Department of Ophthalmology, Taipei City Hospital, ZhongXing Branch, Taipei, Taiwan, ROC.
Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2024 Jul 1;87(7):722-727. doi: 10.1097/JCMA.0000000000001112. Epub 2024 May 21.
We evaluated the diagnostic ability of macula retinal nerve fiber layer (mRNFL) thickness in preperimetric glaucoma (PPG) patients.
This prospective study included 83 patients with PPG and 83 age- and refractive error-matched normal control subjects. PPG was defined as a localized RNFL defect corresponding to glaucomatous optic disc changes with a normal visual field test. We used spectral-domain (SD) optical coherence tomography (OCT) to measure the circumpapillary RNFL (cpRNFL) thickness and macular ganglion cell-inner plexiform layer (GCIPL) thickness. Swept-source (SS) OCT was used to measure cpRNFL thickness, macular ganglion cell layer + inner plexiform layer (IPL) thickness (GCL+), and macular ganglion cell layer + IPL+ mRNFL thickness (GCL++). The mRNFL thickness was defined as GCL++ minus GCL+. To evaluate the diagnostic power of each parameter, the area under the receiver operating characteristics curve (AUROC) was analyzed to differentiate PPG from the normal groups.
Using SD-OCT, all GCIPL parameters and most cpRNFL parameters, except at the nasal and temporal quadrant, were significantly lower in PPG versus normal controls. PPG eyes had significantly smaller values than normal controls for all cpRNFL and GCL parameters measured by SS-OCT, except mRNFL at the superonasal area. The inferotemporal GCL++ had the largest AUROC value (0.904), followed by inferotemporal GCL+ (0.882), inferotemporal GCIPL thickness (0.871), inferior GCL++ (0.866), inferior cpRNFL thickness by SS-OCT (0.846), inferior cpRNFL thickness by SD-OCT (0.841), and inferotemporal mRNFL thickness (0.840). The diagnostic performance was comparable between inferotemporal mRNFL thickness and the best measures of GCL (inferotemporal GCL++, p = 0.098) and cpRNFL (inferior cpRNFL thickness by SS-OCT, p = 0.546).
The diagnostic ability of mRNFL thickness was comparable to that of the best measures of cpRNFL and GCL analysis for eyes with PPG. Therefore, mRNFL thickness could be a new parameter to detect early structural changes in PPG.
我们评估了在预周边青光眼（PPG）患者中黄斑视网膜神经纤维层（mRNFL）厚度的诊断能力。
本前瞻性研究纳入了 83 例 PPG 患者和 83 名年龄和屈光不正相匹配的正常对照组。PPG 的定义为与青光眼视盘改变相对应的局部 RNFL 缺损，同时视野检查正常。我们使用频域（SD）光学相干断层扫描（OCT）测量了周边视网膜神经纤维层（cpRNFL）厚度和黄斑神经节细胞内丛状层（GCIPL）厚度。扫频源（SS）OCT 用于测量 cpRNFL 厚度、黄斑神经节细胞层+内丛状层（IPL）厚度（GCL+）和黄斑神经节细胞层+内丛状层+mRNFL 厚度（GCL++）。mRNFL 厚度定义为 GCL++减去 GCL+。为了评估每个参数的诊断能力，我们分析了受试者工作特征曲线下的面积（AUROC），以区分 PPG 与正常组。
使用 SD-OCT，与正常对照组相比，除了鼻侧和颞侧象限外，所有 GCIPL 参数和大多数 cpRNFL 参数在 PPG 中均显著降低。与正常对照组相比，PPG 眼的所有 cpRNFL 和 GCL 参数的测量值均较小，除了超鼻上区域的 mRNFL。下颞侧 GCL++的 AUROC 值最大（0.904），其次是下颞侧 GCL+（0.882）、下颞侧 GCIPL 厚度（0.871）、下侧 GCL++（0.866）、下侧 SS-OCT 测量的 cpRNFL 厚度（0.846）、下侧 SD-OCT 测量的 cpRNFL 厚度（0.841）和下颞侧 mRNFL 厚度（0.840）。下颞侧 mRNFL 厚度与 GCL 最佳测量值（下颞侧 GCL++，p=0.098）和 cpRNFL（下侧 SS-OCT 测量的 cpRNFL 厚度，p=0.546）之间的诊断性能相当。
在 PPG 眼中，mRNFL 厚度的诊断能力与最佳的 cpRNFL 和 GCL 分析测量值相当。因此，mRNFL 厚度可能是检测 PPG 早期结构变化的一个新参数。
