RESUMO
PURPOSE: Assessment of the diagnostic ability of segmented macular inner retinal layer thickness and peripapillary retinal nerve fiber layer (pRNFL) measured by spectral-domain optical coherence tomography (SD-OCT) in patients with normal-tension (NT) and high-tension (HT) perimetric and preperimetric glaucoma. METHODS: The 212 participants included 45 healthy subjects, 55 patients with ocular hypertension, 56 patients with preperimetric glaucoma, and 56 patients with perimetric glaucoma. The preperimetric and perimetric groups were further subdivided into NT and HT groups. Sectoral and global thickness of macular retinal nerve fiber layer (mRNFL), ganglion cell layer (mGCL), inner plexiform layer (mIPL), ganglion cell complex (mGCC), and pRNFL were measured using SD-OCT (Spectralis, Heidelberg Engineering, Germany). Diagnostic performance was ascertained by sectoral and global comparison of the sensitivities at specificity ≥ 95%. RESULTS: For all layers, the largest thickness decrease was reported in the HT perimetric group. In all groups, the sensitivities of mGCL showed a comparable diagnostic value to pRNFL in order to distinguish between healthy subjects and glaucoma patients. In the perimetric group, mGCL (85.7%) exhibited higher sensitivities than mRNFL (78.6%) and mGCC (78.6%). Both mRNFL and pRNFL demonstrated equal diagnostic performance in the HT perimetric group (88.5 and 96.2%), in the NT groups, mRNFL was inferior to all other layers. CONCLUSION: The sensitivities of mGCL and mRNFL were comparable to the sensitivities of pRNFL. In clinical application, mGCL and mRNFL, with a focus on the temporal and inferior sectors, may provide a convincing supplementation to pRNFL. CLINICAL TRIAL REGISTRATION: Erlangen Glaucoma Registry www.clinicaltrials.gov ID: NCT00494923.
Assuntos
Angiofluoresceinografia/métodos , Glaucoma de Ângulo Aberto/diagnóstico , Pressão Intraocular , Hipertensão Ocular/diagnóstico , Células Ganglionares da Retina/patologia , Segmento Interno das Células Fotorreceptoras da Retina/patologia , Tomografia de Coerência Óptica/métodos , Progressão da Doença , Feminino , Fundo de Olho , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Hipertensão Ocular/fisiopatologia , Disco Óptico/patologia , Curva ROC , Fatores de TempoRESUMO
PURPOSE: The aim of this study was to assess the repeatability and reproducibility (R&R) of Bruch membrane opening based on minimum rim width (BMO-MRW), minimum rim area (BMO-MRA) and peripapillary retinal nerve fiber layer thickness (RNFLT) with the Spectralis optical coherence tomography (Heidelberg Engineering) for normal and glaucoma subjects. Precise measurement of these parameters can support detection of structural glaucomatous damage and progression. METHODS: This cross-sectional study included 16 healthy controls and 16 patients with glaucoma. One eye was randomly selected and included in this study. Subjects underwent 1 baseline and 3 follow-up measurements, using 3 different Spectralis optical coherence tomography devices in randomized order, each operated by a single operator. Outcome measures were global and sectorial averages of BMO-MRW and BMO-MRA, and of peripapillary RNFLT obtained from 12/14/16-degree circle scans. Coefficients of variation (COV) were calculated and a mixed-effects analysis of variance was performed to compare R&R between devices. RESULTS: COVs of global and sectorial BMO-MRW measurement under repeatability conditions ranged from 0.51% to 1.7% (normal, 0.62% to 1.3%; glaucoma, 0.64% to 2.3%). Respective COVs under reproducibility conditions ranged from 0.89% to 1.9% (normal, 0.77% to 2.8%; glaucoma, 1.1% to 2.6%). COVs of global and sectorial RNFLT measurements under repeatability conditions ranged from 0.5% to 2.8%. Respective COVs under reproducibility conditions ranged from 1.6% to 3.5%. CONCLUSIONS: For R&R, the COVs of measured parameters were by trend higher for glaucoma eyes compared with normal controls. The BMO-MRW measurement system has an excellent precision taking into account that major and minor corrections of segmentation have to be done by the examiner before evaluation.
