Bengtsson Boel, Leske M Cristina, Yang Zhongming, Heijl Anders
Department of Clinical Sciences, Ophthalmology, Lund University, Malmö University Hospital, Sweden.
Ophthalmology. 2008 Nov;115(11):2044-8. doi: 10.1016/j.ophtha.2008.05.031. Epub 2008 Aug 9.
To evaluate the effect of intraocular pressure (IOP)-reducing treatment on the development of disc hemorrhages in patients with glaucoma.
Prospective cohort study of patients in the Early Manifest Glaucoma Trial, followed up to 11 years (median = 8 years).
Patients with newly detected glaucoma randomized to argon laser trabeculoplasty plus betaxolol (n = 129) or no initial treatment (n = 126), followed with tonometry, perimetry, and ophthalmoscopy every 3 months, and fundus photography every 6 months.
Logistic regression expressed as odds ratios (OR) and 95% confidence intervals (CIs), analysis of variance, and Cox time-dependent models, expressed as hazard ratios (HRs) and CIs.
Presence (yes/no) and frequency of disc hemorrhages.
Disc hemorrhages were identified in approximately 55% of all patients, whether by ophthalmoscopy or review of photographs. In analyses including data up to the time of progression, disc hemorrhages were equally common among treated and control patients: 51.2% versus 45.2%, respectively (P = 0.34), based on ophthalmoscopy, and 50.4% versus 44.4%, respectively (P = 0.34), based on photographs. Gender was the only factor related to the presence of disc hemorrhages detected by both ophthalmoscopy (OR = 0.48; CI, 0.26-0.88; P = 0.022) and photographs (OR = 0.64; CI, 0.38-1.09; P = 0.099) for male patients. The frequency of disc hemorrhages over time did not differ between treated and control patients: 8.4% versus 8.5%, respectively (P = 0.93), based on ophthalmoscopy, and 12.4% versus 11.2%, respectively (P = 0.36), based on photographs. Disc hemorrhages were significantly associated with time to progression (HR = 1.02; CI, 1.01-1.04), and there was no evidence of interaction between treatment group and disc hemorrhages.
IOP-reducing treatment was unrelated to the presence or frequency of disc hemorrhages. The results may suggest that disc hemorrhages cannot be considered an indication of insufficient IOP-lowering treatment, and that glaucoma progression in eyes with disc hemorrhages cannot be totally halted by IOP reduction. The results also suggest that disc hemorrhages do not occur in all patients with glaucoma.
评估降低眼压治疗对青光眼患者视盘出血发生发展的影响。
对早期显性青光眼试验中的患者进行前瞻性队列研究，随访长达11年（中位数 = 8年）。
新诊断为青光眼的患者被随机分为氩激光小梁成形术联合倍他洛尔组（n = 129）或初始不治疗组（n = 126），每3个月进行眼压测量、视野检查和检眼镜检查，每6个月进行眼底照相。
采用以比值比（OR）和95%置信区间（CI）表示的逻辑回归、方差分析以及以风险比（HR）和CI表示的Cox时间依赖性模型。
视盘出血的存在情况（是/否）及发生频率。
无论通过检眼镜检查还是照片回顾，约55%的患者出现视盘出血。在纳入进展期前数据的分析中，基于检眼镜检查，治疗组和对照组患者视盘出血同样常见：分别为51.2%和45.2%（P = 0.34）；基于照片，分别为50.4%和44.4%（P = 0.34）。性别是通过检眼镜检查（OR = 0.48；CI，0.26 - 0.88；P = 0.022）和照片（OR = 0.64；CI，0.38 - 1.09；P = 0.099）检测到的视盘出血相关的唯一因素，男性患者中更为明显。随着时间推移，治疗组和对照组患者视盘出血的频率无差异：基于检眼镜检查，分别为8.4%和8.5%（P = 0.93）；基于照片，分别为12.4%和11.2%（P = 0.36）。视盘出血与进展时间显著相关（HR = 1.02；CI，1.01 - 1.04），且没有证据表明治疗组与视盘出血之间存在相互作用。
降低眼压治疗与视盘出血的存在或频率无关。结果可能表明，视盘出血不能被视为眼压降低治疗不足的指标，且眼压降低不能完全阻止视盘出血患者青光眼的进展。结果还表明，并非所有青光眼患者都会出现视盘出血。
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