Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
Ophthalmology. 2020 Oct;127(10):1322-1330. doi: 10.1016/j.ophtha.2020.03.019. Epub 2020 Mar 29.
Evaluation of glaucoma progression with OCT has been centered on the analysis of progressive retinal nerve fiber layer (RNFL) thinning over the parapapillary region and/or progressive ganglion cell inner plexiform layer (GCIPL) thinning over the macula. We investigated (1) whether combining the RNFL and GCIPL as a single layer (i.e., RNFL-GCIPL) for wide-field progression analysis outperforms wide-field progression analysis of the RNFL or the GCIPL, and (2) whether eyes with progressive RNFL-GCIPL thinning are at risk of visual field (VF) progression.
Prospective, longitudinal study.
A total of 440 eyes from 236 glaucoma patients; 98 eyes from 49 healthy individuals.
OCT RNFL/GCIPL/RNFL-GCIPL thickness and VF measurements were obtained at ∼4-month intervals for ≥3 years. Progressive changes of the RNFL/GCIPL/RNFL-GCIPL thicknesses were analyzed over a wide field (12×9 mm) covering the parapapillary region and the macula with trend-based progression analysis (TPA) controlled at a false discovery rate of 5%. VF progression was determined by the Early Manifest Glaucoma Trial criteria.
Proportions of eyes with progressive RNFL/GCIPL/RNFL-GCIPL thinning; hazard ratios (HRs) for development of VF progression.
More eyes showed progressive RNFL-GCIPL thinning (127 eyes; 28.9%, 95% confidence interval [CI]: 23.9%-33.8%) than progressive RNFL thinning (74 eyes; 16.8%, 95% CI: 13.1%-20.6%) and progressive GCIPL thinning (26 eyes; 5.9%, 95% CI: 3.7%-8.1%) in the glaucoma group over the study follow-up. Progressive RNFL-GCIPL thinning was almost always detected before or simultaneously with progressive RNFL thinning or progressive GCIPL thinning. The specificity of TPA (estimated from the healthy group) for detection of progressive RNFL-GCIPL thinning, progressive RNFL thinning, and progressive GCIPL thinning was 83.7% (95% CI: 74.9%-92.4%), 94.9% (95% CI: 90.6%-99.2%), and 96.9% (95% CI: 93.5%-100.0%), respectively. Eyes with progressive RNFL-GCIPL thinning had a higher risk to develop possible (HR: 2.4, 95% CI: 1.2-5.0) or likely (HR: 4.6, 95% CI: 1.5-14.0) VF progression, with adjustment of covariates, compared with eyes without progressive RNFL-GCIPL thinning.
Progression analysis of RNFL-GCIPL thickness reveals a significant portion of progressing eyes that neither progression analysis of RNFL thickness nor GCIPL thickness would identify. Wide-field progression analysis of RNFL-GCIPL thickness is effective to inform the risk of VF progression in glaucoma patients.
OCT 对青光眼进展的评估主要集中在分析视盘旁区域的视网膜神经纤维层（RNFL）渐进性变薄和/或黄斑区的节细胞内丛状层（GCIPL）渐进性变薄。我们研究了（1）在宽视野进展分析中，将 RNFL 和 GCIPL 组合成单个层（即 RNFL-GCIPL）是否优于 RNFL 或 GCIPL 的宽视野进展分析，以及（2）RNFL-GCIPL 变薄的眼睛是否有发生视野（VF）进展的风险。
前瞻性、纵向研究。
共有 236 名青光眼患者的 440 只眼；49 名健康个体的 98 只眼。
对 440 只眼进行 OCT RNFL/GCIPL/RNFL-GCIPL 厚度和 VF 测量，间隔约 4 个月，持续≥3 年。使用基于趋势的进展分析（TPA）在假发现率为 5%的情况下对宽视野（12×9mm）内视盘旁区域和黄斑区的 RNFL/GCIPL/RNFL-GCIPL 厚度进行渐进性变化分析。VF 进展由早期显性青光眼试验标准确定。
RNFL/GCIPL/RNFL-GCIPL 变薄的眼的比例；发生 VF 进展的危险比（HR）。
在研究随访期间，与 RNFL 变薄（74 只眼；16.8%，95%置信区间[CI]：13.1%-20.6%）和 GCIPL 变薄（26 只眼；5.9%，95%CI：3.7%-8.1%）相比，青光眼组中更多的眼出现了 RNFL-GCIPL 变薄（127 只眼；28.9%，95%CI：23.9%-33.8%）。在研究随访期间，RNFL-GCIPL 变薄几乎总是在 RNFL 变薄或 GCIPL 变薄之前或同时被检测到。TPA 的特异性（从健康组估计）用于检测 RNFL-GCIPL 变薄、RNFL 变薄和 GCIPL 变薄，分别为 83.7%（95%CI：74.9%-92.4%）、94.9%（95%CI：90.6%-99.2%）和 96.9%（95%CI：93.5%-100.0%）。与没有 RNFL-GCIPL 变薄的眼相比，出现 RNFL-GCIPL 变薄的眼发生可能（HR：2.4，95%CI：1.2-5.0）或可能（HR：4.6，95%CI：1.5-14.0）VF 进展的风险更高，调整了协变量。
RNFL-GCIPL 厚度的进展分析揭示了一部分进展眼，无论是 RNFL 厚度还是 GCIPL 厚度的进展分析都无法识别。RNFL-GCIPL 厚度的宽视野进展分析有助于告知青光眼患者 VF 进展的风险。
