녹내장에서 망막신경섬유층구역에 상응하는 시야지역 지도
Visual Field Cluster Map Corresponding to Retinal Nerve Fiber Layer Sectors in Glaucoma
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초록
목적: 국소적 망막신경섬유층결손이 있는 환자에서 빛간섭단층촬영으로 구한 망막신경섬유층구역에 상응하는 시야지역의 지도를 만 들고자 하였다. 대상과 방법: 국소적 망막신경섬유층결손이 있는 시야결손전녹내장 24명과 시야결손녹내장 173명에서 자동시야검사와 빛간섭단층촬 영을 하였다. 요인분석으로 시야 상반부와 하반부에서 관련된 시야점의 평균 역치들을 묶어 시야지역을 만들었다. 12개의 망막신경섬 유층구역과 관련된 시야지역의 지도는 망막신경섬유층구역과 시야지역간의 강한 상관관계를 기초로 만들었다. 결과: 요인분석으로 시야점들을 묶어 시야 상반부, 하반부 각각 5개 시야지역으로 나누었다. 상반부와 하반부의 시야지역들의 분포는 약간 비대칭이었다. 선형회귀분석 결과 상측 활모양, 비측계단 시야지역은 하측 망막신경섬유층구역 6시, 7시와 상관관계가 높았다 (r=0.51-0.59). 시야결손(pattern deviation, p＜5%)의 빈도수와 망막신경섬유층두께 비정상(p＜5%)의 빈도수는 지형적으로 관련이 있었다. 결론: 새로 만든 시야지도는 구조와 기능이 지형적으로 유의한 관계가 있음을 나타내었으며, 특히 활모양, 비측계단 시야지역에서 강했다.
Abstract
Purpose: To generate a map relating visual field (VF) test points to corresponding areas of the retinal nerve fiber layer (RNFL) measured with optical coherence tomography (OCT) in patients with localized RNFL defects. Methods: Twenty-four patients with preperimetric glaucoma and 173 patients with perimetric glaucoma, all with localized RNFL defects, underwent standard automated perimetry (SAP) and OCT measurements. To define zones of related point, factor analysis of the mean thresholds for the SAP test points was performed, independently for each hemifield. A map relating the VF zones to the 12 OCT sectors was plotted based on the strongest correlations between both techniques. Results: Factor analysis divided the VF points into five VF zones for each hemifield. Distribution of the VF zones for the superior and inferior hemifields was slightly asymmetric. Linear regression results showed that superior VF zones corresponding to the superior arcuate and nasal step regions were best correlated with 6- and 7-o’clock RNFL sectors (inferior and inferior temporal) of thickness (r = 0.51-0.59). RNFL thinning (defined by abnormal sector at p < 5%) and regional decreases in SAP sensitivity (defined by abnormal pattern deviation at p < 5%) were topographically related. Conclusions: A newly developed VF cluster map revealed significant topographical structure-function relationships, especially in the arcuate and nasal step region of the VF.
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