高级青光眼眼中黄斑厚度的进展检测能力。
Progression detection capability of macular thickness in advanced glaucomatous eyes.
机构信息
Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea.
出版信息
Ophthalmology. 2012 Feb;119(2):308-13. doi: 10.1016/j.ophtha.2011.08.022. Epub 2011 Dec 17.
PURPOSE
To evaluate the progression rate of macular and circumpapillary retinal nerve fiber layer (RNFL) thickness in advanced glaucomatous eyes using spectral domain optical coherence tomography (Cirrus HD-OCT, Carl Zeiss Meditec, Dublin, CA).
DESIGN
Longitudinal, observational study.
PARTICIPANTS
A total of 98 eyes of 98 patients with advanced glaucoma (visual field [VF] mean deviation [MD] <-10 dB) with a mean follow-up time of 2.2 years.
METHODS
Three glaucoma experts independently reviewed optic disc and RNFL photographs and classified patients into 3 groups: progressed, stable, and undetermined (criterion 1). Patients in the undetermined group could not be evaluated because of advanced optic disc cupping. The eyes were also classified into 2 groups, progressed and stable, by serial VF data (criterion 2).
MAIN OUTCOME MEASURES
Progression rates as determined by linear regression analysis against patient age using serial macular and RNFL thickness parameters were compared among different groups.
RESULTS
By criterion 1, 25 eyes (25.5%) were classified as stable, 13 eyes (13.3%) were classified as progressed, and 60 eyes (61.2%) were classified as undetermined. By criterion 2, 86 eyes (87.8%) were classified as stable, and 12 eyes (12.2%) were classified as progressed. By criterion 1, the mean progression rate of average macular thickness was significantly higher in the progressed group than in the stable and undetermined groups (-4.74±4.40, -0.53±1.44, and -2.72±4.75 μm/year, respectively; P = 0.01). The undetermined group showed a higher progression rate than the stable group (P = 0.045). However, the progression rate of average RNFL thickness did not differ significantly among the 3 groups (-1.19±2.62, -0.33±1.29, and -1.21±2.75 μm/year, respectively; P = 0.34). By criterion 2, the mean progression rate of average RNFL thickness did not differ significantly between the stable and progressed groups (-0.90±2.42 and -2.08±2.85 μm/year; P = 0.459). However, the progression rate as revealed by average macular thickness was significantly different between the 2 groups (-2.22±4.33 and -5.12±2.40 μm/year, respectively; P = 0.039).
CONCLUSIONS
Exploration of changes over time in macular thickness may improve detection of progression in patients with advanced glaucoma.
目的
使用频域光相干断层扫描（Cirrus HD-OCT，卡尔蔡司 Meditec，都柏林，CA）评估晚期青光眼患者黄斑和环视盘视网膜神经纤维层（RNFL）厚度的进展速度。
设计
纵向观察性研究。
参与者
共纳入 98 例晚期青光眼（视野[VF]平均偏差[MD]<-10 dB）患者的 98 只眼，平均随访时间为 2.2 年。
方法
3 名青光眼专家独立评估视盘和 RNFL 照片，并将患者分为 3 组：进展组、稳定组和不确定组（标准 1）。不确定组的患者由于视盘杯状进展严重，无法进行评估。根据连续 VF 数据，将这些眼睛也分为进展组和稳定组（标准 2）。
主要观察指标
使用线性回归分析，根据患者年龄对连续黄斑和 RNFL 厚度参数进行比较，比较不同组之间的进展率。
结果
根据标准 1，25 只眼（25.5%）被归类为稳定，13 只眼（13.3%）被归类为进展，60 只眼（61.2%）被归类为不确定。根据标准 2，86 只眼（87.8%）被归类为稳定，12 只眼（12.2%）被归类为进展。根据标准 1，进展组的平均黄斑厚度的平均进展率明显高于稳定组和不确定组（分别为-4.74±4.40、-0.53±1.44 和-2.72±4.75 μm/年；P=0.01）。不确定组的进展率高于稳定组（P=0.045）。然而，3 组之间平均 RNFL 厚度的进展率无显著差异（分别为-1.19±2.62、-0.33±1.29 和-1.21±2.75 μm/年；P=0.34）。根据标准 2，稳定组和进展组之间平均 RNFL 厚度的平均进展率无显著差异（分别为-0.90±2.42 和-2.08±2.85 μm/年；P=0.459）。然而，两组之间平均黄斑厚度的进展率有显著差异（分别为-2.22±4.33 和-5.12±2.40 μm/年；P=0.039）。
结论
探索黄斑厚度随时间的变化可能有助于提高对晚期青光眼患者进展的检测。
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