P > 0.14）。
正常眼和青光眼患眼中临床视盘面积均大于BMOA，但仅在正常组达到统计学意义。CDA - BMOA不匹配随BMOA增加而减小，但不受青光眼存在的影响。这些发现对视神经乳头的临床评估具有重要的临床意义。
