정상안압녹내장에서 서로 다른 빛간섭단층촬영기를 이용한 망막신경섬유층의 측정 비교 = Comparison of RNFL Thickness Measured by Two Different Kind of OCT in NTG Patients

다국어 초록 (Multilingual Abstract)

Purpose: To compare retinal nerve fiber layer (RNFL) thicknesses with two types of OCT in patients with normal tension glaucoma
(NTG) and early NTG.
Methods: We evaluated the RNFL thicknesses of 101 eyes in 101 patients using Fourier domain OCT and time domain OCT. We
compared the measured RNFL thicknesses according to the subject groups and the type of OCT. We calculated the area under
the receiver operating characteristic curve (AUROC) to determine the best parameters with which to make a diagnosis of NTG or
early NTG.
Results: The RNFL thicknesses measured by 3D OCT were greater than that measured by Stratus OCT for all of the groups. The
RNFL thickness in each group was statistically significantly different in the superior quadrant, the inferior quadrant, and the 1 and
2 o’clock positions when using 3D OCT. It was statistically significantly different in the superior, temporal, and inferior quadrant, as
well as the 1, 7, 8, 9, 10 and 11 o’clock positions when using Stratus OCT. The largest AUROC was found for the inferior quadrant
thickness (0.773) using Stratus OCT and the 1 o’clock thickness (0.712) using 3D OCT when comparing normal patients and those with
suspected NTG. The largest AUROC was found for the inferior quadrant thickness (0.888) using Stratus OCT and the superior quadrant
thickness (0.802) using 3D OCT when comparing normal patients and those with early NTG. The AUROC was greater in the temporal
and inferior quadrants and in the 6, 7, 8, 9 and 10 o’clock thicknesses using Stratus OCT compared to the 3D OCT in differentiating
patients with suspected NTG from normal patients. The AUROC found using 3D OCT compared to the Stratus OCT was greater only
in the 1 o’clock thickness (p<0.05). The AUROC differentiating patients with early NTG from normal patients was greater in the temporal,
inferior, nasal quadrant, and in the 5, 6, 7, 8, 9, 10 and 11 o’clock positions using the Stratus OCT compared to the 3D OCT (p<0.05).
Conclusions: The RNFL thicknesses measured using 3D OCT were generally greater than those measured using Stratus OCT.
The largest AUROCs for differentiating patients with suspected NTG and early NTG from normal patients were in the 1 o’clock position
and the superior quadrant RNFL thickness using 3D OCT and the inferior quadrant RNFL thickness using Stratus OCT. The AUROCs
using the 3D OCT parameters were less than those from the Stratus OCT when comparing normal patients and those with suspected
or early NTG.

국문 초록 (Abstract)

목적: 서로 다른 빛간섭단층촬영기로 정상안과 정상안압녹내장 의증안, 초기 정상안압녹내장안의 망막신경섬유층의 두께를 측정하여
측정치를 비교해 보고자 하였다.
대상과 방법: 총 101명 101안을 푸리에도메인과 타임도메인 빛간섭단층촬영기를 이용하여 망막신경섬유층의 두께를 촬영하였다. 대상군
및 기기에 따라 두께에 차이가 있는지 알아보고, AUROC (Area under ROC curve)를 구하여 정상안압녹내장 의증안과 초기 정상안압
녹내장안을 정상안으로부터 구분하는데 유용한 지표를 알아보았다.
결과: 모든 군에서 3D OCT의 측정치가 Stratus OCT로 측정한 경우보다 전반적으로 두껍게 측정되었다. 3D OCT는 상사분원, 하사분원,
1, 2시 부위, Stratus OCT는 상, 하, 이측사분원 및 1, 7, 8, 9, 10, 11시 부위에서 세 군간 망막신경섬유층의 평균 두께에 차이가 있었다.
정상으로부터 정상안압녹내장 의증안을 구분하는 가장 넓은 AUROC를 보이는 지표는 Stratus OCT의 하사분원 두께(AUROC 0.773), 3D
OCT의 1시 두께(0.712)였고, 초기 정상안압녹내장안에서는 Stratus OCT의 하사분원 두께(0.888)와 3D OCT의 상사분원 두께(0.802)였다.
두 기기간의 AUROC를 비교하면, 정상안압녹내장 의증안을 정상으로부터 구분하는데 Stratus OCT의 이측사분원, 하사분원, 6, 7, 8, 9,
10시 부위가 3D OCT 보다 넓었으며, 3D OCT의 AUROC가 넓었던 경우는 1시 부위뿐이었다(p<0.05). 초기 정상안압녹내장안을 정상으로
부터 구분하는 AUROC는 Stratus OCT의 이측, 하측, 비측사분원 및 5, 6, 7, 8, 9, 10, 11시 부위에서 3D OCT 보다 넓었다(p<0.05).
결론: 3D OCT의 측정치는 Stratus OCT 보다 두껍게 측정되는 경향이 있었다. 정상안으로부터 정상안압녹내장 의증안과 초기 정상안압
녹내장안을 구분하는데 가장 넓은 AUROC를 보이는 지표는 3D OCT에서는 1시 두께와 상사분원 두께, Stratus OCT에서는 두 가지 모두
하사분원 두께로 나타났다. 각 지표를 비교해 보았을 때, 3D OCT 지표의 AUROC는 Stratus OCT의 지표에 비해 낮았다.