Assuntos
Lâmina Basilar da Corioide/diagnóstico por imagem , Glaucoma/diagnóstico , Hipertensão Ocular/diagnóstico , Disco Óptico/diagnóstico por imagem , Retina/diagnóstico por imagem , Neurônios Retinianos/citologia , Tomografia de Coerência Óptica/métodos , Lâmina Basilar da Corioide/citologia , Lâmina Basilar da Corioide/patologia , Estudos de Casos e Controles , Contagem de Células , Estudos Transversais , Progressão da Doença , Diagnóstico Precoce , Feminino , Glaucoma/patologia , Humanos , Pressão Intraocular , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Fibras Nervosas/ultraestrutura , Hipertensão Ocular/patologia , Disco Óptico/citologia , Disco Óptico/patologia , Tamanho do Órgão , Reprodutibilidade dos Testes , Retina/citologia , Retina/patologia , Células Ganglionares da Retina/citologia , Células Ganglionares da Retina/patologia , Neurônios Retinianos/patologiaRESUMO
PURPOSE: The purpose of this study was to compare the ability of scanning laser polarimetry (SLP) and spectral-domain optical coherence tomography (SD-OCT) to predict future visual field conversion of subjects with ocular hypertension and early glaucoma. METHODS: All patients were recruited from the Erlangen glaucoma registry and examined using standard automated perimetry, 24-hour intraocular pressure profile, and optic disc photography. Peripapillary retinal nerve fiber layer thickness (RNFL) measurements were obtained by SLP (GDx-VCC) and SD-OCT (Spectralis OCT). Positive and negative predictive values (PPV, NPV) were calculated for morphologic parameters of SLP and SD-OCT. Kaplan-Meier survival curves were plotted and log-rank tests were performed to compare the survival distributions. Contingency tables and Venn-diagrams were calculated to compare the predictive ability. RESULTS: The study included 207 patients-75 with ocular hypertension, 85 with early glaucoma, and 47 controls. Median follow-up was 4.5 years. A total of 29 patients (14.0%) developed visual field conversion during follow-up. SLP temporal-inferior RNFL [0.667; 95% confidence interval (CI), 0.281-0.935] and SD-OCT temporal-inferior RNFL (0.571; 95% CI, 0.317-0.802) achieved the highest PPV; nerve fiber indicator (0.923; 95% CI, 0.876-0.957) and SD-OCT mean (0.898; 95% CI, 0.847-0.937) achieved the highest NPV of all investigated parameters. The Kaplan-Meier curves confirmed significantly higher survival for subjects within normal limits of measurements of both devices (P<0.001). Venn diagrams tested with McNemar test statistics showed no significant difference for PPV (P=0.219) or NPV (P=0.678). CONCLUSIONS: Both GDx-VCC and SD-OCT demonstrate comparable results in predicting future visual field conversion if taking typical scans for GDx-VCC. In addition, the likelihood ratios suggest that GDx-VCC's nerve fiber indicator<30 may be the most useful parameter to confirm future nonconversion. (http://www.ClinicalTrials.gov number, NTC00494923; Erlangen Glaucoma Registry).
