PURPOSE To evaluate the potential of the temporal raphe sign on the macular ganglion cell-inner plexiform layer (mGCIPL) thickness map for discriminating glaucomatous from nonglaucomatous optic neuropathy (NGON) in eyes with mGCIPL thinning. DESIGN Cross-sectional study. PARTICIPANTS A total of 175 eyes of 175 patients with mGCIPL thinning on Cirrus (Carl Zeiss Meditec, Dublin, CA) high-definition OCT were retrospectively included. Glaucoma specialists and neuro-ophthalmology specialists evaluated the patients' medical records for diagnosis of glaucomatous optic neuropathy (GON) or NGON. Finally, by consensus, 67 eyes with GON and 73 eyes with NGON were enrolled. METHODS A positive temporal raphe sign was declared in patients in whom there was a straight line longer than one-half of the length between the inner and outer annulus in the temporal elliptical area of the mGCIPL thickness map. Decision tree analysis was performed to formulate a diagnostic model. MAIN OUTCOME MEASURES Area under receiver operating characteristic curve (AUC) with sensitivity and specificity. RESULTS The temporal raphe sign was observed in 61 of 67 GON eyes (91.0%), but in only 21 of 73 NGON eyes (28.8%) (P < 0.001; chi-square test). On this basis, the diagnostic ability of the temporal raphe sign for discriminating GON from NGON was judged to be good (AUC, 0.811; 95% confidence interval, 0.749-0.874; sensitivity, 91.0%; specificity, 71.2%). The diagnostic performance of the decision tree-based model (AUC 0.879; 95% confidence interval, 0.824-0.933; sensitivity, 88.1%; specificity, 87.7%) was better than that of the temporal raphe sign or the relative afferent pupillary defect (RAPD) alone (P = 0.005, P < 0.001, respectively; DeLong's test). The decision tree model revealed the following: (1) If the temporal raphe sign is positive and the RAPD is absent, the case should be diagnosed as GON; (2) if the temporal raphe sign is absent regardless of the presence or absence of the RAPD, or both the temporal raphe sign and the RAPD are present, the case should be diagnosed as NGON. CONCLUSIONS In clinical practice, determining whether the temporal raphe sign appears on OCT macular scans can be a useful tool for discrimination of glaucomatous from nonglaucomatous mGCIPL thinning.

中文翻译：

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时间性拉菲征从视神经病变中鉴别出青光眼与黄斑神经节细胞内柱状细胞层变薄的眼睛。

目的评估黄斑神经节细胞内丛状层（mGCIPL）厚度图上颞腺征兆的潜力，以鉴别mGCIPL变薄眼中的青光眼与非青光眼性视神经病变（NGON）。设计横断面研究。研究对象回顾性分析了175例在Cirrus（Carl Zeiss Meditec，都柏林，加利福尼亚州）高清OCT上发生mGCIPL变薄的患者中的175眼。青光眼专家和神经眼科专家评估了患者的病历，以诊断青光眼性视神经病变（GON）或NGON。最后，通过协商一致，纳入了67眼GON眼和73眼NGON眼。方法在mGCIPL厚度图的时间椭圆形区域中，内圆环和外圆环之间的直线长度比长度的二分之一长的患者，应宣布为阳性颞颞沟征兆。进行决策树分析以制定诊断模型。主要观察指标接收机工作特性曲线（AUC）下的区域，具有灵敏度和特异性。结果67眼GON眼中有61眼（91.0％）出现颞缝征象，但73眼NGON眼中只有21眼（28.8％）观察到颞缝征象（P <0.001；卡方检验）。在此基础上，判断时域点状符号对GON和NGON的诊断能力良好（AUC，0.811； 95％置信区间，0.749-0.874；敏感性，91.0％；特异性，71.2％）。基于决策树模型的诊断性能（AUC 0.879; 95％置信区间0.824-0.933；灵敏度为88.1％；特异性为87.7％）优于单纯的颞缝征兆或相对传入瞳孔缺损（RAPD）（分别为P = 0.005，P <0.001； DeLong检验）。决策树模型揭示了以下内容：（1）如果时间网点符号为正且没有RAPD，则应将该病例诊断为GON；（2）如果无论是否存在RAPD都不存在颞缝征，或者同时存在颞缝征和RAPD，则应将病例诊断为NGON。结论在临床实践中，确定OCT黄斑扫描中是否出现颞缝征兆可作为区分青光眼和非青光眼mGCIPL变薄的有用工具。7％的患者）优于单纯的颞缝征兆或相对传入瞳孔缺损（RAPD）（分别为P = 0.005，P <0.001； DeLong检验）。决策树模型揭示了以下内容：（1）如果时间网点符号为正且RAPD不存在，则应将该病例诊断为GON；（2）如果无论是否存在RAPD都不存在颞缝征，或者同时存在颞缝征和RAPD，则应将病例诊断为NGON。结论在临床实践中，确定OCT黄斑扫描中是否出现颞缝征兆可作为区分青光眼和非青光眼mGCIPL变薄的有用工具。7％的患者）优于单纯的颞缝征兆或相对传入瞳孔缺损（RAPD）（分别为P = 0.005，P <0.001； DeLong检验）。决策树模型揭示了以下内容：（1）如果时间网点符号为正且RAPD不存在，则应将该病例诊断为GON；（2）如果无论是否存在RAPD都不存在颞缝征，或者同时存在颞缝征和RAPD，则应将病例诊断为NGON。结论在临床实践中，确定OCT黄斑扫描中是否出现颞缝征兆可作为区分青光眼和非青光眼mGCIPL变薄的有用工具。决策树模型揭示了以下内容：（1）如果时间网点符号为正且RAPD不存在，则应将该病例诊断为GON；（2）如果无论是否存在RAPD都不存在颞缝征，或者同时存在颞缝征和RAPD，则应将病例诊断为NGON。结论在临床实践中，确定OCT黄斑扫描中是否出现颞缝征兆可作为区分青光眼和非青光眼mGCIPL变薄的有用工具。决策树模型揭示了以下内容：（1）如果时间网点符号为正且RAPD不存在，则应将该病例诊断为GON；（2）如果无论是否存在RAPD都不存在颞缝征，或者同时存在颞缝征和RAPD，则应将病例诊断为NGON。结论在临床实践中，确定OCT黄斑扫描中是否出现颞缝征兆可作为区分青光眼和非青光眼mGCIPL变薄的有用工具。该病例应被诊断为NGON。结论在临床实践中，确定OCT黄斑扫描中是否出现颞缝征兆可作为区分青光眼和非青光眼mGCIPL变薄的有用工具。该病例应被诊断为NGON。结论在临床实践中，确定OCT黄斑扫描中是否出现颞缝征兆可作为区分青光眼和非青光眼mGCIPL变薄的有用工具。