ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2015-1-46-56ophthalmology-224Research ArticleКЛИНИЧЕСКИЕ И ЭКСПЕРИМЕНТАЛЬНЫЕ ИССЛЕДОВАНИЯCLINICAL & EXPERIMENTAL RESEARCHОптическая когерентная томография и её роль в диагностике глазной гипертензии, препериметрической и периметрической глаукомыOptical coherence tomography and its role in the diagnosis of ocular hypertension, preperimetric and perimetric glaucomaАнгеловБ.AngelovB.botio.ang@abv.bgПетроваК.PetrovaK.Кафедра офтальмологии Медицинского университета, УМБАЛ «Александровская», ул. Святого Георгия Софийского, д. 1, София, 1434, БолгарияБолгарияDepartment of Ophthalmology, Medical University, «Alexandrovska» Hospital, Sofia, Bulgaria, 1, St. Georgiy Sofiyskiy Str. Sofia, Bulgaria, 1434Bulgaria2015310320151214656Copyright © Ангелов Б., Петрова К., 20152015Ангелов Б., Петрова К.Angelov B., Petrova K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ophthalmojournal.com/opht/article/view/224Цель

Цель. Оценить диагностические возможности и информативность параметров карт GCC и RNFL, анализируемых посредством оптической когерентной томографии (ОКТ), и их дифференциально-диагностический потенциал у лиц с офтальмогипертензией, пациентов с препериметрической глаукомой и периметрически верифицированной начальной, развитой и далеко зашедшей глаукомой. 

Материалы и методы

Материалы и методы. Проанализированы данные обследований 353 глаз. Пациенты были разделены на 6 групп: офтальмогипертензия (32 глаза), препериметрическая глаукома (46 глаз), начальная глаукома (104 глаза), развитая глаукома (54 глаза), далеко зашедшая глаукома (60 глаз) и клинически здоровые глаза (57 глаз). Во всех случаях проводилось стандартное офтальмологическое обследование, автоматизированная периметрия и ОКТ. Анализировались параметры Avg. GCC, Inf. GCC, Sup. GCC, GLV, FLV и Avg., Sup. и Inf. RNFL (карта ONH). Для каждого параметра определялись чувствительность, специфичность, положительный (PLR) и отрицательный коэффициенты вероятности (NLR) и выстраивалиcь графики ROC. 

Результаты

Результаты. Чувствительность и специфичность изучаемых параметров в группе офтальмогипертензии превышает 66% (для FLV и GLV > 98%), а в группе препериметрической глаукомы составляет более 82% (для GLV, Avg. GCC, Avg. RNFL и Sup. RNFL > 91). При начальной глаукоме максимальной чувствительностью и специфичностью характеризуется Inf. GCC (91%), а при развитой глаукоме — Avg. GCC (98%). При далеко зашедшей глаукоме чувствительность и специфичность большинства параметров достигают 100%. В случае офтальмогипертензии максимальный диагностический потенциал характерен для GLV (0,795) и Inf. GCC (0,790), а в случае препериметрической глаукомы — для GLV (0,981). При начальной и развитой глаукоме наилучшими диагностическими возможностями обладает GLV (0,971 и 0,999, соответственно), а при далеко зашедшей глаукоме — Avg. RNFL и Inf. RNFL (1,0). 

Заключение

Заключение. При препериметрической и верифицированной глаукоме все параметры карт GCC и RNFL имеют высокие чувствительность и специфичность и высокий диагностический потенциал (более 0,90). При офтальмогипертензии диагностический потенциал показателей меньше (порядка 0,66). Диагностические возможности параметров карт GCC и RNFL сопоставимы и высоки вне зависимости от степени глаукомного повреждения. ОКТ позволяет выявлять ранние структурные изменения у лиц с офтальмогипертензией и препериметрической глаукомой. По мере прогрессирования глаукомных изменений диагностический потенциал анализируемых параметров увеличивается. 

Aim

Aim. To study diagnostic capabilities of OCT parameters (ganglion cell complex/GCC and retinal nerve fiber layer/RNFL) and their ability to discriminate between normal and ocular hypertension (OH), preperimetric glaucoma (PPG), and early, moderate, and advanced perimetric glaucoma (PG) eyes. 

Material and methods

Material and methods. 353 eyes enrolled in the study were divided into six groups: OH (32 eyes), PPG (46 eyes), early PG (104 eyes), moderate PG (54 eyes), advanced PG (60 eyes), and healthy individuals (57 eyes). Complete eye examination including standard automated perimetry and OCT was performed. Avg. GCC, Inf. GCC, Sup. GCC, GLV, FLV, and Avg., Sup. and Inf. RNFL (ONH map) were measured. ROC curves were constructed. Sensitivity and specificity of each parameter, positive (PLR) and negative likelihood ratio (NLR) were analyzed. 

Results

Results. In OH group, sensitivity and specificity of all parameters were above 66% (> 98% for FLV and GLV). In PPG group, sensitivity and specificity were above 82% (>91% for GLV, Avg. GCC Avg. RNFL and Sup. RNFL). In OH group, GLV and Inf. GCC were the most accurate diagnostic parameters (0.795 and 0.790, respectively). In PPG group, GLV was the most accurate diagnostic parameter (0.981). In early PG group, maximum sensitivity and specificity were found for Inf. GCC (91%). In moderate PG group, maximum sensitivity and specificity were found for the Avg. GCC (98%). In early and moderate PG groups, GLV was the most accurate diagnostic parameter (0.971 and 0.999, respectively). In advanced PG group, sensitivity and specificity of all parameters were about 100%. In advanced PG groups, Avg. RNFL and Inf. RNFL were the most accurate diagnostic parameters (1.0). 

Conclusions

Conclusions. In PPG and PG groups, high sensitivity and specificity of GCC map and RNFL map parameters as well as their very high diagnostic accuracy (more than 0.90) was demonstrated. In OH group, the diagnostic accuracy of these parameters was lower (0.66). GCC map and RNFL map parameters are characterized by high and comparable diagnostic abilities irrespective of glaucoma damage severity. ОСТ is a valuable diagnostic method of early glaucomatous changes detection in OH and PPG. Diagnostic capabilities of the parameters improve as disease severity increases. 

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The authors declare that there are no conflicts of interest present.