Assuntos
Glaucoma de Ângulo Aberto/diagnóstico , Polarimetria de Varredura a Laser/métodos , Tomografia de Coerência Óptica/métodos , Transtornos da Visão/diagnóstico , Campos Visuais/fisiologia , Idoso , Reações Falso-Positivas , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/fisiopatologia , Valor Preditivo dos Testes , Células Ganglionares da Retina/patologia , Estudos Retrospectivos , Tonometria Ocular , Transtornos da Visão/fisiopatologia , Testes de Campo VisualRESUMO
PURPOSE: The aim of this study was to compare the predictive value of retinal nerve fiber layer thickness (RNFLT) measurements obtained by optical coherence tomography (OCT), morphometric parameters of confocal scanning laser ophthalmoscopy (CSLO), and frequency-doubling technique perimetry to predict visual field conversion of normal individuals, ocular hypertensive subjects, and early preperimetric glaucoma patients as determined by standard automated perimetry (SAP). PATIENTS AND METHODS: This longitudinal single-center study included 107 eyes of 56 controls, 164 eyes of 98 patients with ocular hypertension, and 169 eyes of 110 patients with preperimetric glaucoma. At baseline, all patients and controls underwent OCT (Spectralis OCT), CSLO (Heidelberg Retina Tomograph) examination, optic disc photography, and frequency-doubling technique perimetry. At baseline SAP was normal in all participants. Univariate and multivariate hazard ratios (HRs) were measured to model the conversion-free survival including morphometric functional and clinical variables. RESULTS: The median follow-up period was 6.9 years. In total, 48 eyes (10.9%) demonstrated visual field conversion in the follow-up. RNFLT temporal-inferior outside normal limits demonstrated the highest HR with 1.2 (95% confidence interval, 1.1-1.4) per 10 µm loss for OCT, and Glaucoma probability score global outside normal limits demonstrated the highest HR with 1.3 (95 % confidence interval, 1.1-1.5) per 0.1 increase for CSLO in a multivariate model adjusted for photograph-based glaucoma staging, central corneal thickness, and SAP pattern SD. CONCLUSIONS: Both measurement of RNFLT by OCT and Glaucoma probability score by CSLO are highly predictive of future visual field conversion and provide independent predictive information beyond optic disc assessment, central corneal thickness, and SAP pattern SD.
Assuntos
Glaucoma/diagnóstico , Pressão Intraocular/fisiologia , Fibras Nervosas/patologia , Oftalmoscopia/métodos , Retina/patologia , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , Adulto , Idoso , Estudos de Casos e Controles , Progressão da Doença , Feminino , Glaucoma/fisiopatologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/fisiopatologia , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Prospectivos , Sensibilidade e Especificidade , Tomografia de Coerência Óptica/métodosRESUMO
PURPOSE: Meibomian gland disease is generally accepted as the leading cause for evaporative dry eye disease (DED). In a previous study, perfluorohexyloctane, a semifluorinated alkane, has been demonstrated to significantly increase tear film breakup time and to reduce corneal fluorescein staining in patients with evaporative DED, thereby vastly reducing dry eye-related symptoms. This study was set up to evaluate perfluorohexyloctane in a larger population of patients with Meibomian gland dysfunction. METHODS: Seventy-two patients with Meibomian gland disease and associated dry eye received 1 drop of perfluorohexyloctane 4 times daily during an observational, prospective, multicenter, 6-8-week study. Clinical assessment included best-corrected visual acuity, intraocular pressure, Schirmer test I, tear film breakup time, anterior and posterior blepharitis assessment, number of expressible Meibomian glands, meibum quality and quantity, ocular surface fluorescein staining, lid margin and symptom assessment, and Ocular Surface Disease Index (OSDI©). RESULTS: From the 72 patients recruited, 61 completed the trial per protocol. Nine patients did not apply the medication as recommended and 2 patients were lost to follow-up. Tear film breakup time, corneal and conjunctival fluorescein staining, number of expressible Meibomian glands, and severity of anterior and posterior blepharitis significantly improved after 6-8 weeks of perfluorohexyloctane application. In addition, symptoms improved as demonstrated by a significant decrease of OSDI-values from 37 (±13) to 26 (±16). CONCLUSIONS: In concordance with previous findings, 6-8 weeks of topical application of perfluorohexyloctane significantly improves clinical signs of Meibomian gland disease and associated mild to moderate DED.
