정상안압녹내장에서 시간에 따른 망막신경섬유층 두께변화와 시야변화의 비교분석
Comparison Between Retinal Nerve Fiber Layer Change and Visual Field Change in Normal Tension Glaucoma
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 정상안압녹내장안에서 광간섭단층촬영과 시야검사를 시행하여 망막신경섬유층의 두께변화와 시야변화를 비교분석하여 녹내장 의 진행에 관하여 알아보고자 하였다. 대상과 방법: 정상안압녹내장환자 30안과 정상인 30안에 대하여 초진 시와 23.3 ± 15.3개월 후 망막신경섬유층 두께와 시야민감도를 측정하였다. 측정된 망막신경섬유층을 12개의 방향으로, 시야를 21개의 구역으로 나누어 두 군간의 차이와 시간에 따른 변화를 분석하 였고 망막신경섬유층두께 감소속도도 비교하였다. 결과: 시간에 따른 망막신경섬유층의 두께변화는 정상군에서는 유의하지 않았으나 정상안압녹내장군에서는 4, 5, 6, 7, 11, 12시 방향이 감소된 소견을 보였다(p＜0.05). 시간에 따른 시야검사의 mean deviation의 변화는 정상군, 정상안압녹내장군 모두 의미있는 소견을 보이지 않았다. 결론: 정상안압녹내장군에서 시간에 따른 망막신경섬유층 두께감소가 위쪽과 아래쪽에서 두드러지게 나타났지만 시야검사에서는 유 의한 변화를 보이지 않았다. 따라서 시야변화보다 망막신경섬유층 두께감소가 선행하는 정상안압녹내장의 진행과정을 초기에 파악하 는 데 광간섭단층촬영이 유용할 것으로 생각된다.
Abstract
Purpose: To evaluate longitudinal changes in retinal nerve fiber layer thickness (RNFL) and visual field in patients with normal tension glaucoma (NTG). Methods: Thirty eyes of 30 NTG patients and 30 eyes of 30 normal control subjects were enrolled in the present study. RNFL thickness was measured using optical coherence tomography (OCT), and visual field tests were performed using a Humphrey visual field analyzer at baseline and 23.3 ± 15.3 months later. Changes in RNFL thickness at each clock-hour segment and visual field sensitivities were analyzed. The rates of change in RNFL thickness were also calculated. Results: Significant differences in RNFL thickness were observed between NTG patients and normal control subjects at the 5, 6, 7 and 12 o’clock positions at baseline (p < 0.001). At follow-up, the RNFL thickness change was not significant for normal control subjects, although it was significant for NTG patients at the 4, 5, 6, 7, 11 and 12 o\'clock positions (p < 0.001). Visual field parameters did not change significantly in the normal control subjects or NTG patients. The reduction rates of RNFL thickness were 0.38 μm/month for the NTG patients and 0.11 μm/month for the normal control group, displaying a 3.5-fold faster reduction rate for NTG patients. Conclusions: The NTG group showed greater reductions in RNFL thickness in the upper and lower sectors over time; however, the visual field parameters did not change significantly. The results suggest that progression of glaucoma can be detected in an earlier stage using OCT than can be detected using a visual field test.
