Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Ophthalmology. 2014 Jul;121(7):1341-9. doi: 10.1016/j.ophtha.2014.01.008. Epub 2014 Feb 22.
To investigate whether the rate of retinal nerve fiber layer (RNFL) thinning differs according to the microstructure of β-zone parapapillary atrophy (PPA) as evaluated by spectral-domain (SD) optical coherence tomography (OCT) in primary open-angle glaucoma (POAG).
Prospective, observational, comparative study.
A total of 195 eyes with POAG that had been evaluated by serial SD-OCT RNFL thickness measurements for ≥ 2 years.
On the basis of the extent of Bruch's membrane (BM) within the β-zone PPA (area without retinal pigment epithelium [RPE]), as shown in the infrared fundus images, PPA was divided into PPA+BM (PPA with intact BM) and PPA-BM (PPA devoid of BM). Eyes were categorized into group A (having PPA+BM only, n=64), group B (having both PPA+BM and PPA-BM, n=58), group C (having PPA-BM only, n=32), and group D (without β-zone PPA, n=41). The rate of progressive OCT RNFL thinning was determined by linear regression and compared between groups. Factors influencing the rate of RNFL thinning were evaluated, including age, sex, follow-up duration, history of filtering surgery, baseline RNFL thickness, baseline intraocular pressure (IOP), mean IOP and IOP fluctuation during follow-up, PPA types, baseline PPA width, PPA width increase, axial length (AXL), central corneal thickness, and visual field mean deviation (MD).
Rate of thinning of OCT RNFL thicknesses over time.
Patients in groups B and C were significantly younger and more myopic, and had a greater AXL, than those in groups A and D (all P<0.001). The rate of global RNFL thinning was significantly faster in group A (-1.66 ± 2.94 μm/year) than in the other groups (group B, -0.87 ± 1.28 μm/year; group C, 0.20 ± 1.86 μm/year; group D, -0.28 ± 1.74 μm/year; P = 0.001). Multivariate regression showed a significant association of shorter follow-up period (P = 0.016), greater baseline global RNFL thickness (P = 0.035), type of β-zone PPA (group A, P = 0.023), and greater baseline PPA+BM width (P = 0.034) with a faster rate of RNFL thinning.
The rate of RNFL thinning differed according to the microstructure of β-zone PPA. It was faster for eyes with β-zone PPA with intact BM than for eyes without β-zone PPA or with β-zone PPA devoid of BM.
通过频域光相干断层扫描（SD-OCT）评估原发性开角型青光眼（POAG）β-区视盘旁萎缩（PPA）的微观结构，探讨视网膜神经纤维层（RNFL）变薄的速度是否存在差异。
前瞻性、观察性、对比研究。
共 195 只眼，通过连续 SD-OCT RNFL 厚度测量进行了≥2 年的评估。
根据红外眼底图像中 Bruch 膜（BM）在β-区 PPA 内的范围（无视网膜色素上皮[RPE]的区域），将 PPA 分为 PPA+BM（有完整 BM 的 PPA）和 PPA-BM（无 BM 的 PPA）。将眼睛分为 A 组（仅存在 PPA+BM，n=64）、B 组（同时存在 PPA+BM 和 PPA-BM，n=58）、C 组（仅存在 PPA-BM，n=32）和 D 组（无β-区 PPA，n=41）。通过线性回归确定 OCT RNFL 变薄的进展速度，并在组间进行比较。评估影响 RNFL 变薄速度的因素，包括年龄、性别、随访时间、滤过性手术史、基线 RNFL 厚度、基线眼压（IOP）、随访期间平均 IOP 和 IOP 波动、PPA 类型、基线 PPA 宽度、PPA 宽度增加、眼轴（AXL）、中央角膜厚度和视野平均偏差（MD）。
随时间变化的 OCT RNFL 厚度变薄率。
与 A 组和 D 组相比，B 组和 C 组患者年龄更小、近视程度更高，AXL 更大（均 P<0.001）。A 组的全球 RNFL 变薄速度明显快于其他组（-1.66±2.94 μm/年）[B 组：-0.87±1.28 μm/年；C 组：0.20±1.86 μm/年；D 组：-0.28±1.74 μm/年；P=0.001]。多变量回归显示，随访时间较短（P=0.016）、基线全球 RNFL 厚度较大（P=0.035）、β-区 PPA 类型（A 组，P=0.023）和基线 PPA+BM 宽度较大（P=0.034）与 RNFL 变薄速度较快显著相关。
β-区 PPA 的微观结构不同，RNFL 变薄的速度也不同。与无β-区 PPA 或无β-区 PPA 的眼睛相比，有完整 BM 的β-区 PPA 眼睛的 RNFL 变薄速度更快。
