Elbendary Amal M, Abd El-Latef Mohamed Hafez, Elsorogy Hisham I, Enaam Kamal M
Mansoura Ophthalmic Center, Mansoura University, Mansoura, Egypt..
Mansoura Ophthalmic Center, Mansoura University, Mansoura, Egypt.
Can J Ophthalmol. 2017 Aug;52(4):355-360. doi: 10.1016/j.jcjo.2017.01.003. Epub 2017 Feb 20.
To evaluate diagnostic accuracy of substructure of ganglion cell complex versus peripapillary nerve fiber layer (NFL) thickness using spectral domain optical coherence tomography (SD-OCT) in different stages of glaucoma.
Thirty eyes were normal, 120 were glaucomatous. Glaucomatous eyes were classified into: early glaucoma (46), moderate glaucoma (48), and severe glaucoma (26). Perimetry and SD-OCT were done. Peripapillary NFL thickness, ganglion cell layer (GCL), macular NFL thickness, combined GCL and macular ganglion cell complex (GCC), were recorded. Area under receiver operating characteristic curves (AUCs) was used to verify performance of different OCT parameters.
Peripapillary NFL, GCL, and GCC thickness values were significantly different in all stages of glaucoma. All comparisons were significantly different; normal versus early, early versus moderate and moderate versus severe. The best parameters that distinguished normal from early stage were: peripapillary NFL (AUC: 0.90), GCC (AUC: 0.75), early from moderate stage were: peripapillary NFL thickness (AUC: 0.85), GCL (0.81),GCC (0.81), moderate from severe stage were: GCC (AUC:0.95), macular NFL (AUC:0.91), GCL (AUC:0.89), and peripapillary NFL (AUC:0.88).
Peripapllary NFL and GCC thinning showed paradoxical course. The most diagnosed parameter in early glaucoma was peripapillary NFL and in severe glaucoma was GCC. In severe glaucoma, macular NFL showed higher diagnostic power than GCL and peripapillary NFL. Ganglion cell complex mapping may provide good alternative to optic disc imaging in advanced glaucoma with poor fixation.
利用光谱域光学相干断层扫描（SD - OCT）评估神经节细胞复合体亚结构与视乳头周围神经纤维层（NFL）厚度在青光眼不同阶段的诊断准确性。
30只眼睛正常，120只患有青光眼。青光眼眼睛分为：早期青光眼（46只）、中度青光眼（48只）和重度青光眼（26只）。进行了视野检查和SD - OCT检查。记录视乳头周围NFL厚度、神经节细胞层（GCL）、黄斑NFL厚度、联合GCL和黄斑神经节细胞复合体（GCC）。采用受试者操作特征曲线下面积（AUC）来验证不同OCT参数的性能。
在青光眼的所有阶段，视乳头周围NFL、GCL和GCC厚度值均有显著差异。所有比较均有显著差异；正常与早期、早期与中度、中度与重度之间。区分正常与早期阶段的最佳参数为：视乳头周围NFL（AUC：0.90）、GCC（AUC：0.75），区分早期与中度阶段的为：视乳头周围NFL厚度（AUC：0.85）、GCL（0.81）、GCC（0.81），区分中度与重度阶段的为：GCC（AUC：0.95）、黄斑NFL（AUC：0.91）、GCL（AUC：0.89）和视乳头周围NFL（AUC：0.88）。
视乳头周围NFL和GCC变薄呈现出矛盾的过程。早期青光眼最具诊断价值的参数是视乳头周围NFL，重度青光眼是GCC。在重度青光眼中，黄斑NFL的诊断能力高于GCL和视乳头周围NFL。对于固视不良的晚期青光眼，神经节细胞复合体成像可能是视盘成像的良好替代方法。
