Omodaka Kazuko, Kikawa Tsutomu, Shiga Yukihiro, Tsuda Satoru, Yokoyama Yu, Sato Haruka, Ohuchi Junko, Matsumoto Akiko, Takahashi Hidetoshi, Akiba Masahiro, Nakazawa Toru
Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan.
PLoS One. 2017 Oct 3;12(10):e0185649. doi: 10.1371/journal.pone.0185649. eCollection 2017.
To identify sectors of the optical coherence tomography (OCT) macular map that could be used to effectively assess structural progression in patients with normal-tension glaucoma (NTG).
This study examined 117 eyes of 117 NTG patients to establish axonal tract-dependent macular sectors, and also examined a separate group of 122 eyes of 81 NTG patients to evaluate the ability of these sectors to reveal glaucoma progression. Longitudinal data, including macular maps from at least 5 OCT examinations performed over at least 2 years, was available for all patients in this group. Circumpapillary retinal nerve fiber layer thickness (cpRNFLT), temporal clockwise sector scans (from 7 to 11 o'clock), macular retinal nerve fiber layer thickness (mRNFLT), and macular ganglion cell layer plus inner plexiform layer thickness (mGCIPLT) were measured with spectral-domain OCT (3D OCT-2000, TOPCON). The axonal tract-dependent macular sectors were identified by calculating Spearman's rank correlation coefficient for each point on a grid overlaid on the macular map and cpRNFLT in each clockwise scan sector. Trend and event analyses for the slope of progression in each sector and macular map were performed. Visual field progression in the macula was defined by the presence of more than 2 progressive test points in the 16 central test points of the Humphrey field analyzer SITA standard 24-2 program, evaluated with Progressor software.
The slope of progression in the entire macular area was -0.22 ± 0.58 μm/year for mRNFLT and -0.35 ± 0.52 μm/year for mGCIPLT. The fastest-progressing mRNFLT sector (-1.00 ± 0.84 μm/year, p < 0.001) and mGCIPLT sector (-1.16 ± 0.63 μm/year, p < 0.001) progressed significantly faster than the overall macula. Classifying patients according to visual field progression showed that baseline mRNFLT in the inferior hemifield, 7 and 8 o'clock sectors, as well as baseline mGCIPLT in the overall macular map, inferior hemifield, and 8 o'clock sector, were significantly lower in progressors (22 eyes) than non-progressors (100 eyes). There were significant differences in mRNFLT slope in 8 o'clock sector and in the fastest progressing sector in progressors and non-progressors, but mGCIPLT did not differ, even in the fastest-progressing sector. Event analysis showed that progression occurred most frequently in inferior mRNFLT and superior mGCIPLT in this study.
Axonal tract-dependent OCT macular sectors could effectively reveal structural change in patients with NTG. Furthermore, mRNFLT slope was consistent with visual field progression. This method promises to open new avenues for the OCT-based evaluation of glaucoma progression.
确定光学相干断层扫描（OCT）黄斑地图中可用于有效评估正常眼压性青光眼（NTG）患者结构进展的区域。
本研究检查了117例NTG患者的117只眼，以确定依赖轴突束的黄斑区域，还检查了另一组81例NTG患者的122只眼，以评估这些区域揭示青光眼进展的能力。该组所有患者均有纵向数据，包括至少2年期间进行的至少5次OCT检查的黄斑地图。使用光谱域OCT（3D OCT - 2000，TOPCON）测量视乳头周围视网膜神经纤维层厚度（cpRNFLT）、颞侧顺时针扇形扫描（从7点至11点）、黄斑视网膜神经纤维层厚度（mRNFLT）以及黄斑神经节细胞层加内丛状层厚度（mGCIPLT）。通过计算覆盖在黄斑地图上的网格上每个点与每个顺时针扫描区域中cpRNFLT的斯皮尔曼等级相关系数，确定依赖轴突束的黄斑区域。对每个区域和黄斑地图的进展斜率进行趋势和事件分析。黄斑部视野进展通过Humphrey视野分析仪SITA标准24 - 2程序的16个中央测试点中出现超过2个进展性测试点来定义，使用Progressor软件进行评估。
整个黄斑区域的mRNFLT进展斜率为-0.22±0.58μm/年，mGCIPLT为-0.35±0.52μm/年。进展最快的mRNFLT区域（-1.00±0.84μm/年，p<0.001）和mGCIPLT区域（-1.16±0.63μm/年，p<0.001）的进展明显快于整个黄斑区域。根据视野进展对患者进行分类显示，进展者（22只眼）的下半视野、7点和8点区域的基线mRNFLT，以及整个黄斑地图、下半视野和8点区域的基线mGCIPLT，均显著低于非进展者（100只眼）。进展者和非进展者在8点区域和进展最快区域的mRNFLT斜率存在显著差异，但mGCIPLT即使在进展最快的区域也无差异。事件分析表明，本研究中进展最常发生在下半mRNFLT和上半mGCIPLT。
依赖轴突束的OCT黄斑区域可有效揭示NTG患者的结构变化。此外，mRNFLT斜率与视野进展一致。该方法有望为基于OCT的青光眼进展评估开辟新途径。
