OCT-GPA技术在监测原发性开角型青光眼进展中的作用

2016-09-02关新辉

国际眼科杂志 2016年9期

关新辉，李　丽，梁　勇

关新辉，李丽，梁勇

Department of Ophthalmology, the Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China

Correspondence to:Yong Liang. Department of Ophthalmology, the Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China. iohey@163.com

Abstract

•AIM:To evaluate the ability of Cirrus spectral domain optical coherence tomography (SD-OCT)-guided progression analysis (GPA) software to detect glaucomatous progression in primary open angle glaucoma (POAG) patients.

•METHODS:Longitudinal study. The study examined 45 eyes of 36 patients with POAG over a 2y period. All eyes underwent at least four serial retinal nerve fiber layer (RNFL) thickness measurements performed by Cirrus OCT, with the first and last measurement separated by at least 2y. Visual field (VF) testing was performed by using the Swedish interactive threshold algorithm (SITA) Standard 30-2 program of the Humphrey field analyzer within the same week as the optic disc/RNFL photography. Serial RNFL thickness were assessed by the GPA software program. Glaucomatous eyes were classified as either early or advanced stage according to VF severity. At the same time each eye was labeled with status of RNFL (diffuse RNFL defect; localized RNFL defect; no RNFL defect; unidentifiable RNFL status) based on baseline RNFL photographs. Reference standard of glaucoma progression was defined by expert assessment of optic disc/RNFL photographs or VF data. Sensitivity and specificity of OCT GPA, as well as agreement between OCT GPA findings and each reference standard data were estimated.

•RESULTS: Eighteen eyes showed progression by optic disc/RNFL photographs or VF data, while 15 eyes by OCT GPA. When expert assessment of optic disc/RNFL photographs and VF data was used as the reference standard, the sensitivity and specificity of OCT GPA employed to detect glaucoma progression were 38.9% and 70.4%. Agreement between OCT GPA and either optic disc/RNFL photographic evaluation or VF analysis was poor (к=0.211, -0.036 respectively). When expert assessment of optic disc/RNFL photographs was used as the reference standard, 6 eyes were detected progression only by photographs, 2 eyes showed a new disc hemorrhage while 4 eyes with optic disc rim thinning. Among 9 eyes processed only by OCT GPA, 8 eyes were in early stage of POAG, of which 5 eyes had a diffuse RNFL defect and 2 eyes with no RNFL defect at baseline. VF analysis used as the reference standard, 7 eyes were detected progression only by VF testing, of which 5 eyes in advanced stage of POAG. Twelve eyes were processed only by OCT GPA, of which 10 in early stage of POAG.

•CONCLUSION:The Cirrus OCT GPA is more sensitive in eyes with a diffuse RNFL defect and may be useful for progression detection in earlier stage of glaucoma to complement other reference standard strategies.

目的：探讨频域光学相干断层扫描(spectral-domain optical coherence tomography，SD-OCT)的青光眼进展引导分析(guided progression analysis，GPA)技术在判断原发性开角型青光眼(primary open angle glaucoma，POAG)进展中的作用。

方法：随访36例45眼POAG患者2a，行视盘OCT、眼底照相及视野检查，至少有4次可信的OCT检查结果。根据视野结果将受试者划分为早期和中晚期。根据基线眼底照相判断视网膜神经纤维层(retinal nerve fiber layer，RNFL)情况(弥漫RNFL缺损、局限缺损、无缺损及无法判断缺损者)。由两位青光眼专家根据眼底照相及视野结果将其分为进展型及非进展型。分析OCT-GPA技术同视野、眼底照相判断的一致性，计算灵敏度及特异度。

结果：眼底照相或视野判断为POAG进展者18眼(40%)，OCT-GPA判断POAG进展者15眼(33%)。以眼底照相及视野判断为标准，OCT-GPA技术的灵敏度和特异度为38.9%和70.4%。OCT-GPA同眼底照相及视野判断结果的一致性较差(к=0.211、-0.036)。以眼底照相为标准，仅眼底照相判断进展者6眼，2眼为新的盘周出血，4眼为盘沿变窄；仅OCT-GPA判断为进展者9眼，8眼为早期，其中5眼基线眼底照相提示弥漫性RNFL缺损，2眼无明显RNFL缺损。以视野为判断标准，仅视野判断进展者7眼，5眼为中晚期；仅OCT-GPA判断进展者12眼，10眼为早期。

结论：OCT-GPA在判断早期POAG进展及弥漫性RNFL缺损上有一定优势，但最好联合视野及眼底照相检查共同判断。

光学相干断层扫描；原发性开角型青光眼；青光眼进展分析；眼底照相

引用：关新辉，李丽，梁勇. OCT-GPA技术在监测原发性开角型青光眼进展中的作用.国际眼科杂志2016;16(9):1687-1691