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Stereometrische Parameter der Papillentopographie

Vergleich einer simultan-stereoskopischen Non-Mydriasis-Funduskamera (KOWA WX 3D) mit dem Heidelberg Retina Tomograph (HRT III)

Stereometric parameters of the optic disc

Comparison between a simultaneous non-mydriatic stereoscopic fundus camera (KOWA WX 3D) and the Heidelberg scanning laser ophthalmoscope (HRT IIII)

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Zusammenfassung

Hintergrund

In der Verlaufsbeurteilung des präperimetrischen Glaukoms ist die konfokale Laserophthalmoskopie (Heidelberg Retina Tomograph, HRT III) das etablierte morphometrische Standardverfahren. Kameras mit topographischer Dokumentation stellen eine Alternative dar (Kowa nonmyd WX 3D). Ziel dieser retrospektiven Studie war es, die unterschiedlichen Erfassungsmethoden miteinander zu vergleichen.

Material und Methoden

Es wurden 45 Normalaugen, 40 Augen mit Makropapillen und 45 Augen von Patienten mit Glaukom eingeschlossen, bei denen eine HRT-III-Untersuchung und ein Fundusfoto mit der Kowa nonmyd WX 3D am selben Tag erfolgten. Für die statistische Auswertung zur Vergleichbarkeit wurde der Bland-Altman-Plot verwendet (Signifikanzniveau 0,05).

Ergebnisse

Der mittlere Unterschied der Papillenfläche betrug bei den Normalaugen 0,33 mm2, bei der Cup-Disc-Ratio (CDR) waren es 0,02, beim Exkavationsvolumen 0,03 mm3, beim Randsaumvolumen 0,04 mm3 und bei der maximalen Exkavationstiefe 0,28 mm. Alle Unterschiede bis auf das Randsaumvolumen waren statistisch signifikant. Bei Makropapillen wurde ein mittlerer Unterschied der Fläche von 0,03 mm, der CDR von 0,09, des Exkavationsvolumen von 0,14 mm3, des Randsaumvolumens von 0,02 mm3 und der maximalen Exkavationstiefe von 0,28 mm gemessen. Papillenfläche und Randsaumvolumen unterschieden sich nicht signifikant. Bei Glaukomaugen zeigte sich ein mittlerer Unterschied der Papillenfläche von 0,33 mm2, der CDR von 0,09, des Exkavationsvolumens von –0,03 mm3, des Randsaumvolumens von 0,08 mm3 und der maximalen Exkavationstiefe von 0,25 mm. Der mittlere Unterschied der Papillenfläche, des Randsaumvolumens und der CDR waren signifikant. Die mittleren Differenzen der jeweiligen Messungen lagen nicht über der in der Literatur angegebenen Intra- und Interobservervariabilität.

Schlussfolgerung

Trotz teilweise statistisch signifikanter Unterschiede lag die Streuung zwischen den beiden Methoden unter der in der Literatur angegebenen Intra- und Interobservervariabilität. Beide Messmethoden erscheinen vergleichbar.

Abstract

Background

The Heidelberg retina tomograph (HRTIII, Heidelberg Engineering, Germany) in conjunction with the Moorfields regression analysis (MRA) allows monitoring for the progression of early damage to the optic nerve suspicious of early stage glaucoma. The confocal scanning laser ophthalmoscope provides clinicians with an objective and reproducible analysis of morphological parameters of the optic disc. Margins of the optic disc are approximated with a contour line to calculate the stereometric parameters leading to interobserver and intraobserver variability of the MRA. New devices enabling 3D fundus photography might be an alternative to the established HRT. It was the goal of this study to compare the methods by assessing the differences in the topographic parameters obtained by the HRT and the Kowa nonmyd WX 3D (2D/3D non-mydriatic retinal camera, Kowa, Japan) in a representative sample.

Methods

This retrospective study included 45 eyes of normal patients, 40 eyes of patients with macropapillae and 45 eyes of glaucoma patients. Each patient underwent an HRT examination and fundus photography with the Kowa nonmyd WX 3D on the same day. Excluded from the study were eyes with hazy media (cornea, lens, vitreous) or refractive anomalies higher than >4 dpt or astigmatisms >2 dpt. Eyes with previous refractive surgery history or other retinal diseases affecting the optic nerve were also excluded from the study. Bland-Altman plots were used for statistical evaluation. Distribution of parameters was described by 95% confidence intervals (CI).

Results

In normal eyes (n=45) a mean difference in the disc area of 0.33 mm2 was found (95 % confidence interval CI: 0.22–0.43), in the cup-disc ratio (CDR) of 0.02 (95% CI: -0.06–0.14), in the cup volume of 0.03 mm3 (95% CI: -0.04–0.01), in the rim volume of 0.04 mm3 (95%-CI: -0.04–0.13) and in the maximum cup depth of 0.28 mm (95 %-CI: 0.34–0.23). All differences, except for the rim volume, were statistically significant (p<0.05). Patients exhibiting a macropapilla (n=40) displayed a mean difference of 0.03 mm2 (95 % CI: -0.18–0.11) for the disc area, a difference in CDR of 0.09 (95% CI: -0.05–0.13), a difference in maximum cup depth of 0.28 mm (95% CI: 0.23–0.34) and a cup volume of 0.14 mm3 (95%-CI: 0.10–0.18). In addition, there were no significant differences in rim volume (difference: -0.02 mm3, 95% CI: -0.07–0.12) or in disc area. In glaucomatous eyes (n=45), the mean difference for cup area was 0.33 mm2 (95% CI: 0.22–0.43), an area of 0.09 mm2 (95% CI: 0.06–0.13) for the CDR, -0.03 mm3 (95 % CI: -0.09–0.02) for the cup volume and 0.08 mm3 (95% CI: 0.03–0.13) for the rim volume. Mean maximum cup depth difference was 0.25 mm (95% CI: 0.20–0.31). Mean differences in CDR, maximum cup depth and cup area were all statistically significant. The mean differences did not exceed the interobserver and intraobserver variability found in HRT measurements of other studies.

Conclusions

To the best of our knowledge this study is the first comparing optic disc parameters of HRT and 3D photography. Mean differences in stereometric parameters did not exceed the known interobserver and intraobserver variability. The combination of non-mydriatic fundus photography and optic disc analysis is a very attractive and time-saving method. However, before progression of early glaucoma can be monitored or suspected glaucoma can be appraised over longer time periods, further studies are needed to clarify test and retest variability.

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Danksagung

Wir danken Frau Hofer und dem Team der Fotoabteilung für die nette Zusammenarbeit.

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Authors and Affiliations

  1. Department für Augenheilkunde, Eberhard-Karls Universität Tübingen, Schleichstr. 12, 72076, Tübingen, Deutschland

    K. Januschowski, C.E. Rayford II, K.-U. Bartz-Schmidt, U. Schiefer & F. Ziemssen

  2. Institut für Medizinische Biometrie, Eberhard-Karls Universität Tübingen, Tübingen, Deutschland

    G. Blumenstock

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  1. K. Januschowski
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  2. G. Blumenstock
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  4. K.-U. Bartz-Schmidt
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  6. F. Ziemssen
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Correspondence to K. Januschowski.

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Januschowski, K., Blumenstock, G., Rayford II, C. et al. Stereometrische Parameter der Papillentopographie. Ophthalmologe 108, 957–962 (2011). https://doi.org/10.1007/s00347-011-2416-8

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