Budenz Donald L, Anderson Douglas R, Feuer William J, Beiser Julia A, Schiffman Joyce, Parrish Richard K, Piltz-Seymour Jody R, Gordon Mae O, Kass Michael A
Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
Ophthalmology. 2006 Dec;113(12):2137-43. doi: 10.1016/j.ophtha.2006.06.022. Epub 2006 Sep 25.
To compare the rates of detection of optic disc hemorrhages by clinical examination and by review of optic disc photographs at the Optic Disc Reading Center (ODRC), to assess the incidence of and the predictive factors for disc hemorrhages in the annual disc photographs of the Ocular Hypertension Treatment Study (OHTS), and to determine whether optic disc hemorrhages predict the development of primary open-angle glaucoma (POAG) in the OHTS.
Cohort study.
Three thousand two hundred thirty-six eyes of 1618 participants.
Both eyes of participants were examined for optic disc hemorrhages every 6 months by clinical examination, with dilated fundus examinations every 12 months, and by annual review of stereoscopic disc photographs at the ODRC.
Incidence of optic disc hemorrhages and POAG end points.
Median follow-up was 96.3 months. Stereophotography-confirmed glaucomatous optic disc hemorrhages were detected in 128 eyes of 123 participants before the POAG end point. Twenty-one cases (16%) were detected by both clinical examination and review of photographs, and 107 cases (84%) were detected only by review of photographs (P<0.0001). Baseline factors associated with disc hemorrhages were older age, thinner corneas, larger vertical cup-to-disc ratio, larger pattern standard deviation index on perimetry, family history of glaucoma, and smoking status. The occurrence of a disc hemorrhage increased the risk of developing POAG 6-fold in a univariate analysis (P<0.001; 95% confidence interval, 3.6-10.1) and 3.7-fold in a multivariate analysis that included baseline factors predictive of POAG (P<0.001; 95% confidence interval, 2.1-6.6). The 96-month cumulative incidence of POAG in the eyes without optic disc hemorrhage was 5.2%, compared with 13.6% in the eyes with optic disc hemorrhage. In eyes with a disc hemorrhage in which a POAG end point developed, the median time between the 2 events was 13 months.
Review of stereophotographs was more sensitive at detecting optic disc hemorrhage than clinical examination. The occurrence of an optic disc hemorrhage was associated with an increased risk of developing a POAG end point in participants in the OHTS. However, most eyes (86.7%) in which a disc hemorrhage developed have not experienced a POAG end point to date.
比较临床检查和视盘阅读中心（ODRC）对视盘照片进行回顾时视盘出血的检出率，评估青光眼治疗研究（OHTS）年度视盘照片中视盘出血的发生率及预测因素，并确定视盘出血是否可预测OHTS中原发性开角型青光眼（POAG）的发生。
队列研究。
1618名参与者的3236只眼。
对参与者的双眼每6个月进行一次视盘出血的临床检查，每12个月进行一次散瞳眼底检查，并每年在ODRC对视盘立体照片进行回顾。
视盘出血和POAG终点的发生率。
中位随访时间为96.3个月。在POAG终点前，123名参与者的128只眼中检测到经立体摄影确认的青光眼性视盘出血。21例（16%）通过临床检查和照片回顾均被检测到，107例（84%）仅通过照片回顾被检测到（P<0.0001）。与视盘出血相关的基线因素包括年龄较大、角膜较薄、垂直杯盘比更大、视野检查中模式标准偏差指数更大、青光眼家族史以及吸烟状况。在单因素分析中，视盘出血的发生使发生POAG的风险增加了6倍（P<0.001；95%置信区间，3.6 - 10.1），在纳入预测POAG的基线因素的多因素分析中增加了3.7倍（P<0.001；95%置信区间，2.1 - 6.6）。无视盘出血的眼中POAG的96个月累积发生率为5.2%，而视盘出血的眼中为13.6%。在发生视盘出血且出现POAG终点的眼中，这两个事件之间的中位时间为13个月。
对视盘立体照片的回顾在检测视盘出血方面比临床检查更敏感。视盘出血的发生与OHTS参与者发生POAG终点的风险增加相关。然而，大多数发生视盘出血的眼（86.7%）迄今为止尚未经历POAG终点。
