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First Author: N.Barua INDIA
Co Author(s): C. Sitaraman S. Goel A. Mathur
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Ganglion cell complex (GCC) combination of the retinal nerve fiber layer (NFL) , the ganglion cell layer (GCL) and the inner-plexiform layer (IPL) are densely located in posterior pole is the target for initial cell death in glaucoma. Thinning increases as disease progesses. OCT a reliable, reproducible preperimetric tool helps in diagnosing disease earlier than detectable visual field loss. The study aimed at analysis the structural changes in glaucoma patients and their correlation with functional changes . We further aimed at documenting the predictive value of each of the OCT parameters in perimetric versus normal and preperimetric versus normal
ANAND HOSPITAL AND EYE CENTRE, JAIPUR. Single centric institutional study. Cross sectional study. Patients were selected from outpatient department of hospital and glaucoma clinic.
60 patients (total 357 eyes) were enrolled in each group after consent. Patients have undergone applation tonometry, pachymetry by OCT (RT-Optovue), gonioscopy, visual field analysis (HFA-2) and OCT (RT-optovue) were done . In OCT 5 parameters of macular GCC : average, superior, inferior, Focal and Global loss of volume and 3 parameters of retinal nerve fiber layer : average, superior, inferior were recorded. Data analysed with SPSS, ANOVA, T test, pearsons correlation. Patients were divided into 5 groups: POAG/normal, POAG/OHT, OHT/normal, EARLY POAG/normal, early POAG/OHT. ROC was calculated for each parameter in each subgroup. The early POAG group were included to detect which parameter was more diagnostic early cases (MD< 6dB).
The average GCC in POAG polutation were Avg GCC 78.19+12.21, sup 80.16+12.01, inf GCC 77.36+ 13.64 ?, FLV 5.77+ 5.28, GLV 17.89+ 11.76, RNFL avg 83.24+17.86 , RNFL sup 87.32+18.32, inf 86.68+ 2.12. There is strong negative correlation between all parameters except FLV and GLV are positively correlated. In POAG/OHT group AUC were .820 for GCC average, .776 for GCC superior, .825 for GCC inferior, .669 for FLV, .743 for GLV, .744 for RNFL average, .671 for RNFL superior, .738 for RNFL inferior. Highest AUC were inferior GCC but the difference were not statistically significant. In POAG/OHT population also inferior GCC had highest AUC (.825). In OHT/normal population none of the parameters were statistically significant. In early POAG/OHT and Early POAG/normal population only Inferior GCC had statistically significant AUC value (.715) . Rest all parameters didnt have statistically significant AUC
Structural and functional parameters showed strong correlation with each other. As the disease progresses all parameters becomes thin except FLV and GLV which are indicators of disease burden. GCC and RNFL showed equal predictive capability to differentiate POAG from normal, Inferior GCC having highest predictive value. GCC and RNFL showed equal predictive capability, Inferior GCC had highest area under curve. Inferior GCC was the best parameter to differentiate early glaucoma (MD<-6dB) from normal and glaucoma from OHT population/ preperimetric population