Choi Jin A, Park Hae-Young Lopilly, Shin Hye-Young, Park Chan Kee
Department of Ophthalmology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon, Republic of Korea.
Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea.
JAMA Ophthalmol. 2014 Sep;132(9):1068-75. doi: 10.1001/jamaophthalmol.2014.1056.
Eyes with initial bihemifield defects show faster progression compared with eyes with initial single-hemifield involvement, suggesting greater optic nerve susceptibility to glaucomatous damage. We hypothesized that certain disc phenotypes may exist in patients with glaucoma who have bihemispheric structural damage at the initial stage of the disease.
To identify the optic disc characteristics related to bihemispheric retinal nerve fiber layer (RNFL) defects in early-stage glaucoma.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study of 136 patients with early-stage primary open-angle glaucoma from a glaucoma referral practice. Eyes were divided into those with RNFL defects in the superior or the inferior hemisphere (group 1) and those with bihemispheric RNFL defects (group 2). We measured the degree of horizontal tilt angle and RNFL thickness using spectral-domain optical coherence tomography. We performed multivariate logistic regression analysis to determine potential risk factors related to the bihemispheric RNFL defects.
Bihemispheric RNFL defects.
Disc ovality (defined as the ratio between the longest and shortest diameters of the optic disc), the degree of horizontal tilt angle, and the presence of bihemispheric RNFL defects. Asymmetry in RNFL thickness between hemispheres was defined as the difference between the superior and inferior mean RNFL thickness.
Disc ovality (mean [SD], 1.09 [0.12] in group 1 vs 1.18 [0.18] in group 2; difference, -0.09; 95% CI, -0.14 to -0.03), proportion of tilted discs (5.3% vs 17.5%, respectively; difference, -12.2; 95% CI, -13.0 to -11.4), and horizontal tilt angle (mean [SD], 4.17° [4.13°] vs 5.93° [4.84°], respectively; difference, -1.76; 95% CI, -3.47 to -0.03) were significantly different between groups 1 and 2 (P = .001, P = .03, and P = .045, respectively). The asymmetry in RNFL thickness decreased with increased disc ovality (exponentiation of the B coefficient, 1.67; 95% CI, 1.10-2.55; P = .02), although associations were not identified with spherical equivalent, axial length, or the angle between the temporal retinal veins. In multivariate logistic analysis, disc ovality was suggested to be an independent risk factor for bihemispheric RNFL defects, after controlling for mean deviation, age, axial length, and disc area (P = .02).
Optic disc tilt appears to be associated with bihemispheric RNFL defects in patients with early glaucoma, regardless of their refractive status. These data suggest that disc tilt, associated with bihemispheric structural damages, is a risk factor for glaucoma progression.
与最初单眼半视野受累的眼睛相比，最初出现双眼半视野缺损的眼睛进展更快，这表明视神经对青光眼性损害更敏感。我们推测，在青光眼疾病初始阶段出现双眼半球结构损害的患者中可能存在某些视盘表型。
确定早期青光眼患者中与双眼半球视网膜神经纤维层（RNFL）缺损相关的视盘特征。
设计、设置和参与者：一项对来自青光眼转诊诊所的136例早期原发性开角型青光眼患者的横断面研究。将眼睛分为上半球或下半球存在RNFL缺损的患者（第1组）和双眼半球均存在RNFL缺损的患者（第2组）。我们使用光谱域光学相干断层扫描测量水平倾斜角和RNFL厚度。我们进行多因素逻辑回归分析以确定与双眼半球RNFL缺损相关的潜在危险因素。
双眼半球RNFL缺损。
视盘椭圆率（定义为视盘最长直径与最短直径之比）、水平倾斜角程度以及双眼半球RNFL缺损情况。半球间RNFL厚度的不对称性定义为上、下平均RNFL厚度之差。
视盘椭圆率（第1组均值[标准差]为1.09[0.12]，第2组为1.18[0.18]；差异为 -0.09；95%置信区间为 -0.14至 -0.03）、倾斜视盘比例（分别为5.3%和17.5%；差异为 -12.2；95%置信区间为 -13.0至 -11.4）以及水平倾斜角（第1组均值[标准差]为4.17°[4.13°]，第2组为5.93°[4.84°]；差异为 -1.76；95%置信区间为 -3.47至 -0.03）在第1组和第2组之间有显著差异（P分别为0.001、0.03和0.045）。RNFL厚度的不对称性随着视盘椭圆率的增加而降低（B系数的指数为1.67；95%置信区间为1.10 - 2.55；P = 0.02），尽管未发现与等效球镜度、眼轴长度或颞侧视网膜静脉夹角之间存在关联。在多因素逻辑分析中，在控制了平均偏差、年龄、眼轴长度和视盘面积后，视盘椭圆率被认为是双眼半球RNFL缺损的独立危险因素（P = 0.02）。
在早期青光眼患者中，无论其屈光状态如何对视盘倾斜似乎与双眼半球RNFL缺损有关。这些数据表明，与双眼半球结构损害相关的视盘倾斜是青光眼进展的一个危险因素。
