Kitazawa Y
Department of Ophthalmology, Gifu University School of Medicine.
Nippon Ganka Gakkai Zasshi. 2001 Dec;105(12):828-42.
Both primary open-angle and normal-tension glaucoma belong to an identical spectrum of diseases. Clinical presentations of primary open-angle or high-tension glaucoma (POAG) and normal-tension glaucoma (NTG) were studied in an attempt to determine prognostic, clinical factors and define the appropriate management. Clinical data obtained from 826 primary open-angle and normal-tension glaucoma patients were analyzed. In addition, the results of laboratory studies, including the immunological assay of heat shock protein (hsp) and gene analyses which were undertaken to identify risk factors at the molecular level, are discussed. 1. The identified prognostic factors were disk hemorrhage, peripapillary chorioretinal atrophy (PPA), maximum intraocular pressure (IOP), the recovery rate of skin temperature after exposure to cold, family history of glaucoma, systemic systolic channel blood pressure, and oral administration of Ca(2+)-channel antagonists. 2. Disk hemorrhage was observed in 30.5% of NTG patients and 15.4% of POAG patients. Cumulative probability of hemorrhagic events was 16.9% in POAG and 38.4% in NTG patients at the end of a 14.8-year follow-up. 3. The hazard ratio of disk hemorrhage decreased with the increase of IOP(26%/5 mmHg) and was 1.46 times higher in females than in males. Disk hemorrhage was closely associated with PPA: PPA becomes greater in association with the progression of glaucomatous optic neuropathy in both POAG and NTG. No such correlation was noted in primary angle-closure glaucoma. 4. Color Doppler imaging analyses and the hourly determination of ocular perfusion pressure (OPP) indicated a difference in retrobulbar hemodynamics between OPP-mean deviation concordant and OPP-mean deviation discordant patients: a circulatory disturbance causally unrelated to OPP seems to be involved in the OPP-mean deviation discordant patients. 5. The oral administration of Ca(2+)-channel antagonists was shown to favorably influence retrobulbar hemodynamics in NTG patients. 6. Serum antigen titer to hsps(hsp 27, alpha B crystallin, human & bacterial hsp 60) was higher in both POAG and NTG patients than in normal subjects. None of the hsp-antigens was correlated to any morphometric parameters of the optic disk or any global indices of the visual field. 7. Myocilin mutation was noted in only 0.5% of POAG patients and 2.37% of NTG patients. The very low rate of occurrence precludes the value of mutation of the gene as a prognostic factor in open-angle glaucoma(OAG). 8. IOP reduction achieved by mitomycin-C trabeculectomy is effective in maintaining visual function in OAG eyes. 9. Brovincamine fumarate is effective in inhibiting the progression of glaucomatous field loss in NTG.
原发性开角型青光眼和正常眼压性青光眼都属于同一类疾病谱。为了确定预后、临床因素并明确合适的治疗方法，对原发性开角型或高眼压性青光眼（POAG）和正常眼压性青光眼（NTG）的临床表现进行了研究。分析了从826例原发性开角型青光眼和正常眼压性青光眼患者获得的临床数据。此外，还讨论了实验室研究结果，包括热休克蛋白（hsp）的免疫测定以及为在分子水平识别危险因素而进行的基因分析。1. 确定的预后因素包括视盘出血、视乳头周围脉络膜视网膜萎缩（PPA）、最高眼压（IOP）、冷刺激后皮肤温度恢复率、青光眼家族史、全身收缩期通道血压以及口服钙通道拮抗剂。2. 在NTG患者中观察到视盘出血的比例为30.5%，在POAG患者中为15.4%。在14.8年随访结束时，POAG患者出血事件的累积概率为16.9%，NTG患者为38.4%。3. 视盘出血的风险比随眼压升高（每5 mmHg升高26%）而降低，女性比男性高1.46倍。视盘出血与PPA密切相关：在POAG和NTG中，随着青光眼性视神经病变的进展，PPA会增大。在原发性闭角型青光眼中未观察到这种相关性。4. 彩色多普勒成像分析和每小时眼压灌注压（OPP）测定表明，OPP-平均偏差一致和OPP-平均偏差不一致的患者球后血流动力学存在差异：在OPP-平均偏差不一致的患者中似乎存在与OPP无因果关系的循环障碍。5. 口服钙通道拮抗剂对NTG患者的球后血流动力学有有利影响。6. POAG和NTG患者血清中热休克蛋白（hsp 27、αB晶状体蛋白、人及细菌hsp 60）的抗原滴度均高于正常受试者。没有一种hsp抗原与视盘的任何形态学参数或视野的任何整体指标相关。7. 在POAG患者中仅0.5%和NTG患者中2.37%检测到肌纤蛋白突变。如此低的发生率排除了该基因突变作为开角型青光眼（OAG）预后因素的价值。8. 丝裂霉素C小梁切除术降低眼压对维持OAG患眼的视功能有效。9. 富马酸溴长春胺对抑制NTG患者青光眼性视野缺损的进展有效。
