Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York, USA.
Ophthalmology. 2010 May;117(5):909-15. doi: 10.1016/j.ophtha.2009.10.016. Epub 2010 Feb 4.
Beta-Zone parapapillary atrophy (PPA) occurs more commonly in eyes with glaucoma. Rates of glaucomatous visual field (VF) progression in eyes with and without beta-zone PPA at the time of baseline assessment were compared.
Retrospective, comparative study.
Two hundred forty-five patients from the New York Glaucoma Progression Study.
Subjects with glaucomatous optic neuropathy and repeatable VF loss were assessed for eligibility. Eyes with a Heidelberg Retina Tomograph II (HRT) examination, at least 5 visual field tests after the HRT in either eye, optic disc photographs, and <6 diopters of myopia were enrolled. beta-Zone PPA was defined as a region of chorioretinal atrophy with visible sclera and choroidal vessels adjacent to the optic disc. Global rates of VF progression were determined by automated pointwise linear regression analysis. Univariate analysis included age, gender, ethnicity, central corneal thickness (CCT), refractive error, baseline mean deviation, baseline intraocular pressure (IOP), mean IOP, IOP fluctuation, disc area, rim area, rim area-to-disc area ratio, beta-zone PPA area, beta-zone PPA area-to-disc area ratio, and presence or absence of beta-zone PPA.
The relationship between beta-zone PPA and the rate and risk of glaucoma progression.
Two hundred forty-five eyes of 245 patients (mean age, 69.6+/-12.3 years) were enrolled. The mean follow-up was 4.9+/-1.4 years and the mean number of VFs after HRT was 9.3+/-2.7. beta-Zone PPA was present in 146 eyes (65%). Eyes with beta-zone PPA progressed more rapidly (-0.84+/-0.8 dB/year) than eyes without it (-0.51+/-0.6 dB/year; P<0.01). Multivariate regression showed significant influence of mean IOP (hazard ratio [HR], 1.11; P<0.01), IOP fluctuation (HR, 1.17; P = 0.02), and presence of beta-zone PPA (HR, 2.59; P<0.01) on VF progression. Moderate (0.5-1.5 dB/year; P = 0.01) and fast (>1.5 dB/year; P = 0.08) global rates of progression occurred more commonly in eyes with beta-zone PPA than in eyes without it. Thinner CCT (<525 microm) had a weak but significant correlation with presence of beta-zone PPA (kappa = 0.13).
Eyes with beta-zone PPA are at increased risk for glaucoma progression and warrant close clinical surveillance.
β区视盘旁萎缩（PPA）在青光眼患者中更为常见。比较基线评估时伴有和不伴有β区 PPA 的青光眼视野（VF）进展的发生率。
回顾性、比较性研究。
纽约青光眼进展研究的 245 名患者。
对具有青光眼视神经病变和可重复 VF 丧失的患者进行资格评估。入选标准为：接受海德堡视网膜断层扫描仪 II（HRT）检查，在双眼中至少有 5 次 HRT 后进行 VF 检查，有视盘照片，近视<6 屈光度。β区 PPA 定义为与视盘相邻的脉络膜视网膜萎缩区，可见巩膜和脉络膜血管。通过自动逐点线性回归分析确定 VF 进展的总体速率。单变量分析包括年龄、性别、种族、中央角膜厚度（CCT）、屈光不正、基线平均偏差、基线眼内压（IOP）、平均 IOP、IOP 波动、视盘面积、边缘面积、边缘面积与视盘面积比、β区 PPA 面积、β区 PPA 面积与视盘面积比以及β区 PPA 的存在与否。
β区 PPA 与青光眼进展的速度和风险之间的关系。
共纳入 245 名患者的 245 只眼（平均年龄 69.6+/-12.3 岁）。平均随访时间为 4.9+/-1.4 年，HRT 后平均 VF 检查次数为 9.3+/-2.7 次。146 只眼（65%）存在β区 PPA。伴有β区 PPA 的眼进展较快（-0.84+/-0.8 dB/年），而无β区 PPA 的眼进展较慢（-0.51+/-0.6 dB/年；P<0.01）。多变量回归显示平均 IOP（危险比[HR]，1.11；P<0.01）、IOP 波动（HR，1.17；P=0.02）和β区 PPA 存在（HR，2.59；P<0.01）对 VF 进展有显著影响。β区 PPA 存在的眼更常出现中度（0.5-1.5 dB/年；P=0.01）和快速（>1.5 dB/年；P=0.08）的整体进展速度。较薄的 CCT（<525 µm）与β区 PPA 的存在有弱但显著的相关性（kappa = 0.13）。
伴有β区 PPA 的眼青光眼进展风险增加，需要密切临床监测。
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