Zeitoun M
Cabinet privé, 31, avenue Gauguin, 95350 Saint-Brice-Sous-Forêt, France.
J Fr Ophtalmol. 2017 Jan;40(1):44-60. doi: 10.1016/j.jfo.2016.08.004. Epub 2016 Nov 17.
To try to establish a "point by point" relationship between the local thickness of the retinal ganglion cell complex and its sensitivity.
In total, 104 glaucomatous eyes of 89 patients with a confirmed 24-2 visual field, were measured by superimposing the visual field, using imaging software, with the Wide 40° by 30° measurements of retinal ganglion cell complex obtained from the Topcon 3D 2000 OCT, after upward adjustment, inversion and scaling. Visual fields were classified into two groups according to the extent of the disease: 58 mild to moderate (MD up to -12dB), and 46 severe (MD beyond -12dB). The 6mm by 6mm central region, equipped with a normative database, was studied, corresponding to 16 points in the visual field. These points were individually matched one by one to the local ganglion cell complex, which was classified into 2 groups depending on whether it was greater or less than 70 microns. The normative database confirmed the pathological nature of the thin areas, with a significance of 95 to 99%. Displacement of central retinal ganglion cells was compensated for. Of 1664 points (16 central points for 104 eyes), 283 points were found to be "borderline" and excluded. Of the 1381 analyzed points, 727 points were classified as "over 70 microns" and 654 points "under 70 microns".
(1) For all stages combined, 85.8% of the 727 points which were greater than 70 microns had a deviation between -3 and +3dB: areas above 70 microns had no observable loss of light sensitivity. (2) In total, 92.5% of the 428 points having a gap ranging from -6 to -35dB were located on ganglion cell complex areas below 70 microns: functional visual loss was identified in thin areas, which were less than 70 microns. (3) Areas which were less than 70 microns, that is 654 points, had quite variable sensitivity and can be divided into three groups: the first with preserved sensitivity, another with obliterated sensitivity, and an intermediate group connecting the two previous ones.
In pathologically thin areas, the distribution of these three functional groups seems to correspond to the progression of glaucomatous visual degradation, including a period of resistance, a period of rapid decline, finally leading to complete functional loss.
In the studied area, the analysis of retinal ganglion cell complex is relevant to identify areas which are still functional when they exceed 70 microns. Scotomas correspond to the thin areas less than 70 microns. The functionality of areas which are pathologically thinned by glaucomatous degeneration is not correlated to their thickness. In the future, the correlation between structure and function, currently "regional" may be realized "point by point" once automation of the visual field superimposition is made available for the ganglion cell complex.
试图建立视网膜神经节细胞复合体局部厚度与其敏感度之间的“逐点”关系。
对89例确诊为24-2视野的青光眼患者的104只眼睛进行研究，使用成像软件将视野与经向上调整、反转和缩放后从拓普康3D 2000 OCT获得的视网膜神经节细胞复合体40°×30°宽测量值叠加。根据疾病程度将视野分为两组：58例轻度至中度（平均缺损达-12dB），46例重度（平均缺损超过-12dB）。对配备有标准数据库的6mm×6mm中央区域进行研究，该区域对应视野中的16个点。这些点逐个与局部神经节细胞复合体进行匹配，根据其是否大于或小于70微米将复合体分为两组。标准数据库证实了薄区域的病理性质，显著性为95%至99%。对视网膜中央神经节细胞的移位进行了补偿。在1664个点（104只眼睛的16个中心点）中，发现283个点为“临界值”并被排除。在1381个分析点中，727个点被分类为“超过70微米”，654个点“低于70微米”。
（1）对于所有阶段合并分析，727个大于70微米的点中有85.8%的偏差在-3至+3dB之间：70微米以上的区域未观察到光敏感度损失。（2）总共有92.5%的428个偏差范围在-6至-35dB之间的点位于70微米以下的神经节细胞复合体区域：在小于70微米的薄区域中发现了功能性视力丧失。（3）小于70微米的区域，即654个点，其敏感度变化很大，可分为三组：第一组敏感度保留，另一组敏感度消失，中间组连接前两组。
在病理性薄区域，这三个功能组的分布似乎与青光眼性视力退化的进展相对应，包括一个抵抗期、一个快速下降期，最终导致完全功能丧失。
在研究区域，视网膜神经节细胞复合体的分析有助于识别超过70微米时仍具有功能的区域。暗点对应于小于70微米的薄区域。因青光眼性退变而病理性变薄的区域的功能与其厚度无关。未来，一旦视野叠加自动化可用于神经节细胞复合体，目前“区域性”的结构与功能之间的相关性可能会实现“逐点”对应。
