Moise and Chella Safra Advanced Ocular Imaging Laboratory, Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, New York.
Moise and Chella Safra Advanced Ocular Imaging Laboratory, Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, New York; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York.
Ophthalmology. 2014 Aug;121(8):1524-30. doi: 10.1016/j.ophtha.2014.02.017. Epub 2014 Mar 31.
To evaluate the association between focal, structural defects of the lamina cribrosa (LC) and glaucomatous visual field (VF) progression.
Retrospective, observational study.
A total of 169 patients with glaucoma (169 eyes) with a range of glaucomatous damage.
Serial horizontal and vertical enhanced-depth imaging optical coherence tomography (EDI OCT) B-scans of the optic nerve head were obtained from patients with glaucoma with 5 or more prior Humphrey 24-2 VFs (Carl Zeiss Meditec, Inc, Dublin, CA). The EDI OCT scans were reviewed for the presence of focal LC defects (laminar holes or disinsertions with a diameter >100 μm). The VF progression was defined as having ≥ 2 significantly progressing test points (with a slope calculated using pointwise linear regression [PLR], worse than -1.0 dB/year at P<0.01). Age, intraocular pressure (IOP), baseline VF mean deviation (MD), disc hemorrhage, and central corneal thickness (CCT) were recorded.
The relationship between focal LC defects and the rate and risk of VF progression.
Mean age and VF MD at the time of EDI OCT were 69 ± 12 years and -11.49 ± 6.87 dB, respectively. Sixty eyes (36%) progressed according to PLR criteria. Progression was more common in eyes with, rather than without, focal LC defects (38/81 eyes [47%] vs. 22/88 eyes [25%], P = 0.003). Among the evaluated parameters, the presence of focal LC defects, disc hemorrhage, higher mean follow-up IOP, greater number of VFs, and longer follow-up period were significantly associated with VF progression in the multivariable analyses (odds ratios, 2.90, 4.66, 1.22, 1.25, and 1.27, respectively; P = 0.010, P = 0.002, P = 0.002, P<0.001, and P<0.001, respectively). The mean global progression rate was significantly faster in the group with focal LC defect than in the group with no focal LC defect (-0.54 ± 0.99 dB/year vs. -0.28 ± 0.52 dB/year; P = 0.031). Among the 60 progressing eyes, despite no significant difference in the mean number of progressing VF points per eye (6.7 ± 7.0 vs. 6.5 ± 4.4; P = 0.899), the mean localized progression rate was significantly faster in the eyes with focal LC defects than in the eyes with no focal LC defects (-2.85 ± 1.85 dB/year vs. -1.75 ± 0.56 dB/year; P = 0.009).
Focal LC defects are strongly associated with glaucomatous VF progression, and eyes with focal LC defects tend to progress faster than those without.
评估局限性、结构性板层裂孔（LC）结构缺陷与青光眼视野（VF）进展之间的关系。
回顾性、观察性研究。
共纳入 169 例（169 只眼）不同程度青光眼患者，这些患者具有一系列青光眼损伤。
对患有青光眼的患者进行了 5 次或 5 次以上的 Humphrey 24-2 VF 检查（德国卡尔蔡司公司），对这些患者进行了视神经头水平和垂直增强深度成像光学相干断层扫描（EDI OCT）B 扫描。对 EDI OCT 扫描进行了检查，以观察是否存在局限性 LC 缺陷（板层孔或与直径>100 μm 的脱离）。VF 进展的定义是有≥2 个显著进展的测试点（使用逐点线性回归[PLR]计算斜率，斜率差大于-1.0 dB/年，P<0.01）。记录了年龄、眼内压（IOP）、基线 VF 平均偏差（MD）、盘出血和中央角膜厚度（CCT）。
局限性 LC 缺陷与 VF 进展的速度和风险之间的关系。
进行 EDI OCT 时的平均年龄和 VF MD 分别为 69±12 岁和-11.49±6.87 dB。根据 PLR 标准，60 只眼（36%）进展。与无局限性 LC 缺陷的眼相比，有局限性 LC 缺陷的眼更常发生进展（38/81 眼[47%] vs. 22/88 眼[25%]，P=0.003）。在评估的参数中，局限性 LC 缺陷、盘出血、较高的平均随访 IOP、更多的 VF 和更长的随访时间在多变量分析中与 VF 进展显著相关（比值比分别为 2.90、4.66、1.22、1.25 和 1.27，P=0.010、P=0.002、P=0.002、P<0.001 和 P<0.001）。局限性 LC 缺陷组的平均全局进展速度明显快于无局限性 LC 缺陷组（-0.54±0.99 dB/年 vs. -0.28±0.52 dB/年；P=0.031）。在 60 只进展的眼中，尽管每只眼进展的 VF 点的平均数量（6.7±7.0 与 6.5±4.4；P=0.899）无显著差异，但局限性 LC 缺陷眼中的局部进展速度明显快于无局限性 LC 缺陷眼（-2.85±1.85 dB/年 vs. -1.75±0.56 dB/年；P=0.009）。
局限性 LC 缺陷与青光眼 VF 进展密切相关，且局限性 LC 缺陷的眼比无局限性 LC 缺陷的眼进展更快。
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