Tan Ava Grace, Mitchell Paul, Burlutsky George, Rochtchina Elena, Kanthan Gowri, Islam F M Amirul, Wang Jie Jin
Department of Ophthalmology and Westmead Millennium Institute, Centre for Vision Research, University of Sydney, Sydney, NSW, Australia.
Ophthalmology. 2008 Oct;115(10):1693-8, 1698.e1. doi: 10.1016/j.ophtha.2008.04.005. Epub 2008 Jun 5.
To determine whether local nutritional or ischemic factors are involved in cataract pathogenesis, we aimed to assess whether narrowed retinal vessel caliber predicted the long-term incidence of age-related cataract, as shown in 1 previous report.
Population-based cohort study.
The Blue Mountains Eye Study examined 3654 baseline participants (1992-1994), 2335 (75.1% of survivors) after 5 years, and 1952 (75.6% of survivors) after 10 years.
Retinal vessel caliber was measured from baseline retinal photographs using computer-assisted techniques. Mean arteriolar and venular diameters of each eye were summarized as central retinal arterial (CRAE) and venular (CRVE) equivalents. Cataract was assessed from lens photographs of both eyes using the Wisconsin grading system.
Nuclear cataract was defined as opacity > Wisconsin standard photograph 3, cortical cataract defined as opacity >or=5% of the lens area, and posterior subcapsular (PSC) cataract as any present. Eye-specific data were analyzed using generalized estimating equations. Odds ratios (OR) and 95% confidence intervals (CI) are reported.
After adjusting for age, gender, smoking, hypertension, diabetes, body mass index, and inhaled steroid use, reduced incidence of nuclear cataract was associated with the narrowest compared with the widest quintile of CRAE and CRVE (for CRAE: OR, 0.62; 95% CI 0.42-0.92; for CRVE: OR, 0.70; 95% CI, 0.47-1.05) but a higher incidence of PSC cataract (for CRAE: OR, 2.40; 95% CI, 1.34-4.29; for CRVE: OR, 3.17; 95% CI, 1.62-6.20) and cataract surgery (for CRAE: OR, 1.52; 95% CI, 1.06-2.17; for CRVE: OR, 1.58; 95% CI, 1.08-2.32). These associations were not maintained when both CRAE and CRVE were included simultaneously in the same models. Path analysis suggested that age was the most important contributor to nuclear cataract incidence, and CRAE and CRVE, as markers of a latent age-related variable, were only indirectly associated with its incidence (for CRAE: OR, 0.61; 95% CI, 0.41-0.91; for CRVE: OR, 0.62; 95% CI, 0.41-0.94).
Retinal vessel narrowing predicted greater risk of long-term incidence of PSC cataract and cataract surgery, and was indirectly linked to a lower incidence of nuclear cataract. Retinal vessel narrowing could be a marker of age-related factors associated with risk of PSC and nuclear cataract.
为了确定局部营养或缺血因素是否参与白内障的发病机制，我们旨在评估视网膜血管管径变窄是否能预测年龄相关性白内障的长期发病率，正如之前一份报告所示。
基于人群的队列研究。
蓝山眼研究对3654名基线参与者（1992 - 1994年）进行了检查，5年后对2335名（幸存者的75.1%）进行了复查，10年后对1952名（幸存者的75.6%）进行了复查。
使用计算机辅助技术从基线视网膜照片测量视网膜血管管径。每只眼睛的平均小动脉和小静脉直径汇总为视网膜中央动脉（CRAE）和静脉（CRVE）等效值。使用威斯康星分级系统从双眼晶状体照片评估白内障情况。
核性白内障定义为混浊程度超过威斯康星标准照片3级，皮质性白内障定义为混浊面积大于或等于晶状体面积的5%，后囊下（PSC）白内障定义为存在任何混浊。使用广义估计方程分析特定眼睛的数据。报告比值比（OR）和95%置信区间（CI）。
在调整年龄、性别、吸烟、高血压、糖尿病、体重指数和吸入性类固醇使用情况后，与CRAE和CRVE最宽五分位数相比，最窄五分位数的核性白内障发病率降低（对于CRAE：OR，0.62；95% CI 0.42 - 0.92；对于CRVE：OR，0.70；95% CI，0.47 - 1.05），但PSC白内障发病率较高（对于CRAE：OR，2.40；95% CI，1.34 - 4.29；对于CRVE：OR，3.17；95% CI，1.62 - 6.20）以及白内障手术率较高（对于CRAE：OR，1.52；95% CI，1.06 - 2.17；对于CRVE：OR，1.58；95% CI，1.08 - 2.32）。当CRAE和CRVE同时纳入同一模型时，这些关联未得到维持。路径分析表明年龄是核性白内障发病率的最重要因素，而CRAE和CRVE作为潜在年龄相关变量的标志物，仅与其发病率间接相关（对于CRAE：OR，0.61；95% CI，0.41 - 0.91；对于CRVE：OR，0.62；95% CI，0.41 - 0.94）。
视网膜血管变窄预示着PSC白内障和白内障手术长期发病的风险更高，并且与核性白内障发病率较低间接相关。视网膜血管变窄可能是与PSC和核性白内障风险相关的年龄相关因素的标志物。
