Objective

Evaluation of glaucoma progression with OCT has been centered on the analysis of progressive retinal nerve fiber layer (RNFL) thinning over the parapapillary region and/or progressive ganglion cell inner plexiform layer (GCIPL) thinning over the macula. We investigated (1) whether combining the RNFL and GCIPL as a single layer (i.e., RNFL-GCIPL) for wide-field progression analysis outperforms wide-field progression analysis of the RNFL or the GCIPL, and (2) whether eyes with progressive RNFL-GCIPL thinning are at risk of visual field (VF) progression.

Design

Prospective, longitudinal study.

Participants

A total of 440 eyes from 236 glaucoma patients; 98 eyes from 49 healthy individuals.

Methods

OCT RNFL/GCIPL/RNFL-GCIPL thickness and VF measurements were obtained at ∼4-month intervals for ≥3 years. Progressive changes of the RNFL/GCIPL/RNFL-GCIPL thicknesses were analyzed over a wide field (12×9 mm²) covering the parapapillary region and the macula with trend-based progression analysis (TPA) controlled at a false discovery rate of 5%. VF progression was determined by the Early Manifest Glaucoma Trial criteria.

Main Outcome Measures

Proportions of eyes with progressive RNFL/GCIPL/RNFL-GCIPL thinning; hazard ratios (HRs) for development of VF progression.

Results

More eyes showed progressive RNFL-GCIPL thinning (127 eyes; 28.9%, 95% confidence interval [CI]: 23.9%–33.8%) than progressive RNFL thinning (74 eyes; 16.8%, 95% CI: 13.1%–20.6%) and progressive GCIPL thinning (26 eyes; 5.9%, 95% CI: 3.7%–8.1%) in the glaucoma group over the study follow-up. Progressive RNFL-GCIPL thinning was almost always detected before or simultaneously with progressive RNFL thinning or progressive GCIPL thinning. The specificity of TPA (estimated from the healthy group) for detection of progressive RNFL-GCIPL thinning, progressive RNFL thinning, and progressive GCIPL thinning was 83.7% (95% CI: 74.9%–92.4%), 94.9% (95% CI: 90.6%–99.2%), and 96.9% (95% CI: 93.5%–100.0%), respectively. Eyes with progressive RNFL-GCIPL thinning had a higher risk to develop possible (HR: 2.4, 95% CI: 1.2–5.0) or likely (HR: 4.6, 95% CI: 1.5–14.0) VF progression, with adjustment of covariates, compared with eyes without progressive RNFL-GCIPL thinning.

Conclusions

Progression analysis of RNFL-GCIPL thickness reveals a significant portion of progressing eyes that neither progression analysis of RNFL thickness nor GCIPL thickness would identify. Wide-field progression analysis of RNFL-GCIPL thickness is effective to inform the risk of VF progression in glaucoma patients.

中文翻译：

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结合视网膜神经纤维层和神经节细胞内柱状膜厚度的基于广域趋势的进展分析：一种改进青光眼进展检测的新范例。

目的

用OCT评估青光眼的进展集中在分析乳头旁区域上渐进性视网膜神经纤维层（RNFL）和/或黄斑上渐进性神经节细胞内丛状层（GCIPL）的分析。我们研究了（1）是否将RNFL和GCIPL组合为一个单层（即RNFL-GCIPL）用于广域进行分析，胜过RNFL或GCIPL的广域进行分析，以及（2）是否患有进行性RNFL的眼睛-GCIPL变薄存在视野（VF）进展的风险。

设计

前瞻性，纵向研究。

参加者

236名青光眼患者共440眼；来自49位健康个体的98眼。

方法

OCT RNFL / GCIPL / RNFL-GCIPL厚度和VF测量值以大约4个月的间隔（≥3年）获得。RNFL / GCIPL / RNFL-GCIPL厚度的渐进变化在覆盖乳头旁区域和黄斑的宽视野（12×9 mm ²）上进行分析，基于趋势的进展分析（TPA）控制在5％的错误发现率下。VF进展由早期青光眼试验标准确定。

主要观察指标

进行性RNFL / GCIPL / RNFL-GCIPL变薄的眼睛比例；室颤进展发展的危险比（HRs）。

结果

RNFL-GCIPL逐渐变薄的眼数（127眼； 28.9％，95％置信区间[CI]：23.9％–33.8％）比RNFL逐渐变薄的眼球（74眼； 16.8％，95％CI：13.1％–20.6％）在研究随访中，青光眼组进展性GCIPL变薄（26眼； 5.9％，95％CI：3.7％–8.1％）。进行性RNFL-GCIPL变薄几乎总是在进行性RNFL变薄或进行性GCIPL变薄之前或同时检测到。TPA（从健康组估计）检测进行性RNFL-GCIPL稀疏，进行性RNFL稀疏和进行性GCIPL稀疏的特异性分别为83.7％（95％CI：74.9％–92.4％），94.9％（95％CI： 90.6％–99.2％）和96.9％（95％CI：93.5％–100.0％）。进行性RNFL-GCIPL变薄的眼睛有更高的风险发展为可能（HR：2.4，95％CI：1.2–5.0）或可能（HR：4.6，95％CI：1.5-14）。

结论

RNFL-GCIPL厚度的进阶分析显示了进行中的眼睛的很大一部分，而RNFL厚度和GCIPL厚度的进阶分析都无法识别。RNFL-GCIPL厚度的广域进展分析可有效告知青光眼患者VF进展的风险。