Department of Ophthalmology, University Hospital of Cologne, Cologne.
Department of Medical Informatics, Biometry, and Epidemiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen.
J Glaucoma. 2018 Dec;27(12):1086-1093. doi: 10.1097/IJG.0000000000001027.
To evaluate the diagnostic power for glaucoma detection using circumpapillary retinal nerve fiber layer (cRNFL) thickness in 3 diameter sizes from the center of the optic nerve head (ONH) by spectral domain optical coherence tomography.
In this cross-sectional study, case-control, 437 eyes diagnosed with glaucoma and 183 eyes of healthy controls underwent spectral domain optical coherence tomography of the ONH, visual field testing, and a clinical examination. cRNFL was measured by circular scans in 3.5 (C1), 4.1 (C2), and 4.7 mm (C3) distance from the center of the ONH. Receiver-operator characteristic analysis was used to assess diagnostic power to detect glaucoma; furthermore, patient-specific maximum localized damage was analyzed.
In C1, mean global cRNFL was 70.03±18.2 μm in glaucomatous eyes and 93.46±9.9 μm in controls. Respectively, cRNFL in C2 was 61.39±14.9 and 80.43±8.4 μm as well as 55.25±12.8 and 70.70±6.7 μm in C3. Using receiver-operator characteristic analysis, the area under the curve (AUC) for cRNFL was 0.855 in C1, 0.850 in C2, and 0.843 in C3. Mean AUCs in ONH sectors ranged from 0.699 to 0.846 and did not exceed AUC of the best scoring global parameter.
Comparing 3.5, 4.1, and 4.7 mm diameters for cRNFL measurement, the inner circle at 3.5 mm distance showed the highest AUC to differentiate glaucoma from healthy controls. However, levels of diagnostic power from wider circular scans were not significantly different and were comparable. Moreover, sectorial cRNFL measurements were nonsuperior. The use of the ONH sector with the highest localized damage seems not to increase diagnostic power.
利用频域光相干断层扫描（OCT）评估 3 个直径大小（视神经头（ONH）中心周围 3.5mm、4.1mm 和 4.7mm）的环周视网膜神经纤维层（cRNFL）厚度对青光眼的诊断能力。
本病例对照的横断面研究纳入了 437 只诊断为青光眼的眼和 183 只健康对照的眼，所有眼均接受了 ONH 的频域 OCT、视野测试和临床检查。通过 3.5mm（C1）、4.1mm（C2）和 4.7mm（C3）的环形扫描测量 cRNFL。采用受试者工作特征分析评估检测青光眼的诊断能力；此外，还分析了患者特异性的最大局部损伤。
在 C1 中，青光眼眼的平均全层 cRNFL 为 70.03±18.2μm，对照组为 93.46±9.9μm。相应地，C2 的 cRNFL 分别为 61.39±14.9μm 和 80.43±8.4μm，C3 的 cRNFL 分别为 55.25±12.8μm 和 70.70±6.7μm。采用受试者工作特征分析，cRNFL 的曲线下面积（AUC）在 C1 为 0.855，在 C2 为 0.850，在 C3 为 0.843。ONH 扇区的平均 AUC 范围为 0.699 至 0.846，并未超过最佳评分全局参数的 AUC。
在比较 3.5、4.1 和 4.7mm 直径的 cRNFL 测量时，3.5mm 距离的内圈显示出最高的 AUC 以区分青光眼与健康对照。然而，更宽的环形扫描的诊断能力水平并没有显著差异，且具有可比性。此外，扇形 cRNFL 测量并无优势。使用具有最高局部损伤的 ONH 扇区似乎不会增加诊断能力。
