Dueker David K, Singh Kuldev, Lin Shan C, Fechtner Robert D, Minckler Don S, Samples John R, Schuman Joel S
Ophthalmology. 2007 Sep;114(9):1779-87. doi: 10.1016/j.ophtha.2007.04.068.
To evaluate published literature to assess whether central corneal thickness (CCT) is a risk factor for the presence, development, or progression of glaucomatous optic nerve damage related to primary open-angle glaucoma (POAG).
A PubMed literature search limited to English language articles conducted on November 15, 2004 retrieved 195 articles. The authors reviewed these abstracts and selected 57 to review in full text to determine relevance to the assessment questions. A further 24 studies of interest were identified from periodic updates to the literature search, surveillance of the literature, and reference lists of reviewed articles. From the 81 published reports identified, the first author applied specified selection criteria that yielded 37 articles for methodological review because of relevance to the assessment questions. The articles were rated according to the strength of evidence by the panel methodologist. A level I rating was assigned to well-designed properly conducted randomized clinical trials or similar quality-validated cohort studies with appropriate reference standards. A level II rating was assigned to well-designed case-control studies, exploratory cohort studies, and other nonrandomized clinical studies lacking consistently applied reference standards. A level III rating was reserved for poorly designed case-control studies, case series, and papers consisting only of expert opinion without supporting evidence. In addition, each study was graded as positive if it supported a statistical association of CCT with the risk of having or developing glaucomatous optic nerve damage or as negative if no such association was found.
There is strong and consistent level I and level II evidence that CCT is a risk factor for progression from ocular hypertension to POAG. Studies that were rated as providing the highest quality of evidence revealed mixed results with respect to glaucoma prevalence. One population-based study (level II) showed a positive association, another larger study (level I) revealed an association of marginal significance, and 3 studies (all level I) found no association of CCT with POAG prevalence.
There is strong evidence that measuring CCT is an important component of a complete ocular examination, particularly for patients being evaluated for the risk of developing POAG. Therefore, CCT measurement should be included in the examination of all patients with ocular hypertension. Although the evidence supporting the necessity of measuring CCT as part of screening for POAG or as a risk factor for glaucoma progression is not as strong, intraocular pressure (IOP) is the only modifiable risk factor in the treatment of glaucoma, and CCT has the potential to significantly impact IOP measurement by applanation tonometry in all patients.
评估已发表的文献，以确定中央角膜厚度（CCT）是否为与原发性开角型青光眼（POAG）相关的青光眼性视神经损害的存在、发展或进展的危险因素。
2004年11月15日在PubMed上进行的仅限于英文文章的文献检索共检索到195篇文章。作者审阅了这些摘要，并选择了57篇进行全文审阅，以确定其与评估问题的相关性。通过文献检索的定期更新、文献监测以及已审阅文章的参考文献列表，又确定了另外24项相关研究。在确定的81篇已发表报告中，第一作者应用特定的选择标准，由于与评估问题相关，选出37篇文章进行方法学审查。文章由小组方法学家根据证据强度进行评级。一级评级适用于设计良好、实施得当的随机临床试验或具有适当参考标准的类似质量验证队列研究。二级评级适用于设计良好的病例对照研究、探索性队列研究以及其他缺乏一致应用参考标准的非随机临床研究。三级评级则用于设计不佳的病例对照研究、病例系列以及仅由专家意见组成而无支持证据的论文。此外，如果一项研究支持CCT与发生或发展青光眼性视神经损害风险之间的统计学关联，则将其评为阳性；如果未发现此类关联，则评为阴性。
有强有力且一致的一级和二级证据表明，CCT是从高眼压症进展为POAG的危险因素。被评为提供最高质量证据的研究在青光眼患病率方面显示出混合结果。一项基于人群的研究（二级）显示出正相关，另一项更大规模的研究（一级）显示出边缘显著性关联，而3项研究（均为一级）未发现CCT与POAG患病率之间存在关联。
有强有力的证据表明，测量CCT是全面眼部检查的重要组成部分，特别是对于评估有发生POAG风险的患者。因此，所有高眼压症患者的检查都应包括CCT测量。尽管支持将测量CCT作为POAG筛查的一部分或青光眼进展危险因素的证据并不那么充分，但眼压（IOP）是青光眼治疗中唯一可改变的危险因素，并且CCT有可能显著影响所有患者通过压平眼压计测量的IOP值。
