频域光相干断层扫描视神经周围视网膜神经纤维层厚度对老年人群中青光眼患者与对照组的诊断能力（MONTRACHET 研究）。
Diagnostic ability of spectral-domain optical coherence tomography peripapillary retinal nerve fiber layer thickness to discriminate glaucoma patients from controls in an elderly population (The MONTRACHET study).
机构信息
Department of Ophthalmology, University Hospital, Dijon, France.
Institut National de la Santé et de la Recherche Médicale (INSERM), Clinical Center Investigation, Clinical Epidemiology/Clinical Trials Unit, University Hospital, Dijon, France.
出版信息
Acta Ophthalmol. 2020 Dec;98(8):e1009-e1016. doi: 10.1111/aos.14448. Epub 2020 Apr 24.
PURPOSE
To evaluate the capacity of retinal nerve fibre layer (RNFL) thickness measured by SD-OCT to discriminate glaucoma patients from controls in an elderly population.
METHODS
The MONTRACHET (Maculopathy, Optic Nerve, nuTRition, neurovAsCular and HEarT diseases) Study is a population-based study including participants aged 75 years and over. All participants underwent a complete eye examination with optic nerve photographs, visual field testing and OCT peripapillary RNFL thickness measurement. Glaucoma was defined according to the ISGEO (International Society for Epidemiologic and Geographical Ophthalmology) classification. Performance indicators were calculated including area under the receiver operating characteristics curves (AUC), likelihood ratios (LR) and diagnostic odds ratios (DOR).
RESULTS
In total, 1061 participants were included in the study, of whom 89 were classified as having glaucoma and 972 were classified as normal. The mean (SD) age of the population was 82.3 (3.7) years. The average RNFL thickness was significantly lower in the glaucoma group than in controls 64.0 (14.9) µm versus 88.9 (12.4) µm, respectively, p < 0.001) and in all sectors compared with controls. The average RNFL thickness had the highest AUC (0.901) followed by the temporal-inferior (0.879) and temporal-superior sectors (0.862). When RNFL thickness was classified as abnormal by SD-OCT, the average RNFL thickness had the best sensitivity (83.75%) followed by the temporal-inferior sector (75.64%). The specificity for these two parameters was 87.34% and 91.08%, respectively. The highest DOR was 28.70 for average RNFL thickness and reached 34.84 when using the reference database of the OCT manufacturer.
CONCLUSION
This study confirms that SD-OCT could be useful as an additional test to discriminate glaucoma patients from controls in an elderly population.
目的
评估 SD-OCT 测量的视网膜神经纤维层（RNFL）厚度区分老年人群中青光眼患者与对照者的能力。
方法
MONTRACHET（Maculopathy、Optic Nerve、nuTRition、neurovAsCular 和 HEarT diseases）研究是一项基于人群的研究，纳入了 75 岁及以上的参与者。所有参与者均接受了全面的眼部检查，包括视神经照片、视野测试和 OCT 视盘周围 RNFL 厚度测量。青光眼根据 ISGEO（国际流行病学和地理眼病学会）分类进行定义。计算了包括接收者操作特征曲线（AUC）下面积、似然比（LR）和诊断比值比（DOR）在内的性能指标。
结果
共有 1061 名参与者纳入本研究，其中 89 名被归类为青光眼患者，972 名被归类为正常。人群的平均（SD）年龄为 82.3（3.7）岁。青光眼组的平均 RNFL 厚度明显低于对照组，分别为 64.0（14.9）µm 和 88.9（12.4）µm，p<0.001），且在所有象限中均低于对照组。平均 RNFL 厚度的 AUC（0.901）最高，其次是颞下象限（0.879）和颞上象限（0.862）。当 SD-OCT 将 RNFL 厚度分类为异常时，平均 RNFL 厚度的灵敏度最高（83.75%），其次是颞下象限（75.64%）。这两个参数的特异性分别为 87.34%和 91.08%。最高的 DOR 为平均 RNFL 厚度的 28.70，当使用 OCT 制造商的参考数据库时达到 34.84。
结论
本研究证实，SD-OCT 可作为一种额外的测试手段，用于区分老年人群中青光眼患者与对照者。
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