Assuntos
Síndromes do Olho Seco/tratamento farmacológico , Doenças Palpebrais/tratamento farmacológico , Fluorocarbonos/uso terapêutico , Glândulas Tarsais/efeitos dos fármacos , Administração Oftálmica , Síndromes do Olho Seco/etiologia , Síndromes do Olho Seco/fisiopatologia , Doenças Palpebrais/complicações , Doenças Palpebrais/fisiopatologia , Feminino , Fluorocarbonos/administração & dosagem , Fluorofotometria , Humanos , Pressão Intraocular/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Estudos Prospectivos , Inquéritos e Questionários , Lágrimas/fisiologia , Acuidade Visual/efeitos dos fármacosRESUMO
PURPOSE: To evaluate rates of changes per year of central corneal thickness after antiglaucomatous drug administration with ß-blockers, prostaglandin analogs, and carbonic anhydrase inhibitors monotherapy and combined topical antiglaucomatous therapy, in a cohort of patients with ocular hypertension, glaucoma suspects, and patients with perimetric glaucoma as compared with normal controls. PATIENTS AND METHODS: This retrospective single-center study included 130 eyes as healthy controls, 121 eyes of ocular hypertensive patients, 105 eyes of glaucoma suspects, and 49 eyes of perimetric glaucoma patients. All patients underwent standard automated perimetry, 24-hour intraocular pressure profile, optic disc photography, and optical coherence pachymetry (OCP; Heidelberg Engineering). The cohort was divided into 8 groups on the basis of topical antiglaucomatous medication. Linear regression analysis was conducted to analyze the relationship between central corneal thickness and exposure to antiglaucomatous medication during the follow-up. RESULTS: Central corneal thickness did not change during the follow-up for investigated diagnostic subgroups. There was a statistically significant decrease in central corneal thickness for eyes treated with prostaglandin monotherapy (-3.1 µm/y for left eye), and a combined therapy with prostaglandins, carbonic anhydrase inhibitors, and ß-blockers (-5.8 and -3.8 µm/y for right and left eye, respectively). CONCLUSIONS: We recommend regular measurements before and during therapy with prostaglandin monotherapy and a combined therapy with prostaglandins, carbonic anhydrase inhibitors, and ß-blockers. Follow-up intraocular pressure measurements may be underestimated for eyes treated with the aforementioned treatment regimens if central corneal thickness is not measured on a regular basis.
Assuntos
Anti-Hipertensivos/efeitos adversos , Córnea/efeitos dos fármacos , Doenças da Córnea/induzido quimicamente , Glaucoma de Ângulo Aberto/tratamento farmacológico , Pressão Intraocular/efeitos dos fármacos , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/efeitos adversos , Adulto , Idoso , Anti-Hipertensivos/administração & dosagem , Inibidores da Anidrase Carbônica/administração & dosagem , Inibidores da Anidrase Carbônica/efeitos adversos , Córnea/fisiopatologia , Doenças da Córnea/fisiopatologia , Paquimetria Corneana , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Interferometria , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/tratamento farmacológico , Hipertensão Ocular/fisiopatologia , Prostaglandinas F Sintéticas/administração & dosagem , Prostaglandinas F Sintéticas/efeitos adversos , Estudos Retrospectivos , Tonometria Ocular , Testes de Campo VisualRESUMO
PURPOSE: To compare Moorfields regression analysis (MRA), Glaucoma probability score (GPS), and different discriminant functions to predict future visual field conversion of patients with ocular hypertension and early glaucoma. PATIENTS AND METHODS: The study included 120 eyes of patients with ocular hypertension and 110 eyes of patients with early glaucoma from the Erlangen glaucoma registry. Annually, all patients underwent standard automated perimetry, 24-hour intraocular pressure profile, optic disc photography, and HRT (Heidelberg Retina Tomograph I-III; Heidelberg Engineering) measurements. The cohort was divided into 2 groups based on the development of repeatable glaucomatous visual fields. Positive predictive values and negative predictive values were compared for MRA, GPS, and the classification of Bathija, Iester, Mardin, and Mikelberg at baseline. Kaplan-Meier Survival curves and Logrank tests were used to evaluate equality of survival distributions for different test results. RESULTS: Median follow-up was 9.04 years. 26 eyes (11.3%) demonstrated glaucomatous visual field loss in the follow-up. MRA temporal-superior and temporal-inferior outside normal limits were predictive of future visual field loss with positive predictive values of 33.3% and 28.6%. Normal GPS Temporal Sector demonstrated a negative predictive value of 96.4% and normal results in discriminant functions between 94.7% and 95.5%. CONCLUSIONS: Confocal scanning laser tomography is a useful imaging modality to predict future visual field conversion. Development of visual field defects in 10 years is highly unlikely, if GPS classification and/or classification of discriminant analysis at baseline are normal. MRA temporal-superior and temporal-inferior outside normal limits are associated with future VF conversion (ClinicalTrials.gov number, NCT00494923).
