Purpose

To investigate the temporal relationship among progressive macular ganglion cell inner plexiform layer (GCIPL) thinning, progressive parapapillary retinal nerve fiber layer (RNFL) thinning, and visual field (VF) progression in patients with primary open-angle glaucoma (POAG).

Design

Prospective study.

Participants

One hundred thirty-six POAG patients (231 eyes) followed up for ≥5 years.

Methods

OCT imaging of the macular GCIPL and parapapillary RNFL and perimetry were performed at ∼ 4-month intervals. Progressive GCIPL and RNFL thinning were determined by Guided Progression Analysis (GPA) of serial GCIPL and RNFL thickness maps. The specificities of GPA were calculated from the proportions of eyes with progressive GCIPL or RNFL thinning in 67 eyes of 36 healthy individuals followed up for ≥5 years. Visual field progression (likely or possible) was determined by the Early Manifest Glaucoma Trial criteria.

Main Outcome Measures

Hazard ratios for VF progression, progressive RNFL thinning, and progressive GCIPL thinning, as determined by time-varying Cox models.

Results

GPA detected 57 eyes (24.7%) with progressive GCIPL thinning and 66 eyes (28.6%) with progressive RNFL thinning at a specificity of 95.5% and 91.0%, respectively. Thirty-five eyes (15.2%) demonstrated progressive RNFL and GCIPL thinning, whereas 53 eyes (22.9%) demonstrated progressive RNFL or GCIPL thinning. Eyes with progressive GCIPL thinning had a higher risk for progressive RNFL thinning (HR, 5.27; 95% confidence interval [CI], 2.89–9.62), whereas eyes with progressive RNFL thinning were also at a higher risk for progressive GCIPL thinning (HR, 2.99; 95% CI, 1.48–6.02), after adjusting for baseline covariates. The HRs for likely and possible VF progression were 3.48 (95% CI, 1.51–8.01) and 2.74 (95% CI, 1.26–5.98), respectively, on detection of progressive GCIPL thinning and 3.66 (95% CI, 1.68–7.97) and 2.54 (95% CI, 1.23–5.21), respectively, on detection of progressive RNFL thinning after adjusting for baseline covariates. Eyes with VF progression were not at risk of progressive RNFL or GCIPL thinning (P ≥ 0.493).

Conclusions

Progressive macular GCIPL thinning and progressive parapapillary RNFL thinning are mutually predictive. Because progressive RNFL thinning and progressive GCIPL thinning are both indicative of VF progression, integrating macular GCIPL and parapapillary RNFL measurements is relevant to facilitate early detection of disease deterioration in glaucoma patients.

中文翻译：

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整合黄斑神经节细胞内柱状神经层和乳头状视网膜神经纤维层的测量，以检测青光眼的进展。

目的

目的探讨原发性开角型青光眼（POAG）患者的进行性黄斑神经节细胞内丛状层（GCIPL）减薄，进行性乳头旁视网膜神经纤维层（RNFL）减薄与视野（VF）进展之间的时间关系。

设计

前瞻性研究。

参加者

136例POAG患者（231只眼）随访≥5年。

方法

黄斑GCIPL和乳头旁RNFL的OCT成像及视野检查每隔约4个月进行一次。通过系列GCIPL和RNFL厚度图的引导进行分析（GPA）确定渐进式GCIPL和RNFL变薄。GPA的特异性是根据36位健康个体（≥5年）的67只眼中进行性GCIPL或RNFL变薄的眼睛比例计算得出的。视野进展（可能或可能）由“早期清单性青光眼”试验标准确定。

主要观察指标

由时变Cox模型确定的VF进展，RNFL逐渐变薄和GCIPL逐渐变薄的危险比。

结果

GPA检测到进行性GCIPL变薄的57眼（24.7％）和进行性RNFL变薄的66眼（28.6％）的特异性分别为95.5％和91.0％。35眼（15.2％）表现为进行性RNFL和GCIPL变薄，而53眼（22.9％）显示为进行性RNFL或GCIPL变薄。进行性GCIPL变薄的眼睛进行RNFL进行性变薄的风险较高（HR，5.27； 95％置信区间[CI]，2.89–9.62），而进行性RNFL变薄的眼睛进行GCIPL进行性变薄的风险也较高（HR， 2.99； 95％CI，1.48–6.02），已针对基线协变量进行了调整。检测到进行性GCIPL变薄时，可能发生和发生VF进展的HR分别为3.48（95％CI，1.51-8.01）和2.74（95％CI，1.26-5.98）和3.66（95％CI，1.68-7.97）。和2.54（95％CI，1.23-5.21），调整基线协变量后检测渐进性RNFL细化的方法。VF进展的眼睛没有进行性RNFL或GCIPL变薄的风险（P ≥0.493）。

结论

黄斑部渐进性GCIPL变薄和渐进性乳头旁RNFL变薄是相互预测的。由于进行性RNFL变薄和进行性GCIPL变薄均指示VF进展，因此整合黄斑GCIPL和乳头旁RNFL测量值有助于早期发现青光眼患者的疾病恶化。