Kwon Young H, Kim Young I, Pereira Mary Lucy M, Montague Paul R, Zimmerman M Bridget, Alward Wallace L M
Department of Ophthalmology and Visual Sciences, College of Public Health, University of Iowa, Iowa City, Iowa 52242, USA.
J Glaucoma. 2003 Oct;12(5):409-16. doi: 10.1097/00061198-200310000-00003.
To quantitatively evaluate the rate of cup-to-disc ratio progression in treated patients with primary open-angle glaucoma and to identify clinical factors associated with cup progression.
Fifty one eyes of 51 treated primary open-angle glaucoma patients with a minimum of 9-year longitudinal series of stereoscopic optic disc photographs were studied. Eyes with any other ocular disease except for mild cataract were excluded. Each set of stereoscopic photographs was digitized and viewed stereoscopically on a computer screen using a hand-held stereoscope. Computer-aided planimetry was performed on each set of photographs with examiner-defined cup and disc margins using custom-made software. The software computed linear cup-to-disc ratios as well as peripapillary atrophy area. Both inter-observer and intra-observer reliabilities were evaluated in a masked, random fashion using intra-class correlation. Changes in linear cup-to-disc ratios and peripapillary atrophy were estimated using linear regression over time. All available clinical factors were evaluated for association with the rate of cup progression using a multiple regression model.
All patients studied were Caucasian; 31(61%) were females. The mean age at the beginning of the study was 61.6 +/- 7.8 years (range 46-81). The mean follow-up period was 14.3 +/- 3.5 years (median 14.0, range 9.6-22.3). A total of 173 sets of stereo disc photographs were analyzed (3.4 +/- 1.3 per patient). The initial and final linear cup-to-disc ratios were 0.64 +/- 0.15 and 0.73 +/- 0.14 respectively. The inter-rater and intra-rater intraclass correlations were 0.76 (95% CI 0.61-0.87) and 0.97 (95% CI 0.93-0.98) respectively. Using linear regression the rate of linear cup-to-disc ratio change was 0.0068 +/- 0.0062 per year (range -0.0025- 0.0269). Three eyes had an increase in the peripapillary atrophy area. The higher yearly average intraocular pressure was significantly associated with faster rate of linear cup-to-disc ratios progression (P = 0.03).
In treated patients with primary open-angle glaucoma, the rate of progressive optic disc cupping was slow (LCDR progression of 0.0068 per year). The higher yearly average intraocular pressure was significantly associated with a faster rate of cup progression.
定量评估原发性开角型青光眼治疗患者的杯盘比进展率，并确定与杯盘进展相关的临床因素。
对51例接受治疗的原发性开角型青光眼患者的51只眼睛进行研究，这些患者至少有9年的立体视盘照片纵向系列资料。排除除轻度白内障外患有任何其他眼部疾病的眼睛。每组立体照片进行数字化处理，并使用手持式立体镜在计算机屏幕上进行立体观察。使用定制软件对每组照片进行计算机辅助平面测量，由检查者确定杯盘边缘。该软件计算线性杯盘比以及视乳头周围萎缩面积。使用组内相关系数以盲法、随机方式评估观察者间和观察者内的可靠性。使用线性回归估计随时间变化的线性杯盘比和视乳头周围萎缩的变化。使用多元回归模型评估所有可用的临床因素与杯盘进展率的相关性。
所有研究患者均为白种人；31例（61%）为女性。研究开始时的平均年龄为61.6±7.8岁（范围46 - 81岁）。平均随访期为14.3±3.5年（中位数14.0，范围9.6 - 22.3年）。共分析了173组立体视盘照片（每位患者3.4±1.3组）。初始和最终的线性杯盘比分别为0.64±0.15和0.73±0.14。观察者间和观察者内的组内相关系数分别为0.76（95%可信区间0.61 - 0.87）和0.97（95%可信区间0.93 - 0.98）。使用线性回归，线性杯盘比变化率为每年0.0068±0.0062（范围 - 0.0025 - 0.0269）。三只眼睛的视乳头周围萎缩面积增加。较高的年平均眼压与线性杯盘比进展速度较快显著相关（P = 0.03）。
在原发性开角型青光眼治疗患者中，视神经盘凹陷进展速度缓慢（线性杯盘比每年进展0.0068）。较高的年平均眼压与杯盘进展速度较快显著相关。
