青光眼的初始旁中心视野缺损与周边视野缺损：危险因素和视野特征。

Initial parafoveal versus peripheral scotomas in glaucoma: risk factors and visual field characteristics.

机构信息

Department of Ophthalmology, the New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003, USA.

出版信息

Ophthalmology. 2011 Sep;118(9):1782-9. doi: 10.1016/j.ophtha.2011.02.013. Epub 2011 Jun 12.

DOI:10.1016/j.ophtha.2011.02.013

PMID:21665283

Abstract

OBJECTIVE

To assess risk factors for an initial parafoveal scotoma (IPFS) compared with an initial nasal step (INS) in glaucoma.

DESIGN

Retrospective, observational study.

PARTICIPANTS

Sixty-nine patients with glaucoma with an isolated IPFS and 53 patients with an isolated INS.

METHODS

On the basis of 2 reliable, consistent 24-2 Swedish interactive threshold algorithm standard visual fields (VFs), 2 groups of patients with glaucoma were studied: those with an IPFS in 1 hemifield (≥3 adjacent points with P<5% within the central 10 degrees of fixation, ≥1 point with P<1% lying at the innermost paracentral points, and no VF abnormality outside the central 10 degrees) and those with an INS in 1 hemifield (≥3 adjacent points with P<5% in the nasal periphery outside 10 degrees of fixation, the nasal-most point with P<1%, and no VF abnormality within the central 10 degrees). Clinical characteristics and systemic factors were recorded from charts and compared between the 2 groups.

MAIN OUTCOME MEASURES

Maximum untreated intraocular pressure (IOP), disc hemorrhage (DH) detection during follow-up, systemic risk factors, and VF mean deviation (MD) and pattern standard deviation (PSD).

RESULTS

Maximum untreated IOP (21.6±4.5 vs. 28.3±9.6 mmHg; P<0.001) was significantly lower, and frequency of DH detection (44% vs. 17%; P=0.001) and systemic risk factors (hypotension, migraine, Raynaud's phenomenon, and sleep apnea; 16%, 23%, 24%, and 9% vs. 0%, 4%, 9%, and 0%; P=0.001, 0.002, 0.025, and 0.030, respectively) were significantly higher in patients with an IPFS than in patients with an INS. There were no significant differences in age, gender, family history of glaucoma, refractive error, central corneal thickness, and disc area between the 2 groups (all P>0.1). Mean deviation was similar between the 2 groups (P=0.346), but PSD was significantly greater in the IPFS group than in the INS group (P=0.043).

CONCLUSIONS

Eyes with an IPFS differ from those with an INS. These findings may help clinicians identify patients at higher risk of early central field loss.

摘要

目的

评估青光眼患者初次出现旁中心视野缺损（IPFS）与初次出现鼻侧阶梯（INS）的风险因素。

设计

回顾性、观察性研究。

参与者

69 例青光眼伴孤立性 IPFS 患者和 53 例孤立性 INS 患者。

方法

基于 2 份可靠、一致的 24-2 瑞典互动阈值算法标准视野（VF），对 2 组青光眼患者进行研究：1 半视野出现 IPFS（≥3 个相邻点在中央 10 度固视范围内的 P<5%，≥1 个点在最内旁中心点的 P<1%，中央 10 度以外无视野异常），1 半视野出现 INS（≥3 个相邻点在鼻侧 10 度固视范围以外的 P<5%，最鼻侧点的 P<1%，中央 10 度以内无视野异常）。从图表中记录临床特征和全身因素，并比较 2 组之间的差异。

主要观察指标

最大未治疗眼内压（IOP）、随访中发现的盘状出血（DH）、全身危险因素以及视野平均偏差（MD）和模式标准差（PSD）。

结果

最大未治疗 IOP（21.6±4.5 与 28.3±9.6 mmHg；P<0.001）显著较低，DH 检出率（44%与 17%；P=0.001）和全身危险因素（低血压、偏头痛、雷诺现象和睡眠呼吸暂停；16%、23%、24%和 9%与 0%、4%、9%和 0%；P=0.001、0.002、0.025 和 0.030）在 IPFS 患者中显著更高。2 组间年龄、性别、青光眼家族史、屈光不正、中央角膜厚度和视盘面积无显著差异（均 P>0.1）。2 组间 MD 相似（P=0.346），但 IPFS 组 PSD 显著大于 INS 组（P=0.043）。