UlAin Noor, Shaikh Rehan Moinuddin, Malik Tayyaba Gul
Mughal Eye Hospital Trust, Lahore, Pakistan.
Postgraduate Medical Institute/Lahore General Hospital, Lahore, Pakistan.
Turk J Ophthalmol. 2025 Jun 25;55(3):127-133. doi: 10.4274/tjo.galenos.2025.88834.
To determine patterns of peripapillary retinal nerve fiber layer (RNFL) damage in early- and late-stage glaucoma based on the Disc Damage Likelihood Scale (DDLS).
This cross-sectional, multi-center study involved 267 eyes of 135 patients aged 18 years or older with suspected or diagnosed glaucoma. Exclusion criteria were high refractive errors, media opacities, trauma history, and systemic conditions affecting the optic disc. After a comprehensive ocular examination, the DDLS was used for glaucoma staging. Disease severity was classified into three zones: green, orange, and red. RNFL thickness was measured in four quadrants using optical coherence tomography. Patterns of RNFL damage were analyzed, especially in terms of the ISNT (inferior>superior>nasal>temporal) rule, and compared between the three groups.
The male-to-female ratio was 1.59:1 and the mean age was 45.12±15.76 years. There were statistically significant differences among the groups for average, inferior, superior, and temporal RNFL thickness (p<0.00001). However, the difference in nasal RNFL was insignificant. The ISNT rule was the commonest pattern in the study participants (64.4%) and progressive loss of pattern was observed with increased disease severity.
This study revealed an association between disease severity and RNFL thinning in the inferior, superior, and temporal quadrants, while nasal RNFL showed no significant association with disease severity. The ISNT rule was more frequently observed in the early stages and diminished with advanced glaucoma. These results highlight RNFL thinning based on the DDLS as an important marker for glaucoma monitoring.
根据视盘损伤可能性量表（DDLS）确定早期和晚期青光眼患者视乳头周围视网膜神经纤维层（RNFL）的损伤模式。
这项横断面、多中心研究纳入了135例年龄在18岁及以上疑似或确诊青光眼患者的267只眼睛。排除标准为高度屈光不正、介质混浊、外伤史以及影响视盘的全身性疾病。经过全面的眼部检查后，使用DDLS对青光眼进行分期。疾病严重程度分为三个区域：绿色、橙色和红色。使用光学相干断层扫描在四个象限测量RNFL厚度。分析RNFL损伤模式，特别是根据ISNT（下方>上方>鼻侧>颞侧）规则，并在三组之间进行比较。
男女比例为1.59:1，平均年龄为45.12±15.76岁。三组之间平均、下方、上方和颞侧RNFL厚度存在统计学显著差异（p<0.00001）。然而，鼻侧RNFL的差异不显著。ISNT规则是研究参与者中最常见的模式（64.4%），并且随着疾病严重程度的增加观察到模式的逐渐丧失。
本研究揭示了疾病严重程度与下方、上方和颞侧象限RNFL变薄之间的关联，而鼻侧RNFL与疾病严重程度无显著关联。ISNT规则在早期更常观察到，在晚期青光眼时减少。这些结果强调基于DDLS的RNFL变薄作为青光眼监测的重要标志物。
