원발개방각녹내장 환자에서 브루크막 개방 최소 시신경 유두테 폭과 망막신경섬유층 두께의 진단력 비교
Diagnostic Accuracies of Bruch Membrane Opening-minimum Rim Width and Retinal Nerve Fiber Layer Thickness in Glaucoma
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목적: 원발개방각녹내장 환자에서 브루크막 개방 최소 시신경 유두테 폭(Bruch membrane opening-minimum rim width, BMOMRW)과 망막신경섬유층(retinal nerve fiber layer, RNFL) 두께 간의 진단력을 비교하고자 하였다. 대상과 방법: 스펙트럼영역 빛간섭단층촬영(Spectral Domain Optical Coherence Tomography, SD-OCT)인 Spectralis OCTⓇ (Heidelberg Engineering, Heidelberg, Germany)를 사용하여 브루크막 개방(Bruch membrane opening, BMO)을 중심으로 24방향의 방사형, 1개의 유두 주위 B-scan을 시행하였다. BMO와 내경계막(internal limiting membrane, ILM) 사이의 최소거리와 RNFL 두께에 대하여 전체 평균 및 구역별 평균을 구하였다. 전체 평균 및 구역별 평균 BMO-MRW와 RNFL 두께의 녹내장 진단능력 비교는 area under the receiver operating characteristic curve (AUC)로 분석하였다. 결과: 114안(정상 52안, 녹내장 62안)이 연구에 포함되었다. 전체 평균 BMO-MRW의 진단력은 RNFL 두께의 진단력과 통계적으로 유의한 차이는 없었다(AUC 0.95 [95% confidence interval {CI}, 0.91-0.99], 0.95 [95% CI, 0.91-0.99], p=0.93). 구역별 평균은 상이측, 상비측, 비측 구역에서 BMO-MRW가 RNFL 두께보다 더 높은 녹내장 진단력을 보였고(p=0.033, p<0.001, p=0.032), 나머지 구간에서는 통계학적으로 유의한 차이가 없었다. 가장 큰 AUC를 갖는 것은 BMO-MRW와 RNFL 두께 모두에서 하이측 영역이었다(AUC 0.98 [95% CI, 0.96-1.00], 0.98 [95% CI, 0.96-1.00], p=0.99). 결론: 한국인 원발개방각녹내장 환자에서 전체 평균 BMO-MRW는 전체 평균 RNFL 두께와 유사한 녹내장 진단능력을 나타내었다. 상이측, 상비측과 비측 영역에서 BMO-MRW는 RNFL 두께보다 더 우수한 녹내장 진단력을 보였다.
Abstract
Purpose: To compare the diagnostic capability of Bruch membrane opening-minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness for the detection of primary open angle glaucoma. Methods: Spectral-domain optical coherence tomography (SD-OCT) with 24 radial and 1 peripapillary B-scans centered on the Bruch membrane opening (BMO) was performed. Two SD-OCT parameters were computed globally and sectorally: (1) BMOMRW, the minimum distance between BMO and internal limiting membrane; and (2) peripapillary retinal nerve fiber layer (RNFL) thickness. The diagnostic performance of BMO-MRW and RNFL thickness were compared with receiver operating characteristic (ROC) analysis globally and sectorally. Areas under the ROC (AUC) were calculated and compared. Results: One hundred fourteen eyes (52 healthy, 62 glaucomatous) of 114 participants were included. In global analyses, the performance of BMO-MRW was similar to that of RNFL thickness (AUC 0.95 [95% confidence interval {CI}, 0.91-0.99], and 0.95 [95% CI, 0.91-0.99], respectively, p=0.93). In sectoral analyses, the pair-wise comparison among the ROC curves showed no statistical difference for all sectors except for the superotemporal, superonasal, and nasal sectors, which had significantly larger AUCs in BMO-MRW compared to RNFL thickness (p=0.03, p<0.001, and p=0.03, respectively). The parameter with the largest AUC was the inferotemporal sector for both BMO-MRW and RNFL thickness (AUC 0.98 [95% CI, 0.96-1.00], and 0.98 [95% CI, 0.96-1.00], respectively, p=0.99). Conclusions: Global BMO-MRW performed as well as global RNFL thickness for detection of glaucoma. In superotemporal, superonasal and nasal sectors, regional BMO-MRW performed better than regional RNFL thickness.
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