고도근시녹내장에서 안축장으로 보정한 빛간섭단층촬영 Significance Map의 유용성
Effects of Axial Lengths in High Myopia on the Significance Maps of Optical Coherence Tomography
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목적: 고도근시안의 황반부 및 시신경유두주변 significance map을 안축장으로 보정하여 지도의 각 망막영역별로 녹내장 진단 정확도의 변화를 분석하고 임상적 유용성에 대해 고찰하고자 한다. 대상과 방법: 고도근시를 동반한 정상안 42안과 정상안압녹내장 28안을 대상으로 후향적 분석하였다. Mirante spectral domain-optical coherence tomography를 이용하여 significance map을 얻었으며, 내장된 소프트웨어를 통해 안축장으로 보정하였다. 보정 전후로지도의 각 망막 영역별 민감도 및 특이도를 지도의 최소 한 영역에서 빨간색으로 표시되는 경우를 정상의 1% 수준에서 비정상, 노란색으로 표시되는 경우를 정상의 5% 수준에서의 비정상으로 정의하여 비교하였다. 결과: 정상치의 1% 수준에서는 유의한 변화가 없었다. 5% 수준에서는 황반부 GChart의 안쪽동심원의 하이측 영역은 61.9%에서78.6%로(p=0.016), 바깥쪽동심원의 하이측 영역은 69%에서 83.3%로의 증가(p=0.031)를 보였다. 시신경유두 주변의 whole chart, superior/inferior chart는 상측에서 각각 54.8%에서 78.6% (p=0.002), 59.5%에서 76.2% (p=0.039)로의 특이도의 증가, 12-clockwise map에서는 59.5%에서 76.2% (p=0.002)로의 특이도의 유의한 증가를 보였다. 결론: 안축장을 보정한 significance map의 참고가 위양성률을 줄이는 데 기여할 수 있으며, 고도근시안 환자의 녹내장 진료에 있어서도움을 줄 수 있을 것으로 생각된다.
Abstract
Purpose: We corrected the axial lengths of the macular and peripapillary significance maps using software embedded in a commercial spectral domain optical coherence tomography (SD-OCT) package. We evaluated the accuracy of glaucoma diagnosis in patients with high myopia, and the clinical implications. Methods: Seventy eyes of 70 highly myopic patients with or without normal-tension glaucoma were retrospectively reviewed. The sensitivities and specificities of the color-coded significance maps were calculated using 1% (red) or 5% (yellow) as the abnormality criteria, and the values compared before and after axial length corrections performed using embedded SD-OCT software. Results: At the 1% level of the normative database, we found no significant difference in specificity or sensitivity. At the 5% level, the increase in specificity was significant only for the inferotemporal sectors of the macular significance map. The specificity of the inferotemporal sector of the inner scan circle increased from 61.9 to 78.6% (p = 0.016) and that of the outer scan circle from 69 to 83.8% (p = 0.031). The specificities of the entire chart, the superior sector of the superior/inferior chart, and the 12-clockwise map increased significantly from 54.8 to 78.6% (p = 0.002), 59.5 to 76.2% (p = 0.039), and 59.5 to 76.2% (p = 0.002) respectively. Conclusions: Clinicians should note that axial length correction of significance maps reduces the false-positive glaucoma diagnostic rates in highly myopic eyes. Correction of significance maps using embedded software may thus aid clinicians in the diagnosis of glaucoma in high myopic eyes.
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