브루크막 개방 기반 시신경유두 지표들을 이용한 시신경테 너비 규칙의 적용성
Applicability of ISNT Rule Using Bruch's Membrane Opening-based Optic Nerve Head Parameters
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목적: 정상안과 녹내장안을 구별하기 위해 브루크막 개방(Bruch’s membrane opening, BMO) 기반 시신경유두 지표들을 이용한 ISNT 규칙의 적용성을 알아보고자 한다. 대상과 방법: 정상안 41안과 개방각녹내장 62안의 의무기록을 후향적으로 분석하였다. 시신경 사진에서 측정한 시신경테두께, Bruch’s membrane opening-minimum rim width (BMO-MRW), BMO-MRW average, Bruch’s membrane opening-minimum rim area (BMO-MRA)의 4가지 지표에서 시신경의 상측, 하측, 비측, 이측에 해당하는 값을 분석하였다. 정상안과 녹내장안에서 각각의 지표를 이용한 ISNT 규칙의 부합 여부를 조사하고 민감도와 특이도를 비교하였다. 결과: 정상안과 녹내장안에서 각각 시신경 사진에서 측정한 시신경테두께, BMO-MRW, BMO-MRW average를 비교하였을 때 상측, 하측, 이측, 비측 모두 시신경 사진에서 측정한 시신경테두께가 가장 컸다(p<0.001). 네 가지 지표를 이용한 ISNT 규칙의 부합 여부를 비교한 결과 민감도는 시신경 사진보다 BMO-MRW average와 BMO-MRA가 유의하게 높았다(각각 82.3% vs. 98.4%, p<0.05; 82.3% vs. 95.2%, p<0.05). 특이도는 4가지 지표 사이에 유의한 차이가 없었다. 결론: 기존의 시신경 사진을 이용한 ISNT 규칙에 비해 BMO 기반 시신경유두 지표들을 이용한 ISNT 규칙은 정상안과 녹내장안 감별에 더 높은 진단력을 보였다.
Abstract
Purpose: To evaluate the applicability of the ISNT rule (neuroretinal rim thickness order: inferior > superior > nasal > temporal) when using Bruch's membrane opening-based optic nerve head parameters to discriminate between normal and glaucomatous eyes. Methods: The medical records of 41 normal eyes and 62 open-angle glaucoma eyes were reviewed retrospectively. We analyzed the neuroretinal rim thickness values corresponding to the superior, inferior, nasal, and temporal sides of the optic disc as measured using color stereo optic-disc photographs, Bruch’s membrane opening-minimum rim width (BMO-MRW), the BMO-MRW average, and Bruch’s membrane opening-minimum rim area (BMO-MRA). The sensitivity and specificity of the ISNT rule in differentiating normal and glaucomatous eyes were compared across the four methods. Results: In normal and glaucomatous eyes, measuring neuroretinal rim thickness in color stereo optic-disc photographs produced larger values for the superior, inferior, nasal, and temporal sides compared to measurements using BMO-MRW and the BMO-MRW average (p < 0.001). With respect to ISNT rule compliance using the four methods, the sensitivities of the BMO-MRW average and BMO-MRA methods were significantly higher than that when disc photographs were used (82.3% vs. 98.4%, p < 0.05; and 82.3% vs. 95.2%, p < 0.05, respectively). Specificity did not differ significantly among the four methods. Conclusion: BMO-based optic nerve head parameters exhibited higher diagnostic power for differentiating between normal and glaucomatous eyes based on the ISNT rule, compared with the classic method of using disc photographs.
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