Moorfields回归分析及多变量区别分析诊断开角型青光眼

Diagnosis of open-angle glaucoma by Moorfields regression analysis and multivariate discriminate analysis

目的研究Moorfields回归分析(MRA)及多变量区别分析(MDA)的2个指标FSM和RB诊断开角型青光眼的能力,及MRA在视盘整体和视盘分区间的差异。方法对23例正常人(26眼)、26例可疑开角型青光眼患者(32眼)和21例开角型青光眼患者(21眼)进行HRT-Ⅱ和OCTOPUS视野计G2-TOP程序两项检查。结果视盘整体MRA、FSM、RB与视野缺损指数间相关系数分别为0.537、-0.565、-0.716(P<0.01),且3个组间差异均有统计学意义(P<0.01),随着视盘面积增大,MRA、FSM和RB特异性均下降。可疑组中视盘分区MRA与视野检查一致率均高于整体,一致率最高分区为颞下(78.13%)。各分区中MRA敏感性、特异性最高的分区为颞上和颞下。结论MRA和MDA检测开角型青光眼能力较强,且与视野检查间存在较好的相关性,但应用于大视盘分析时须谨慎下结论。

Objective Morphological analysis of the optic disk is important in the diagnosis of open-angle glaucoma. This study was to evaluate the diagnosis value of Moorfields regression analysis （MRA） and multivariate discriminate analysis （MDA, include FSM and RB） performed by the Heidelberg Retina Tomograph Ⅱ（HRT-Ⅱ ） in detecting open-angle glaucomatous eyes and evaluate the difference of MRA between entire disk and sectional disk. Methods Seventy-five patients （79 eyes） were enrolled in the study,including 26 normal eyes,32 suspected primary open-angle glaucoma （POAG） and 21 definite POAG. All patients underwent the examinations of HRT-Ⅱ and OCTOPUS perimeter G2-TOP program. Results The statistically significant correlations between MRA, FSM, RB and visual fields defect （MD） were seen（ P 〈 0.01 ） with the Spearman correlation coefficient 0. 537, - 0. 565 and -0. 716, respectively. Significant differences were found in MRA, FSM and RB among three groups （χ62 = 53. 229, P 〈0. 001 ; F = 90. 279, P 〈 0. 001 ; F = 57. 769, P 〈 0. 001 ; respectively ）. Based on the outcome of visual fields examination,the sensitivity and specificity of the MRA, FSM and RB was 92% and 88.89% （MRA ＂ borderline＂ considered as normal） , 100% and 62.96% （ MRA ＂ borderline＂ considered as abnormal） ,96% and 68.52% , 76% and 92. 59% ,respectively. As increase of optic disk area, the specificities of three methods decreased. MRA and perimetry showed a better agreement in sectional disk than in the entire one for the suspect patients, and temporal-inferior sector was found to have the best agreement （78. 13% ）. Temporal-superior and temporal-inferior sectors exhibited the highest sensitivity and specificity in MRAs of sectional disk. Conclusion MRA and MDA had considerable capability in detecting POAG and correlated moderately with MD,but it should be cautious in interpreting the results of patients with larger disk. In clinical setting, MRA seems to be more valuable in sectional disk than in the entire ,especially in temporal-superior and temporal-inferior sectors.