Renard J-P, Fénolland J-R, Giraud J-M
Centre du glaucome ophtalmologie, hôpital Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
Centre du glaucome ophtalmologie, hôpital Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
J Fr Ophtalmol. 2019 May;42(5):499-516. doi: 10.1016/j.jfo.2019.03.001. Epub 2019 Apr 5.
Spectral domain optical coherence tomography (SD-OCT) provides an objective quantification of the lesions of various target tissue structures in glaucoma, with unprecedented resolution, which has now demonstrated its interest in controlling the progression of glaucomatous neuropathy, from early stages to late stages. A certain number of well-established proofs state that a progressive modification in OCT is a common predictor of functional loss, and that patients with rapid OCT changes have an increased risk of developing glaucomatous scotoma. Follow-up of the progression goes through three stages. It consists first of all in detecting the evolution of damage to the retinal nerve fiber layer (RNFL), then that of the macular ganglion cell complex (GCC), in order to better define this progression of the damage to the target structures and, thirdly, to complete its analysis by integrating it with the analysis of the functional impairment. We note today that there is a greater risk of developing a future functional deficit of the visual field in subjects with a RNFL loss slope greater than -1/year, for all clinical stages of glaucoma. The characteristics of GCC progression are much better specified. Often earlier than that of the progress of the thinning of the RNFL and much faster in the subjects considered as "progressors", its cartography is better defined, with a particular interest for the follow-up of diversion maps and "wide field" acquisitions offering better visibility of deficits and their progression. To date, a certain number of suspicious indicators of short-term progress can be retained, highlighting the essential precaution of having two or more basic measures and a confirmation of the change on at least one new OCT acquisition. Finally, if the interpretation of the progression must always be based on clinical examination data, and the macula in particular, it remains crucial to confront the progression of the RNFL with that of the GCC and with that of the visual field.
光谱域光学相干断层扫描（SD-OCT）能够以前所未有的分辨率对青光眼各种靶组织结构的病变进行客观量化，现已证明其在监测青光眼性神经病变从早期到晚期进展方面的价值。大量确凿证据表明，OCT的渐进性改变是功能丧失的常见预测指标，且OCT变化迅速的患者发生青光眼性暗点的风险增加。青光眼进展的随访分为三个阶段。首先是检测视网膜神经纤维层（RNFL）损伤的演变，其次是黄斑神经节细胞复合体（GCC）损伤的演变，以便更好地界定靶组织结构损伤的进展情况，第三是通过将其与功能损害分析相结合来完成分析。我们现在注意到，对于青光眼的所有临床阶段，RNFL损失斜率大于-1/年的受试者未来发生视野功能缺损的风险更高。GCC进展的特征更为明确。通常比RNFL变薄进展更早，在被视为“进展者”的受试者中进展更快，其绘图更清晰，对于追踪偏移图和“广角”采集特别有意义，后者能更好地显示缺损及其进展情况。迄今为止，可以保留一些短期进展的可疑指标，这突出了进行两次或更多次基础测量以及至少通过一次新的OCT采集确认变化的重要预防措施。最后，如果对进展的解读始终必须基于临床检查数据，尤其是黄斑的检查数据，那么将RNFL的进展与GCC的进展以及视野的进展进行对比仍然至关重要。
