Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
Ophthalmology. 2017 Jul;124(7):1056-1064. doi: 10.1016/j.ophtha.2017.03.014. Epub 2017 Apr 10.
To investigate the temporal relationship between inferior macular ganglion cell-inner plexiform layer (mGCIPL) loss and corresponding peripapillary retinal nerve fiber layer (pRNFL) defect on the optical coherence tomography (OCT) deviation map in glaucoma.
Retrospective, observational study.
A total of 151 patients with early-stage glaucoma (visual field [VF] mean deviation between -1.5 and -5.5 decibels [dB]).
Spectral-domain OCT mGCIPL and pRNFL deviation maps were obtained for the baseline (from January 2012 to August 2012) and again for the follow-up (from January 2015 to August 2015). An integrated deviation map thereafter was merged by vascular landmark-guided superimposition of mGCIPL and pRNFL deviation maps onto RNFL imagery. On the basis of an earlier schematic model, the inferotemporal peripapillary area was divided into (1) the macular vulnerability zone (MVZ) and (2) the inferoinferior portion.
Temporal sequence of inferior mGCIPL loss and corresponding pRNFL (i.e., pRNFL in MVZ) defect on integrated deviation map.
At baseline, 99 (65.6%) of the 151 eyes showed inferior mGCIPL loss. In addition, 112 eyes (74.2%) and 5 eyes (3.3%) showed inferoinferior pRNFL defect and pRNFL defect in the MVZ, respectively. At the 3-year follow-up, 112 (74.2%) of the eyes showed inferior mGCIPL loss, whereas 123 eyes (81.5%) and 25 eyes (16.6%) showed inferoinferior pRNFL defect and pRNFL defect in the MVZ, respectively. Ninety-four eyes initially showed inferior mGCIPL loss without pRNFL defect in the MVZ; among them, 19 (20.2%) subsequently showed defect during the 3-year follow-up interval. Meanwhile, among the 52 eyes without preexisting inferior mGCIPL loss, only 1 (1.9%; P < 0.001) developed a pRNFL defect in the MVZ during the 3-year follow-up interval.
In eyes with early glaucoma, mGCIPL change is frequently detected before corresponding pRNFL change. This could be the result of a superior sensitivity of mGCIPL deviation map that allows detection of an abnormality in the mGCIPL thickness earlier. In this light, OCT pRNFL analysis alone likely would overlook macular damage. Macular OCT imaging should be included in the imaging algorithm for the serial observation of patients with glaucoma.
探讨青光眼患者光学相干断层扫描（OCT）偏差图中下方黄斑神经节细胞-内丛状层（mGCIPL）丢失与相应的视盘周围神经纤维层（pRNFL）缺损之间的时间关系。
回顾性、观察性研究。
共 151 例早期青光眼患者（视野平均缺损值在-1.5 至-5.5 分贝之间）。
对基线（2012 年 1 月至 2012 年 8 月）和随访（2015 年 1 月至 2015 年 8 月）时的光谱域 OCT mGCIPL 和 pRNFL 偏差图进行了检测。随后，通过血管标志引导的 mGCIPL 和 pRNFL 偏差图到 RNFL 图像的叠加，将综合偏差图合并。基于早期的示意图模型，将视盘周围下方区域分为（1）黄斑易损区（MVZ）和（2）下下方部分。
整合偏差图上下方 mGCIPL 丢失与相应的 pRNFL（即 MVZ 中的 pRNFL）缺损的时间顺序。
在基线时，151 只眼中有 99 只（65.6%）出现下方 mGCIPL 丢失。此外，112 只眼（74.2%）和 5 只眼（3.3%）出现下方下方 pRNFL 缺损和 MVZ 中的 pRNFL 缺损。在 3 年随访时，112 只眼（74.2%）出现下方 mGCIPL 丢失，而 123 只眼（81.5%）和 25 只眼（16.6%）出现下方下方 pRNFL 缺损和 MVZ 中的 pRNFL 缺损。94 只眼最初出现下方 mGCIPL 丢失而 MVZ 中无 pRNFL 缺损；其中，19 只眼（20.2%）在 3 年随访期间出现缺损。同时，在 52 只没有预先存在的下方 mGCIPL 丢失的眼中，只有 1 只眼（1.9%；P < 0.001）在 3 年随访期间出现 MVZ 中的 pRNFL 缺损。
在早期青光眼患者中，mGCIPL 变化常先于相应的 pRNFL 变化检测到。这可能是因为 mGCIPL 偏差图的敏感性更高，因此可以更早地检测到 mGCIPL 厚度的异常。由此看来，仅 OCT pRNFL 分析可能会忽略黄斑损伤。OCT 黄斑成像应纳入青光眼患者的成像算法中，用于对患者进行连续观察。