Assuntos
Glaucoma de Ângulo Aberto/diagnóstico , Microscopia Confocal , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Transtornos da Visão/diagnóstico , Campos Visuais , Adulto , Diagnóstico Precoce , Reações Falso-Positivas , Feminino , Seguimentos , Gonioscopia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Valor Preditivo dos Testes , Probabilidade , Estudos Prospectivos , Sensibilidade e Especificidade , Tomografia , Tonometria OcularRESUMO
PURPOSE: To compare the diagnostic value of Bruch's membrane opening minimum rim width (BMO-MRW) and retinal nerve fiber layer thickness (RNFLT) in patients with ocular hypertension, preperimetric, and perimetric glaucoma. METHODS: One hundred eighty-one eyes consisting of 40 healthy controls, 41 ocular hypertensive subjects, 50 subjects with preperimetric glaucoma and 50 with perimetric glaucoma were included. One randomly selected eye was included. All patients underwent slit-lamp examination, funduscopy, achromatic perimetry, and 24-hour IOP profile. Bruch's membrane opening-MRW and RNFLT (3 peripapillary circle scans, 12°/14°/16°) data were obtained using spectral domain optical coherence tomography. Areas under the receiver operating characteristics curves (AUROC) as well as sensitivity at fixed specificity were computed globally and for six vertical split sectors. Venn diagrams were plotted to identify patients that were diagnosed by one of the two parameters only. RESULTS: For RNFLT the smallest circle diameter showed highest diagnostic accuracy and was used for comparison with BMO-MRW. Distinguishing perimetric glaucoma, RNFLT and BMO-MRW showed comparable AUROCs in global (AUROC, 95% confidence interval: 0.954, 0.911-0.996 and 0.929, 0.872-0.986) and sectoral (0.929, 0.877-0.981 and 0.946, 0.904-0.996) analysis. For preperimetric glaucoma BMO-MRW and RNFLT also demonstrated comparable performance in global (0.839, 0.757-0.921 and 0.821, 0.731-0.912) and sectoral (0.860, 0.782-0.938 and 0.835, 0.750-0.920) analysis. When identifying ocular hypertensive eyes AUROCs were lower for global RNFLT and BMO-MRW (0.493, 0.365-0.621 and 0.562, 0.433-0.691). A combined parameter showed an AUROC of 0.959, 0.921 to 0.996 for perimetric and 0.849, 0.770 to 0.929 for preperimetric glaucoma. CONCLUSIONS: Bruch's membrane opening-MRW and RNFLT are comparably useful parameters for discrimination of preperimetric and perimetric glaucomatous eyes and show potential to assist each other in glaucoma diagnosis. (www.ClinicalTrials.gov number, NTC00494923; Erlangen Glaucoma Registry.).
