새로운 시신경 테 너비의 규칙을 이용한 정상안과 녹내장안의 구별
Discriminating Between Normal and Glaucomatous Eyes Using the Modified ISNT Rule
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목적: 정상안과 녹내장안을 대상으로 기존의 시신경 테 너비에 관한 규칙(ISNT rule, 시신경 테 너비가 하측＞상측＞비측＞이측)과 비교하여 새로운 ISNT rule (하측과 상측 시신경 테 너비 중 작은 것＞비측과 이측 시신경 테 너비 중 큰 것)의 진단적 유용성에 대해알아보고자 하였다. 대상과 방법: 113명 113안의 정상인과 108명 108안의 초기, 중기 녹내장 환자들을 대상으로 하여 입체 시신경사진을 촬영하였다. 입체시신경사진을 통해 유두함몰 경계를 정한 후 3, 6, 9, 12시 방향의 시신경 테의 너비를 측정하였다. 그 결과를 이용하여 기존의 ISNTrule과 새로운 ISNT rule의 정상안과 녹내장안 진단 정확도를 비교하였다. 결과: 113안의 정상안 중 기존의 ISNT rule로 정상 판정된 경우는 58안(51.3%)이며 새로운 ISNT rule로 정상 판정된 경우는 98안(94.2%)이며 108안의 녹내장안 중 기존의 ISNT rule로 녹내장 판정된 경우는 104안(96.3%), 새로운 ISNT rule로 녹내장 판정된 경우는102안(94.4%)이었다. Cohen’s Kappa analysis를 통해 두 진단법의 정확도를 비교해본 결과 새로운 ISNT rule이 기존의 ISNT rule보다유의하게 높았다(k=0.8102, 0.4713, p＜0.001). 결론: 기존의 ISNT rule에 비해 새로운 ISNT rule은 정상안 및 녹내장안의 진단에 유용하며 임상에서도 손쉽게 사용할 수 있는 방법이다.
Abstract
Purpose: To evaluate the diagnostic ability of the modified ISNT rule (disc rim thickness of the smaller of inferior and superior> the larger of nasal and temporal) for normal and glaucomatous eyes compared to the classic ISNT rule (disc rimthickness of inferior > superior > nasal > temporal). Methods: Color stereo optic disc photographs of 113 normal subjects and 108 open angle glaucoma patients with earlyand moderate stage were morphometrically evaluated. The classic ISNT rule and the modified ISNT rule were assessedby masked evaluation of disc photographs at the 3, 6, 9 and 12 o’clock positions. Results: Among normal subjects, 58 of 113 eyes (51.3%) were normal and in open angle glaucoma patients, 104 of 108eyes (96.3%) were abnormal with the classic ISNT rule. Among normal subjects, 98 of 113 eyes (94.2%) were normal andin open angle glaucoma patients, 102 of 108 eyes (94.4%) were abnormal with the modified ISNT rule. The modified ISNTrule was more accurate than the classic ISNT rule in terms of Cohen’s Kappa analysis used for discriminating between normaland glaucomatous eyes. Conclusions: The modified ISNT rule is useful for differentiating between normal and glaucomatous optic nerves and easilyapplied in clinical practice.
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