Fujihara Fernanda Mari Fagundes, de Arruda Mello Paulo Augusto, Lindenmeyer Rodrigo Leivas, Pakter Helena Messinger, Lavinsky Jaco, Benfica Camila Zanella, Castoldi Nedio, Picetti Egidio, Lavinsky Daniel, Finkelsztejn Alessandro, Lavinsky Fabio
Department of Ophthalmology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
Hospital Banco de Olhos de Porto Alegre, Porto Alegre, RS, Brazil.
Clin Ophthalmol. 2020 Jun 15;14:1591-1599. doi: 10.2147/OPTH.S256755. eCollection 2020.
To evaluate differences in the thickness of the individual macular layers between early, moderate, and severe glaucomatous eyes and compare them with healthy controls.
Subjects with glaucoma presenting typical optic nerve head findings, high intraocular pressure with or without visual field (VF) damage and normal controls were included. All participants underwent 24-2 perimetry and spectral-domain OCT. Patients were divided into three groups (early, moderate, and severe) based on the mean deviation of the VF and a healthy control group. The device segmented the layers automatically, and their measurements were plotted using the means of the sectors of the inner (3mm) and outer (6mm) circles of the ETDRS grid.
A total of 109 eyes qualified for the study: 14 in the control group and 52, 18 and 25 in the early, moderate and severe groups, respectively. Mean age was 66.13 (SD=12.38). The mean thickness of the circumpapillary retinal nerve fiber layer (RNFL), total macular thickness (TMT), macular RNFL, ganglion cell layer (GCL) and inner plexiform layer (IPL) were significantly different between the 4 groups, with progressive decrease in thickness. Significant overall difference was found for the inner nuclear layer (INL), and the severe glaucoma group presented thicker measurements than controls and early glaucoma. Outer nuclear layer (ONL) was thinner in severe glaucoma group compared with early glaucoma group.
Individual macular layer measurement using the inner and outer circles of the ETDRS grid is useful to evaluate different stages of glaucoma. The INL thickening and ONL thinning in advanced glaucoma should be explored in the future studies.
评估早期、中度和重度青光眼患眼各黄斑层厚度的差异，并与健康对照进行比较。
纳入呈现典型视神经乳头表现、伴有或不伴有视野（VF）损害的高眼压青光眼患者以及正常对照。所有参与者均接受24-2视野检查和光谱域光学相干断层扫描（OCT）。根据VF的平均偏差将患者分为三组（早期、中度和重度）以及一个健康对照组。该设备自动分割各层，并使用ETDRS网格内圈（3mm）和外圈（6mm）扇形区域的平均值绘制测量结果。
共有109只眼符合研究条件：对照组14只眼，早期、中度和重度组分别为52只、18只和25只。平均年龄为66.13（标准差=12.38）。视盘周围视网膜神经纤维层（RNFL）、黄斑总厚度（TMT）、黄斑RNFL、神经节细胞层（GCL）和内丛状层（IPL）的平均厚度在这4组之间存在显著差异，且厚度逐渐降低。内核层（INL）存在显著的总体差异，重度青光眼组的测量值比对照组和早期青光眼组更厚。重度青光眼组的外核层（ONL）比早期青光眼组更薄。
使用ETDRS网格的内圈和外圈测量黄斑各层有助于评估青光眼的不同阶段。晚期青光眼INL增厚和ONL变薄的情况有待未来研究进一步探索。