Assuntos
Lâmina Basilar da Corioide/diagnóstico por imagem , Diagnóstico Precoce , Glaucoma de Ângulo Aberto/diagnóstico , Pressão Intraocular/fisiologia , Disco Óptico/patologia , Epitélio Pigmentado da Retina/patologia , Tomografia de Coerência Óptica/métodos , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Oftalmoscopia , Estudos Prospectivos , Curva ROC , Testes de Campo Visual , Campos VisuaisRESUMO
PURPOSE: To analyze the contralateral unaffected eyes of patients with microbial keratitis (MK) for any immune cell or nerve changes by laser in vivo confocal microscopy (IVCM). METHODS: A prospective study was performed on 28 patients with MK, including acute bacterial, fungal, and Acanthamoeba keratitis, as well as on their contralateral clinically unaffected eyes and on control groups, which consisted of 28 age-matched normal controls and 15 control contact lens (CL) wearers. Laser IVCM with the Heidelberg Retinal Tomograph 3/Rostock Cornea Module and Cochet-Bonnet esthesiometry of the central cornea were performed. Two masked observers assessed central corneal dendritiform cell density and subbasal corneal nerve parameters. RESULTS: The contralateral clinically unaffected eyes of patients with MK demonstrated significant diminishment in nerve density (15,603.8 ± 1265.2 vs. 24,102.1 ± 735.6 µm/mm²), total number of nerves (11.9 ± 1.0 vs. 24.9 ± 1.2/frame), number of branches (1.7 ± 0.2 vs. 19.9 ± 1.3/frame), and branch nerve length (5775.2 ± 757.1 vs. 12,715.4 ± 648.4 µm/mm²) (P < 0.001 for all parameters) compared to normal controls and CL wearers. Further, dendritiform cell density in the contralateral unaffected eyes was significantly increased as compared to that in controls (117.5 ± 19.9 vs. 24.2 ± 3.5 cells/mm², P < 0.001). CONCLUSIONS: We demonstrate a subclinical involvement in the contralateral clinically unaffected eyes in patients with unilateral acute MK. In vivo confocal microscopy reveals not only a diminishment of the subbasal corneal nerves and sensation, but also an increase in dendritiform cell density in the contralateral unaffected eyes of MK patients. These findings show bilateral immune alterations in a clinically unilateral disease.
Assuntos
Córnea/metabolismo , Infecções Oculares Bacterianas/metabolismo , Imunidade Celular , Ceratite/metabolismo , Nervo Oftálmico/fisiopatologia , Adulto , Contagem de Células , Córnea/inervação , Córnea/patologia , Infecções Oculares Bacterianas/imunologia , Infecções Oculares Bacterianas/patologia , Feminino , Humanos , Ceratite/imunologia , Ceratite/patologia , Masculino , Microscopia Confocal , Estudos ProspectivosRESUMO
IMPORTANCE: New methods are needed to compare peripapillary retinal nerve fiber layer thickness (pRNFLT) measurements taken from time-domain optical coherence tomography (TD-OCT) and spectral-domain OCT (SD-OCT). OBJECTIVE: To compare the agreement of measured and predicted pRNFLT using different equations based on pRNFLT measurements obtained by TD-OCT and SD-OCT. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional single-center study that took place at the Department of Ophthalmology, University of Erlangen-Nuremberg from November 16, 2005, to June 3, 2015, and included 138 eyes of control participants, 126 eyes of patients with ocular hypertension, 128 eyes of patients with preperimetric glaucoma, and 160 eyes of patients with perimetric glaucoma. All participants had standard clinical examinations to obtain TD-OCT (via Stratus OCT) and SD-OCT (via Spectralis OCT) measurements of pRNFLT. Two groups were matched for diagnostic subgroup, eye side, sex, and age. The TD-OCT measurements of the first group were used to predict the mean SD-OCT and 6-sector vertical-split pRNFLT