참고문헌 (Reference)

1 강성민, "한국인 정상치를 이용한 Stratus 광간섭단층촬영기의 초기 정상안압녹내장 진단 능력" 대한안과학회 49 (49): 798-810, 2008

2 송유미, "광간섭단층촬영기를 이용한 정상안과 초기 녹내장안의 구별" 대한안과학회 48 (48): 1675-1685, 2007

3 Choplin NT, "The effect of excimer laser photorefractivekeratectomy for myopia on nerve fiber layer thickness measurements as determined by scanning laser polarimetry" 106 : 1019-1023, 1999

4 Quigley HA, "Retinal ganglion cell atrophy correlated with automated perimetry in human eyes with glaucoma" 107 : 453-464, 1989

5 Schuman JS, "Reproducibility of nerve fiber layer thickness measurements using optical coherence tomography" 103 : 1889-1898, 1996

6 Menke MN, "Reproducibility of nerve fiber layer thickness measurements using 3D fourier-domain OCT" 49 : 5386-5391, 2008

7 Harwerth RS, "Neural losses correlated with visual losses in clinical perimetry" 45 : 3152-3160, 2004

8 Colen TP, "Motion artifacts in scanning laser polarimetry" 109 : 1568-1572, 2002

9 Gupta P, "Morphological changes in the retinal pigment epithelium on spectral-domain OCT in the unaffected eyes with idiopathic central serous chorioretinopathy" 2009

10 Kremmer S, "Influence of cataract surgery with implantation of different intraocular lenses on scanning laser tomography and polarimetry" 136 : 1016-1021, 2003

11 Nouri-Mahdavi K, "Identifying early glaucoma with optical coherence tomography" 137 : 228-235, 2004

12 Menke MN, "Features of age-related macular degeneration assessed with three-dimensional Fourier-domain optical coherence tomography" 92 : 1492-1497, 2008

13 Kanamori A, "Evaluation of the glaucomatous damage on retinal nerve fiber layer thickness measured by optical coherence tomography" 135 : 513-520, 2003

14 Hong SM, "Early glaucoma detection using the Humphery matrix perimeter, GDx VCC, Stratus OCT, and retinal nerve fiber layer photography" 114 : 210-215, 2007

15 Odberg T, "Early diagnosis of glaucoma: the value of successive stereophotography of the optic disc" 63 : 257-263, 1985

16 Parikh RS, "Diagnostic capability of optical coherence tomography (Stratus OCT 3) in early glaucoma" 114 : 2238-2243, 2007

17 Takahashi H, "Diabetes-associated retinal nerve fiber damage evaluated with scanning laser polarimetry" 142 : 88-94, 2006

18 Bowd C, "Detecting early glaucoma by assessment of retinal nerve fiber layer thickness and visual fuction" 42 : 1993-2003, 2001

19 Melo GB, "Comparison of optic disk and retinal nerve fiber layer thickness in nonglaucomatous and glaucomatous patients with high myopia" 142 : 858-860, 2006

20 Leung CK, "Comparison of macular thickness measurements between time domain and spectral domain optical coherence tomography" 49 : 4893-4897, 2008

21 DeLong ER, "Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach" 44 : 837-845, 1988

22 Quigley HA, "Chronic human glaucoma causing selectively greater loss of larger optic nerve fibers" 95 : 357-363, 1988

23 Hood DC, "Blood vessel contributions to retinal nerve fiber layer thickness profiles measured with optical coherence tomography" 17 : 519-528, 2008

24 Kim TW, "Ability of Stratus OCT to identify localized retinal nerve fiber layer defects in patients with normal standard automated perimetry results" 48 : 1635-1641, 2007