참고문헌 (29)
- Levene RZ, "Low tension glaucoma: a critical review and new material", Surv Ophthalmol, 24, pp.621~664 (1980)
- Quigley HA, "Clinical evaluation of nerve fiber layer atrophy as an indicator of glaucomatous optic nerve damage", Arch Ophthalmol, 98, pp.1564~1571 (1980)
- Gupta N, "New definition of glaucoma", Curr Opinion in Ophthalmol, 8, pp.38~41 (1997)
- Salmon JF, "Predisposing factors for chronic angle-closure glaucoma", Prog Retin Eye Res, 18, pp.121~132 (2000)
- Quigley HA, "Retinal ganglion cell atrophy correlated with automated perimetry in human eyes with glaucoma", Am J Ophthalmol, 107, pp.453~464 (1989)
- Sommer A, "Clinically detectable nerve fiber atrophy precedes the onset of glaucomatous field loss", Arch Ophthalmol, 109, pp.77~83 (1991)
- Sommer A, "The nerve fiber layer in the diagnosis of glaucoma", Arch Ophthalmol, 95, pp.2149~2156 (1977)
- Niessen AG, "Retinal nerve fiber layer assessment by laser polarimetry and standardized photography", Am J Ophthalmol, 48, pp.484~493 (1996)
- Tuulonen A, "Screening for glaucoma with a non-mydriatic fundus camera", Arch Ophthalmol, 68, pp.445~449 (1990)
- Quigley HA, "An evaluation of optic disc and nerve fiber layer examinations in monitoring progression of early glaucoma damage", Ophthalmology, 99, pp.19~28 (1992)
- Weinreb RN, "Association between quantitative nerve fiber layer measurement and visual field loss in glaucoma", Am J Ophthalmol, 120, pp.732~738 (1995)
- Poinoosawmy D, "Longitudinal nerve fiber layer thickness change in normal-pressure glaucoma", Graefe’s Arch Clin Exp Ophthalmol, 238, pp.965~969 (2000)
- Tjon-Fo-Sang MJ, "Retinal nerve fiber layer measurements in normal black subjects as determined with scanning laser polarimetry", Ophthalmology, 105, pp.78~81 (1998)
- Chi T, "Racial differences in optic nerve head parameters", Arch Ophthalmol, 107, pp.836~839 (1989)
- Poinoosawmy D, "Variation of nerve fiber layer thickness measurements with age and ethnicity by scanning laser polarimetry", Br J Ophthalmol, 81, pp.350~354 (1997)
- Weber J, "A perimetric nerve fiber bundle map", Int Ophthalmol, 15, pp.193~200 (1991)
- Johnson CA, "The relationship between structural and fucntional alterations in glaucoma: a review", Semin Ophthalmol, 15, pp.221~223 (2000)
- Tjon-Fo-Sang MJ, "Measurement by nerve fiber layer analyzer of retinal nerve fiber layer thickness in normal subjects and patients with ocular hypertension", Am J Ophthalmol, 122, pp.220~227 (1996)
- Lee WH, "Retinal nerve fiber layer measurement by nerve fiber analyzer in normal subjects and patients with glaucoma", Ophthalmology, 105, pp.1006~1008 (1999)
- Choplin NT, "Differentiating patients with glaucoma from glaucoma suspects and normal subjects by nerve fiber layer assessment with scanning laser polarimetry", Ophthalmology, 105, pp.2068~2076 (1998)
- Tuulonen A, "Polarimetry of the retinal nerve fiber layer", Curr Opin Ophthalmol, 7, pp.34~38 (1996)
- Lee WH, "Nerve fiber layer measurement of the Hong Kong Chinese population by scanning laser polarimetry", Eye, 14, pp.371~374 (2000)
- Radius RL, "Regional specificity in anatomy at the lamina cribrosa", Arch Ophthalmol, 99, pp.478~480 (1981)
- Quigley HA, "Regional differences in the structure of the lamina cribrosa and their relation to glaucomatous optic nerve damage", Arch Ophthalmol, 99, pp.137~143 (1981)
- Leung CK, "Evaluation of retinal nerve fiber layer progression in glaucoma: a study on optical coherence tomography guided progression analysis", Invest Ophthalmol Vis Sci, 51, pp.217~222 (2010)
- Lee EJ, "Ability of Stratus OCT to detect progressive retinal nerve fiber layer atrophy in glaucoma", Invest Ophthalmol Vis Sci, 50, pp.662~668 (2009)
- Jonas J, "Correlation between mean visual field loss and morphometric optic disc variables in the open angle glaucoma", Am J Ophthalmol, 124, pp.488~497 (1997)
- 이희정, "개방각녹내장 환자에서 경과 관찰한 시신경섬유층의 정량분석", 대한안과학회지, 43(9), pp.1656~1663 (2002), 대한안과학회
- Wollstein G, "Optical coherence tomography longitudinal evaluation of retinal nerve fiber layer thickness in glaucoma", Arch Ophthalmol, 123, pp.464~470 (2005)