measurements of the second group and vice versa. The agreement between the predicted pRNFLT calculations of conversion equations and measured pRNFLT of the second group was evaluated by intraclass correlation coefficients and Bland-Altman plots. MAIN OUTCOMES AND MEASURES: Mean and sectoral pRNFLT measurements obtained by TD-OCT and SD-OCT as well as the agreement between measured and predicted pRNFLT. RESULTS: The agreement for all investigated equations to predict mean pRNFLT measurements with intraclass correlation coeffecients ranged from 0.937 to 0.939. Bland-Altman plots demonstrated systemic biases between -0.7 µm and +1.1 µm for measured and predicted mean pRNFLT measurements. The ratio method demonstrated an intraclass correlation coefficient of 0.969 for the temporal-inferior sector. The best color-code agreement between both OCT devices was achieved by the no conversion method, with κ = 0.731 (95% CI, 0.656-0.806) for the mean pRNFLT. CONCLUSIONS AND RELEVANCE: These data suggest that the prediction of mean pRNFLT values by equations derived from TD-OCT and SD-OCT can be conducted with high levels of agreement. In individual cases and singular sectors, high prediction errors may occur. When longitudinal imaging data from both TD-OCT and SD-OCT are available, conversion equations may provide longitudinal comparability.
Assuntos
Glaucoma/diagnóstico , Fibras Nervosas/patologia , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Adulto , Idoso , Estudos Transversais , Progressão da Doença , Reações Falso-Negativas , Feminino , Gonioscopia , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Tempo , Tomografia de Coerência Óptica/instrumentação , Tonometria Ocular , Testes de Campo VisualRESUMO
PURPOSE: To investigate the impact of typical scan score (TSS) on discriminating glaucomatous and healthy eyes by scanning laser polarimetry and spectral domain optical coherence tomography (SD-OCT) in 32 peripapillary sectors. PATIENTS AND METHODS: One hundred two glaucoma patients and 32 healthy controls underwent standard automated perimetry, 24-hour intraocular pressure profile, optic disc photography, GDxVCC, and SD-OCT measurements. For controls, only very typical scans (TSS=100) were accepted. Glaucoma patients were divided into 3 subgroups (very typical: TSS=100; typical: 99≥TSS≥80, atypical: TSS<80). Receiver operating characteristic curves were constructed for mean retinal nerve fiber layer values, sector data, and nerve fiber indicator (NFI). Sensitivity was estimated at ≥90% specificity to compare the discriminating ability of each imaging modality. RESULTS: For discrimination between healthy and glaucomatous eyes with very typical scans, the NFI and inferior sector analyses 26 to 27 demonstrated the highest sensitivity at ≥90% specificity in GDxVCC and SD-OCT, respectively. For the typical and atypical groups, sensitivity at ≥90% specificity decreased for all 32 peripapillary sectors on an average by 10.9% and 17.9% for GDxVCC and by 4.9% and 0.8% for SD-OCT. For GDxVCC, diagnostic performance of peripapillary sectors decreased with lower TSS, especially in temporosuperior and inferotemporal sectors (sensitivity at ≥90% specificity decreased by 55.3% and by 37.8% in the atypical group). CONCLUSIONS: Diagnostic accuracy is comparable for SD-OCT and GDxVCC if typical scans (TSS=100) are investigated. Decreasing TSS is associated with a decrease in diagnostic accuracy for discriminating healthy and glaucomatous eyes by scanning laser polarimetry. NFI is less influenced than the global or sector retinal nerve fiber layer thickness. The TSS score should be included in the standard printout. Diagnostic accuracy of SD-OCT is barely influenced by low TSS.
