Caprioli J, Park H J, Ugurlu S, Hoffman D
Glaucoma Division, Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles, California 90095-7004, USA.
Invest Ophthalmol Vis Sci. 1998 Nov;39(12):2321-8.
To develop structural markers of early glaucomatous optic nerve damage with confocal scanning laser ophthalmoscopy.
Custom software was developed to analyze the images of 53 patients with open-angle glaucoma and 43 healthy subjects (matched for age, race, and refractive error), with images acquired with a confocal scanning laser ophthalmoscope. Height values were obtained along radial profiles of the peripapillary nerve fiber layer surface at 5-degree intervals around the disc edge. Two new parameters were derived: mean height and mean slope of the peripapillary nerve fiber layer surface. Mean slope was tested for its independence from a retinal reference plane. A logistic regression analysis was used to determine functions of disease probability. Receiver-operating characteristic (ROC) curves were used to evaluate sensitivity and specificity of peripapillary nerve fiber layer slope and height to discriminate normal subjects from glaucoma patients.
Mean (+/-SD) visual field mean deviation in the glaucoma group was -4.8 +/- 3.3 dB. Mean slope (+/-SD) of the peripapillary nerve fiber layer was significantly (P < 0.001) steeper (0.30 +/- 0.12) in glaucoma patients than in healthy subjects (0.11 +/- 0.12). Mean slope values were identical with or without the retinal reference plane. Mean height (+/-SD) values with respect to a retinal reference plane were 45.2 +/- 103 microm in healthy subjects and -65.2 +/- 105 microm in glaucoma patients, which were significantly different (P < 0.001). The differences for mean slope and for mean height between the healthy subjects and the glaucoma patients were greatest inferiorly. The diagnostic precision, sensitivity, and specificity of mean slope were 83%, 85%, and 80%, respectively. The diagnostic precision, sensitivity, and specificity of mean height were 75%, 69%, and 83%, respectively.
Mean peripapillary slope of the nerve fiber layer surface can be used to discriminate between healthy subjects and glaucoma patients with clinically useful diagnostic precision. This parameter is independent of a retinal reference plane and may be particularly useful to detect progressive glaucoma damage.
利用共焦扫描激光眼科显微镜开发早期青光眼性视神经损伤的结构标志物。
开发定制软件，分析53例开角型青光眼患者和43例健康受试者（年龄、种族和屈光不正相匹配）的图像，这些图像由共焦扫描激光眼科显微镜采集。沿视盘边缘以5度间隔在视乳头周围神经纤维层表面的径向轮廓上获取高度值。得出两个新参数：视乳头周围神经纤维层表面的平均高度和平均斜率。测试平均斜率与视网膜参考平面的独立性。采用逻辑回归分析确定疾病概率函数。使用受试者操作特征（ROC）曲线评估视乳头周围神经纤维层斜率和高度区分正常受试者与青光眼患者的敏感性和特异性。
青光眼组平均（±标准差）视野平均缺损为-4.8±3.3dB。青光眼患者视乳头周围神经纤维层的平均斜率（±标准差）（0.30±0.12）比健康受试者（0.11±0.12）明显更陡（P<0.001）。无论有无视网膜参考平面，平均斜率值均相同。相对于视网膜参考平面，健康受试者的平均高度（±标准差）值为45.2±103μm，青光眼患者为-65.2±105μm，差异有统计学意义（P<0.001）。健康受试者与青光眼患者之间平均斜率和平均高度的差异在下方最大。平均斜率的诊断精度、敏感性和特异性分别为83%、85%和80%。平均高度的诊断精度、敏感性和特异性分别为75%、69%和83%。
神经纤维层表面的视乳头周围平均斜率可用于以具有临床实用价值的诊断精度区分健康受试者和青光眼患者。该参数独立于视网膜参考平面，可能对检测进行性青光眼损伤特别有用。
