Morfometrijska analiza glave vidnog živca kod pacijenata sa glaukomom otvorenog ugla
Introduction: Stereoscopic examination of the fundus of the eye reveals the exit of retinal ganglion cell axons, which we call the optic nerve head. Glaucoma belongs to a heterogeneous group of diseases which leads to progressive loss of retinal ganglion cells and damage to their axons, resulting in glaucoma optic neuropathy with corresponding loss of visual field and morphometric changes of the optic nerve head, such as a thinning of the neuroretinal rim. Aims: The aims of the research were to determine whether the optic nerve head morphology analysis parameters differ among the groups of respondents with different degrees of glaucoma, to determine whether there is a difference in the morphometry of spatial distribution parameters and retinal vascular branching among the groups of respondents and to determine whether quantitative analysis allows classification into appropriate glaucoma progression groups. Material and methods: The research included 67 patients diagnosed with primary open-angle glaucoma. The patients were divided into three groups, based on the degree of glaucoma. Group 1 consisted of the patients with mild glaucoma, Group 2 consisted of the patients with moderate glaucoma, and Group 3 consisted of the patients with severe glaucoma. After the visualization and digitization of the optic nerve head and retinal blood vessels, the images were processed using the software program ImageJ 1.48v, and then the fractal analysis and statistical processing of the obtained results were performed. Morphometry included the analysis of neuroretinal rim by calculating the binary fractal dimensions of the surface, skeletonized images of contours, surface and length. Morphometric analysis of retinal blood vessels included the determination of the fractal dimension, circularity, the diameter of the central retinal artery and vein branches, the branching angle of the central retinal artery and the angle of connection of the central retinal vein branches, the circularity of arterial and venous retinal blood vessels. Results: The patients from the Group 1 have the highest value of the binary fractal dimension of the neuroretinal rim without arterial and venous retinal blood vessels, the patients from the Group 2 have a lower value, while the patients from the Group 3 have the lowest value. The patients from the Group 1 have the lowest dimension of the skeletonized image of the neuroretinal rim contours without arterial and venous retinal blood vessels, the patients from the Group 2 have a higher value, while the patients from the Group 3 have the highest value. The patients from the Group 1 have the largest neuroretinal rim area; the patients from the Group 2 have a lower value, while the patients from the Group 3 have the lowest value. The patients from the Group 1 have the lowest value of the binary fractal dimension of the central retinal vein; the patients from the Group 2 have somewhat higher value, while the patients from the Group 3 have the highest value. The highest value of the branching angle of the central retinal artery was found among the patients from the Group 1, the patients from the Group 2 have a lower branching angle value, while the patients from the Group 3 have the lowest branching angle value. Conclusions: Progression of the primary open-angle glaucoma leads to a decrease in the value of the binary fractal dimension of the neuroretinal rim, an increase in the value of the skeletonized image of the neuroretinal rim contour and a decrease in the value of the neuroretinal rim area. Binary fractal dimension of the central retinal vein and its branches increases with the progression of the primary open-angle glaucoma, while the branching angle of the central retinal artery decreases with the progression of the glaucoma. Quantitative analysis allows classification into appropriate progression groups of glaucoma.
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