青光眼疑似患者的视网膜神经纤维层变薄率。
Rates of retinal nerve fiber layer thinning in glaucoma suspect eyes.
机构信息
Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan.
Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California.
出版信息
Ophthalmology. 2014 Jul;121(7):1350-8. doi: 10.1016/j.ophtha.2014.01.017. Epub 2014 Mar 13.
PURPOSE
To compare the rates of retinal nerve fiber layer (RNFL) loss in patients suspected of having glaucoma who developed visual field damage (VFD) with those who did not develop VFD and to determine whether the rate of RNFL loss can be used to predict the development of VFD.
DESIGN
Prospective, observational cohort study.
PARTICIPANTS
Glaucoma suspects, defined as having glaucomatous optic neuropathy or ocular hypertension (intraocular pressure, >21 mmHg) without repeatable VFD at baseline, from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study.
METHODS
Global and quadrant RNFL thickness (RNFLT) were measured with the Spectralis spectral-domain optical coherence tomography (SD-OCT; Spectralis HRA+OCT [Heidelberg Engineering, Heidelberg, Germany]). Visual field damage was defined as having 3 consecutive abnormal visual fields. The rate of RNFL loss in eyes developing VFD was compared to eyes not developing VFD using multivariate linear mixed-effects models. A joint longitudinal survival model used the estimated RNFLT slope to predict the risk of developing VFD, while adjusting for potential confounding variables.
MAIN OUTCOME MEASURES
The rate of RNFL thinning and the probability of developing VFD.
RESULTS
Four hundred fifty-four eyes of 294 glaucoma suspects were included. The average number of SD-OCT examinations was 4.6 (range, 2-9), with median follow-up of 2.2 years (0.4-4.1 years). Forty eyes (8.8%) developed VFD. The estimated mean rate of global RNFL loss was significantly faster in eyes that developed VFD compared with eyes that did not develop VFD (-2.02 μm/year vs. -0.82 μm/year; P<0.001). The joint longitudinal survival model showed that each 1-μm/year faster rate of global RNFL loss corresponded to a 2.05-times higher risk of developing VFD (hazard ratio, 2.05; 95% confidence interval, 1.14-3.71; P = 0.017).
CONCLUSIONS
The rate of global RNFL loss was more than twice as fast in eyes that developed VFD compared with eyes that did not develop VFD. A joint longitudinal survival model showed that a 1-μm/year faster rate of RNFLT loss corresponded to a 2.05-times higher risk of developing VFD. These results suggest that measuring the rate of SD-OCT RNFL loss may be a useful tool to help identify patients who are at a high risk of developing visual field loss.
目的
比较怀疑患有青光眼的患者中出现视野损害（VFD）和未出现 VFD 的患者的视网膜神经纤维层（RNFL）损失率，并确定 RNFL 损失率是否可用于预测 VFD 的发生。
设计
前瞻性观察队列研究。
参与者
青光眼疑似患者，定义为具有青光眼视神经病变或高眼压（眼内压>21mmHg），但基线时无可重复的 VFD，来自诊断性青光眼研究和非裔美国人及青光眼评估研究。
方法
使用光谱域光学相干断层扫描（SD-OCT；Spectralis HRA+OCT[海德堡工程公司，海德堡，德国]）测量全视网膜和象限 RNFL 厚度（RNFLT）。将 3 次连续异常视野定义为视野损害。使用多元线性混合效应模型比较发生 VFD 眼与未发生 VFD 眼的 RNFL 损失率。联合纵向生存模型使用估计的 RNFLT 斜率来预测发生 VFD 的风险，同时调整潜在的混杂变量。
主要观察指标
RNFL 变薄率和发生 VFD 的概率。
结果
共纳入 294 例青光眼疑似患者的 454 只眼。SD-OCT 检查的平均次数为 4.6（范围，2-9），中位随访时间为 2.2 年（0.4-4.1 年）。40 只眼（8.8%）发生了 VFD。与未发生 VFD 的眼相比，发生 VFD 的眼的全视网膜平均 RNFL 损失率明显更快（-2.02μm/年比-0.82μm/年；P<0.001）。联合纵向生存模型显示，全视网膜 RNFL 每年每增加 1μm 的损失率，发生 VFD 的风险增加 2.05 倍（风险比，2.05；95%置信区间，1.14-3.71；P=0.017）。
结论
与未发生 VFD 的眼相比，发生 VFD 的眼的全视网膜 RNFL 损失率快了两倍多。联合纵向生存模型显示，RNFLT 损失率每年增加 1μm，发生 VFD 的风险增加 2.05 倍。这些结果表明，测量 SD-OCT RNFL 损失率可能是帮助识别发生视野丧失风险较高的患者的有用工具。
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