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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2022.tde-28042022-122202
Document
Author
Full name
Lucas Antonio de Almeida Torres
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2021
Supervisor
Committee
Hatanaka, Marcelo (President)
Barboza, Wilma Lelis
Suzuki, Ricardo
Zacharias, Leandro Cabral
Title in Portuguese
Impacto do ajuste da medida da rima neurorretiniana dada pelo tomógrafo de coerência óptica no diagnóstico de glaucoma
Keywords in Portuguese
Cabeça do nervo óptico
Glaucoma
Glaucoma/diagnóstico
Minimum Rim Width
Nervo óptico
Parâmetros neurorretinianos
Tomografia de coerência óptica
Abstract in Portuguese
Introdução: Foi demonstrado recentemente que as medidas de espessura da rima neurorretiniana através do parâmetro minimum rim width (MRW) da tomografia de coerência óptica (TCO) inclui componentes como a extensão da camada de fibras nervosas da retina (CFNR) e das camadas retinianas externas. Objetivo: Determinar se a subtração dos componentes de retina externa, denominados camadas retinianas protrusas (CRPs), das medidas de MRW está associada à melhora da capacidade diagnóstica de glaucoma pela TCO. Métodos: Estudo transversal com 123 pacientes diagnosticados com glaucoma de ângulo aberto e 123 controles normais, com idade semelhante, dos quais foram obtidas imagens de TCO da cabeça do nervo óptico (24 varreduras) na região peripapilar (varredura circular). Quando presentes, as CRPs foram segmentadas manualmente e as medidas de MRW ajustada (MRWa, gerada pela subtração da espessura das CRPs do total da medida de MRW) foram calculadas. Foi comparada a capacidade diagnóstica dos parâmetros MRW e MRWa e foi determinado se o parâmetro MRWa se correlaciona melhor com o parâmetro de espessura da CFNRp em comparação com a correlação de MRW com o parâmetro de espessura da CFNRp. Resultados: Nas 5.904 varreduras obtidas com TCO, as CRPs foram identificadas com menos frequência em pacientes com glaucoma (448, 7,6%) em comparação com os controles (728, 12,3%; P <0,01), e estavam presentes com mais frequência no setor temporal de ambos os grupos. Áreas sob as curvas ROC e valores de sensibilidade à uma especificidade de 95% indicaram que o ajuste de MRW para as CRPs não melhorou a capacidade diagnóstica de MRW, global ou setorialmente. Além disso, a geração do parâmetro MRWa através do ajuste de MRW para as CRPs não melhorou a correlação com o parâmetro de espessura da CFNRp em nenhum dos grupos. Conclusão: Embora camadas retinianas externas, às vezes, estejam incluídas nas medições de MRW com TCO, a subtração dessas camadas não melhora a utilidade clínica de MRW
Title in English
Adjustment impact of the minimum rim width measurement provided by the optical coherence tomography for glaucoma diagnosis
Keywords in English
Glaucoma
Glaucoma/diagnosis
Minimum Rim Width
Neuroretinal parameters
Optic nerve
Optic nerve head
Optical coherence tomography
Abstract in English
Introduction: Recent studies have demonstrated that measurements of the neuroretinal rim thickness with the minimum rim width (MRW) parameter of the optical coherence tomography (OCT) may include components such as the extension of the retinal nerve fiber layers (RNFLs) and of the outer retinal layers. Objective: Determine whether the subtraction of the outer retinal components, the protruded retinal layers (PRLs), from the MRW measurement given by OCT is associated with an improvement in the diagnostic capability of this parameter. Methods: A transversal study with 123 open-angle glaucoma patients and 123 similar-age control patients, whose images of the optic nerve head (ONH) (24 scans) in the peripapillary region (circular scan) were acquired with OCT. When present, the PRLs were manually segmented and the measurements of the adjusted MRW (MRWa, determined by the subtraction of PRLs thickness from total MRW) were obtained. The diagnostic capability of MRW and MRWa parameters was compared, and it was determined whether the MRWa parameter would correlate better with the peripapillary RNFL (pRNFL) than MRW correlates. Results: In the 5,904 individual B-scans acquired with OCT, PRLs were less frequently identified in glaucomatous patients (448, 7.6%) when compared to controls (728, 12.3%; P <0.01), and were more frequently found in the temporal sector of both groups. Areas under the receiver operating characteristic (ROC) curve and sensitivity value at 95% specificity indicated that the subtraction of PRL did not improve the diagnostic capacity of MRW, either totally or sectorally. Additionally, the MRW adjustment for PRL did not improve its correlation with the pRNFL thickness in either group. Conclusion: Although the outer retinal layers were sometimes included in the MRW measurement with OCT, the subtraction of these layers did not improve the MRW clinical use
 
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Publishing Date
2022-04-28
 
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