Assuntos
Glaucoma de Ângulo Aberto/diagnóstico , Fibras Nervosas/patologia , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Polarimetria de Varredura a Laser/métodos , Tomografia de Coerência Óptica/métodos , Estudos Transversais , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Curva ROC , Reprodutibilidade dos Testes , Polarimetria de Varredura a Laser/normas , Sensibilidade e Especificidade , Tomografia de Coerência Óptica/normas , Testes de Campo Visual , Campos VisuaisRESUMO
PURPOSE: Scanning laser polarimetry (SLP) results can be affected by an atypical retardation pattern (ARP). One reason for an ARP is the birefringence of the sclera. The purpose of this study was to investigate the influence of the peripapillary choroidal thickness (pChTh) on the occurrence of ARP. METHODS: One hundred ten healthy subjects were investigated with SLP and spectral domain OCT. pChTh was measured in B-scan images at 768 positions using semiautomatic software. Values were averaged to 32 sectors and the total peripapillary mean. Subjects were divided into four groups according to the typical scan score (TSS) provided by the GDxVCC: group 1 TSS, 100; group 2 TSS, 90-99; group 3 TSS, 80-89; group 4 TSS, <80. RESULTS: Mean pChTh (± SD) in 110 healthy subjects was 141 µm (±49 µm). There was a significant correlation between pChTh and TSS (r = 0.608; P < 0.001). In TSS groups 1 to 4, mean pChTh was 168 µm (±38 µm), 148 µm (± 48 µm), 119 µm (±35 µm), and 92 (±42 µm). Mean pChTh of TSS groups 3 and 4 was significantly lower than that of TSS group 1 (P < 0.001). CONCLUSIONS: Low values of TSS resulting from the appearance of ARP in SLP are associated with low peripapillary choroidal thickness. Reduced choroidal thickness may result in an increased amount of confounding light getting to the SLP light detectors.
Assuntos
Lâmina Basilar da Corioide/fisiologia , Corioide/anatomia & histologia , Fibras Nervosas/fisiologia , Células Ganglionares da Retina/efeitos da radiação , Epitélio Pigmentado da Retina/fisiologia , Polarimetria de Varredura a Laser , Birrefringência , Humanos , Luz , Refração Ocular/fisiologia , Células Ganglionares da Retina/fisiologia , Esclera , Tomografia de Coerência Óptica , Testes de Campo Visual , Campos VisuaisRESUMO
PURPOSE: To investigate the relationship between retinal nerve fiber layer (RNFL) measurements in corresponding areas obtained with scanning laser polarimetry and optical coherence tomography and to compare their discriminating ability in the diagnosis of preperimetric and perimetric glaucoma. PATIENTS AND METHODS: Three hundred eighty-six subjects-57 healthy controls, 145 ocular hypertensive patients, 89 with preperimetric glaucoma, and 95 with perimetric glaucoma-were recruited from the Erlangen Glaucoma Registry. Perimetry, 24-hours intraocular pressure profile, stereographic optic disc slides, optical coherence tomography StratusOCT, and scanning laser polarimetry GDx VCC (Carl Zeiss Meditec, Inc, Dublin, CA) were performed in all patients. Receiver operating characteristic (ROC) curves were constructed for mean RNFL values, sector data, and indices. Sensitivity was estimated at >or=90% and >or=80% of specificity to compare the discriminating ability of each imaging modality. RESULTS: For discrimination between glaucomatous and healthy eyes in GDx VCC the nerve fiber index demonstrated the largest area under the ROC curve (AUROC) (0.962+/-0.013), whereas in StratusOCT the largest AUROC (0.986+/-0.006) was found in the inferior quadrant. For preperimetric glaucoma detection the nerve fiber index achieved the largest AUROC (0.783+/-0.037). In contrast, the total RNFL average obtained using StratusOCT showed the largest AUROC (0.904+/-0.025). Bland-Altman plots showed good agreement between both instruments. CONCLUSIONS: Both the GDx VCC and StratusOCT demonstrate increasing RNFL loss with advanced glaucomatous damage and were comparable in the diagnosis of perimetric glaucoma. Preperimetric glaucomatous damage may be better assessed by StratusOCT.