중심부 시야결손을 보이는 초기 녹내장 환자의 진단에서 자동시야계 C10-2의 유용성
The Effectiveness of Visual Field C10-2 in the Early Detection of Glaucoma with Parafoveal Scotoma
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목적: 중심부 시야결손을 보이는 초기녹내장 환자를 진단하는 데 가장 효과적인 시야검사에 대한 방향성을 제시하고자 한다. 대상과 방법: 중심부 시야결손을 가진 초기 녹내장 환자의 총 57안을 대상으로 Humphrey 자동시야계 C24-2, C10-2, 주파수배가시야검사(frequency doubling technology perimetry, FDT) C24-2를 시행하여 이를 황반부의 신경절세포내망상층(the ganglion cell– inner plexiform layer, GC-IPL)의 평균두께와 구조기능적으로 비교분석하였다. 결과: Central sensitivity는 자동시야계 C24-2, 자동시야계 C10-2, FDT C24-2 순으로 각각 27.51 ± 5.43 dB, 27.39 ± 5.05 dB, 22.09 ± 5.08 dB 순이었으며, 평균 GC-IPL thickness는 70.2 ± 8.5 μm였다. 각각의 시야검사의 central sensitivity와 optical coherence tomography에서의 평균 GC-IPL의 두께를 평가한 회귀분석에서는 자동시야계 C10-2만이 유의한 p-value를 보였으며(p<0.05), logarithmic scale에서는 logR2 값이 0.498, antilogarithmic scale에서는 linear R2값이 0.486을 보이며, FDT C24-2와 자동시야계 C24-2에 비해 높은 값을 보였다. 초기 녹내장에서 이러한 관계가 더욱 뚜렷하였다. 결론: 중심부 시야결손을 보이는 초기 녹내장 환자에서 GC-IPL thickness와 중심부 시야 감도 사이의 구조-기능 관계는 Humphrey C10-2 자동시야계가 다른 시야 검사법에 비해 더 잘 반영하였다.
Abstract
Purpose: To identify the correspondence between the central sensitivity of several visual field (VF) tests and ganglion cell inner plexiform layer (GC-IPL) thickness in early glaucoma patients with parafoveal scotoma. Methods: Fifty-seven eyes from 57 patients with glaucomatous optic neuropathy and parafoveal scotoma were analyzed using the standard automated perimetry (SAP) C10-2 test, the SAP C24-2 test, and the frequency doubling technology perimetry (FDT) C24-2 test. The correlation between the VF central sensitivity and the GC-IPL thickness from macular scans via optical coherence tomography was analyzed. Results: The central sensitivity was 27.51 ± 5.43 dB, 27.39 ± 5.05 dB, and 22.09 ± 5.08 dB for SAP C24-2, SAP C10-2, and FDT C24-2, respectively. Mean GC-IPL thickness was 70.2 ± 8.5 μm. Using regression analysis, the value of log R2 between the logarithmic central sensitivity and GC-IPL thickness was 0.498, and the linear R2 between the antilogarithmic central sensitivity and GC-IPL thickness in SAP C10-2 was 0.486, and both were statistically significant (p < 0.05). This relationship was stronger in early glaucoma patients compared to late glaucoma patients using SAP C10-2. Conclusions: The structure-function relationship between GC-IPL thickness and central sensitivity was better with SAP C10-2, especially in early glaucoma patients, compared to other VF modalities.
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