Department of Ophthalmology, Weill Cornell Medical College, New York, New York.
Harkness Eye Institute, Columbia University, New York, New York.
Ophthalmology. 2014 Apr;121(4):842-8. doi: 10.1016/j.ophtha.2013.11.002. Epub 2013 Dec 15.
To determine the characteristics and significance of retinal blood vessel (RBV) positional shifts over time in a cohort of patients with progressive glaucoma.
Retrospective cohort study.
Baseline and serial stereophotographs from 1 eye of 125 patients with open-angle glaucoma with ≥8 reliable Swedish interactive threshold algorithm standard visual fields (VFs) were included. On the basis of global rates of threshold sensitivity change, patients with glaucoma were divided into groups of minimal (<-0.02 decibels [dB]/year), moderate (-0.02 to -0.65 dB/year), or fast (≥-0.65 dB/year) progression. To determine whether graders' assessments of RBV positional shifts were false-positives, a control group consisting of 33 patients with glaucoma with 2 sets of photographs taken on the same day was included.
Masked graders reviewed serial photographs aligned with automated alternation flicker (EyeIC, Narbeth, PA) and assessed them for the presence of any discrete RBV positional shifts (2 graders) and for traditional measures of structural progression (2 graders), including neuroretinal rim loss, parapapillary atrophy progression, and disc hemorrhage (DH).
Presence or absence of RBV positional shifts, rates of VF progression, and presence or absence of traditional measures of structural progression.
A total of 158 image sets (125 longitudinal and 33 same-day controls) from patients with glaucoma were included. Retinal blood vessel shifts were noted in 33 of 125 (26.4%) longitudinally followed glaucomatous eyes and 2 of 33 (6%) same-day control patients (P = 0.01). Agreement between graders I and II was 90.4% (kappa=0.77; P< 0.001). Eyes with RBV positional change progressed more rapidly than those without (-0.55 vs. -0.29 dB/year; 95% confidence interval [CI], 0.03-0.48); P = 0.03). Retinal blood vessel shift was present in 12.1% of minimal progressors versus 31.5% of moderate and fast progressors (P = 0.04). Rate of VF progression was statistically associated with RBV shift (odds ratio [OR], 2.2; 95% CI, 1.1-4.5; P = 0.03). Other variables significantly associated with RBV shift included neuroretinal rim loss (OR, 21.9; 95% CI, 5.7-83.6; P< 0.001) and DH (OR, 4.6; 95% CI, 1.5-15.5; P< 0.01). A multivariable model revealed that rim loss and DH, but not rate of functional change, were significantly associated with RBV shift.
Retinal blood vessel positional shifts occurred in eyes with functionally progressive glaucoma, neuroretinal rim loss, and DH. This is a novel clinical finding that could help identify glaucoma progression or individuals at higher risk for future progression.
确定进展性青光眼患者队列中视网膜血管（RBV）随时间位置变化的特征和意义。
回顾性队列研究。
纳入了 125 名开角型青光眼患者的 1 只眼的基线和系列立体照片，这些患者至少有 8 个可靠的瑞典交互阈值算法标准视野（VF）。根据阈值敏感性变化的全球速率，将青光眼患者分为最小（<-0.02 分贝[dB]/年）、中度（-0.02 至-0.65 dB/年）或快速（≥-0.65 dB/年）进展组。为了确定分级员对 RBV 位置偏移的评估是否为假阳性，纳入了一组由 33 名同一天拍摄了两组照片的青光眼患者组成的对照组。
掩蔽分级员使用自动交替闪烁（EyeIC，Narbeth，PA）对齐连续照片，并评估它们是否存在任何离散的 RBV 位置偏移（2 名分级员）以及传统的结构进展测量（2 名分级员），包括神经视网膜边缘损失、视盘周围萎缩进展和视盘出血（DH）。
RBV 位置偏移的存在或不存在、VF 进展的速度以及传统结构进展测量的存在或不存在。
共纳入 125 名纵向和 33 名同日对照组青光眼患者的 158 个图像组。在 125 名纵向随访的青光眼眼中，有 33 只（26.4%）出现视网膜血管移位，而在 33 名同日对照组患者中，有 2 只（6%）出现视网膜血管移位（P=0.01）。分级员 I 和 II 之间的一致性为 90.4%（kappa=0.77；P<0.001）。有 RBV 位置变化的眼睛比没有 RBV 位置变化的眼睛进展得更快（-0.55 与-0.29 dB/年；95%置信区间[CI]，0.03-0.48；P=0.03）。在最小进展者中，有 12.1%出现 RBV 移位，而在中度和快速进展者中，有 31.5%出现 RBV 移位（P=0.04）。VF 进展的速度与 RBV 移位呈统计学相关（比值比[OR]，2.2；95%CI，1.1-4.5；P=0.03）。与 RBV 移位显著相关的其他变量包括神经视网膜边缘损失（OR，21.9；95%CI，5.7-83.6；P<0.001）和 DH（OR，4.6；95%CI，1.5-15.5；P<0.01）。多变量模型显示，边缘损失和 DH，而不是功能变化的速度，与 RBV 移位显著相关。
在功能进展性青光眼、神经视网膜边缘损失和 DH 眼中发生了视网膜血管位置变化。这是一个新的临床发现，可以帮助识别青光眼进展或未来进展风险较高的个体。
Zotero 插件