Yamazaki Sei, Inoue Rishu, Tsuboi Toshikazu, Kozaki Ai, Inoue Toshu, Inoue Toyoko, Inoue Yoichi
Yamazaki Eye Clinic, Shinagawa-ku, Tokyo, Japan.
Clin Ophthalmol. 2013;7:47-53. doi: 10.2147/OPTH.S39486. Epub 2013 Jan 7.
To determine if qualitatively defining the appearance of optic disc change was a valid characteristic of myopia in subjects with Graves' ophthalmopathy (GO) or primary open-angle glaucoma (POAG).
WE DEFINED TYPICAL TILT APPEARANCE AS THE SIMULTANEOUS PRESENCE OF THE FOLLOWING: an elliptical optic disc, a crescent, unequal sharpness of the cupping margin (horizontally), and nasally displaced vessels in the optic cup. Ninety-two eyes from 92 subjects each with GO or with POAG and no severe complications were included in the study after matching for spherical refractive errors. Using our definition of tilt appearance, two independent observers subjectively judged optic disc photographs. One observer repeated judgments in 70 randomly selected eyes and judgment reproducibility was assessed using kappa statistics. Tilt ratio was used as a quantitative parameter.
The numbers of eyes judged as having a typical tilt appearance in the GO group and in the POAG group were 25 (27.2%) and 39 (42.4%), respectively, by one observer (P = 0.0297), and 12 (13%) and 44 (47.8%), respectively, by another observer (P < 0.0001). Intra- and interobserver reproducibility of tilt judgment were very good (kappa = 0.93) and good (kappa = 0.65), respectively. Tilt ratio did not significantly differ between the two groups. Analytical results including background factors were essentially the same for the two observers: multivariate logistic regression for one observer's judgment showed that the presence of the typical tilt appearance was associated with belonging to the glaucoma group (odds ratio [OR], 6.25; P = 0.0054), tilt ratio (OR per 0.01, 0.77; P < 0.0001), and spherical refractive error (OR per diopter, 0.80; P < 0.003).
The optic disc feature we designated as typical tilt was associated with myopia, and its frequency was higher in subjects with POAG compared to those with GO.
确定定性定义视盘改变的外观是否是格雷夫斯眼病（GO）或原发性开角型青光眼（POAG）患者近视的有效特征。
我们将典型倾斜外观定义为同时具备以下特征：椭圆形视盘、新月形、杯盘边缘锐度不均（水平方向）以及视杯内血管向鼻侧移位。在匹配球镜屈光不正后，研究纳入了92名受试者的92只眼睛，这些受试者分别患有GO或POAG且无严重并发症。根据我们对倾斜外观的定义，两名独立观察者对视盘照片进行主观判断。一名观察者对70只随机选择的眼睛重复进行判断，并使用kappa统计量评估判断的可重复性。倾斜率用作定量参数。
一名观察者判断GO组和POAG组中具有典型倾斜外观的眼睛数量分别为25只（27.2%）和39只（42.4%）（P = 0.0297），另一名观察者判断的数量分别为12只（13%）和44只（47.8%）（P < 0.0001）。观察者内和观察者间倾斜判断的可重复性分别非常好（kappa = 0.93）和好（kappa = 0.65）。两组之间的倾斜率无显著差异。两名观察者包括背景因素的分析结果基本相同：一名观察者判断的多因素逻辑回归显示，典型倾斜外观的存在与属于青光眼组相关（比值比[OR]，6.25；P = 0.0054）、倾斜率（每0.01的OR，0.77；P < 0.0001）以及球镜屈光不正（每屈光度的OR，0.80；P < 0.003）。
我们指定为典型倾斜的视盘特征与近视相关，与GO患者相比，POAG患者中该特征的频率更高。
