녹내장과 비동맥염 앞허혈시신경병증의 진단에서 망막신경섬유층유두비의 유용성
Retinal Nerve Fiber Layer-to-Disc Ratio Distinguishing Glaucoma from Nonarteritic Anterior Ischemic Optic Neuropathy
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목적: 개방각녹내장과 비동맥염 앞허혈시신경병증의 감별진단에서 망막신경섬유층 두께, 브루크막 개방 최소 시신경유두테 폭, 브루크막 개방 최소 시신경유두테 넓이, 망막신경섬유층유두비의 진단력을 비교하였다. 대상과 방법: 시신경유두 크기와 평균 망막신경섬유층 두께를 일치시킨 개방각녹내장과 비동맥염 앞허혈시신경병증 각 23안과 시신경유두 크기를 일치시킨 정상안 23안을 후향적으로 분석하였다. 망막신경섬유층 두께, 브루크막 개방 최소 시신경유두테 폭, 브루크막 개방 최소 시신경유두테 넓이, 망막신경섬유층유두비를 분석하였으며 area under receiver operating characteristic curve (AUC)로 진단력을 비교하였다. 결과: 평균 브루크막 개방 최소 시신경유두테 폭과 총 브루크막 개방 최소 시신경유두테 넓이는 개방각녹내장군이 다른 두 군에 비해 유의하게 작았다(모두 p<0.001). 망막신경섬유층유두비는 개방각녹내장군, 정상안군, 비동맥염 앞허혈시신경병증군 순으로 큰 값을 가졌다(p<0.001). 개방각녹내장과 비동맥염 앞허혈시신경병증을 감별하기 위한 AUC는 하이측 브루크막 개방 최소 시신경유두테 폭이 0.987, 총 브루크막 개방 최소 시신경유두테 넓이가 0.996, 망막신경섬유층 유두비가 1.000으로 하이측 망막신경섬유층 두께의 0.811에 비해 유의하게 컸다(각 p=0.005, p=0.006, p=0.006). 결론: 망막신경섬유층유두비는 개방각녹내장과 비동맥염 앞허혈시신경병증의 진단에서 기존 지표들과 함께 유용하게 이용될 수 있다.
Abstract
Purpose: To evaluate the diagnostic value of retinal nerve fiber layer-to-disc ratio (RDR) compared to established parameters including retinal nerve fiber layer thickness (RNFLT), Bruch membrane opening-minimum rim width (BMO-MRW), and Bruch membrane opening-minimum rim area (BMO-MRA) for differentiating between open angle glaucoma (OAG) and nonarteritic anterior ischemic optic neuropathy (NAION). Methods: This retrospective study included 23 optic disc size-matched normal control eyes and 23 OAG and NAION eyes matched according to global RNFLT. The RDR, RNFLT, BMO-MRW, and BMO-MRA were analyzed; the diagnostic capabilities of these parameters were compared using the area under the receiver operating characteristic curve (AUC). Results: The global BMO-MRW and total BMO-MRA were lower in the OAG group than in the other two groups (all p < 0.001). RDR was greatest in the OAG group, followed by the healthy and NAION groups (p < 0.001). Between the OAG and NAION groups, the AUCs for temporal inferior BMO-MRW, total BMO-MRA, and RDR were 0.987, 0.996, and 1.000, respectively; these were greater than the temporal inferior RNFLT (0.811; p = 0.005, p = 0.006, and p = 0.006, respectively). Conclusions: RDR could be one of the useful parameters for differential diagnosis in OAG and NAION.
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