Department of Ophthalmology, Lund University, Skåne University Hospital, Malmö, Sweden.
Department of Ophthalmology, Lund University, Skåne University Hospital, Malmö, Sweden.
Ophthalmology. 2015 May;122(5):1034-9. doi: 10.1016/j.ophtha.2014.12.004. Epub 2014 Dec 20.
To investigate whether threat to fixation (TTF) at diagnosis increases the risk of central vision loss and glaucoma blindness.
Retrospective cohort study.
A total of 309 patients (309 eyes) with glaucoma were followed up until death; 203 patients (65.7%) had primary open-angle glaucoma, and 106 patients (34.2%) had exfoliation glaucoma.
Study eyes were divided into 2 groups according to TTF in the first glaucomatous visual field: (1) eyes with TTF, defined as visual field loss (VFL) including ≥1 of the 4 innermost points depressed at P < 1% level in 24-2 or 30-2 Humphrey fields; (2) eyes without TTF, defined as VFL only outside the 4 innermost points. Lifetime risk of visual acuity (VA) loss and glaucoma blindness in the 2 groups was compared by logistic regression analysis. A matching technique was used to adjust for differences in disease stage at presentation. The relative influence of TTF on the risk of blindness in the 2 matched groups was analyzed by the Kaplan-Meier method.
Visual acuity <0.3 and blindness from glaucoma (World Health Organization criteria) at last visit.
Threat to fixation was detected in 58.9% of the eyes at diagnosis. The frequency of TTF increased with stage of glaucomatous loss: 28.3% in eyes with mean deviation (MD) >-6.00 decibels (dB) versus 95.7% with MD <-20.00 dB. Univariate analysis demonstrated that eyes with TTF at presentation compared with eyes without TTF became blind more often (56/182 [30.8%] vs. 22/127 [17.3%]; P = 0.008) and faster (mean time from diagnosis to blindness, 84.6±50.7 vs. 126.7±51.4 months; P < 0.002). However, in multivariate analysis, TTF was not an independent risk factor for VA <0.3 (odds ratio, 1.43; 95% confidence interval, 0.75-2.74) or blindness (odds ratio, 1.03; 95% confidence interval, 0.52-2.01). With regard to patient survival time, there were no differences between eyes with TTF and eyes without TTF after adjusting for disparities in disease severity at presentation (P = 0.934).
Including TTF in the assessment of risk for glaucoma blindness did not add any important information when the stage of VFL was taken into account.
研究诊断时的固视威胁（TTF）是否会增加中心视力丧失和青光眼盲的风险。
回顾性队列研究。
共随访了 309 例（309 只眼）青光眼患者，直至死亡；203 例（65.7%）为原发性开角型青光眼，106 例（34.2%）为剥脱性青光眼。
根据首次青光眼视野中的 TTF，将研究眼分为 2 组：（1）TTF 组，定义为视野损失（VFL）包括 24-2 或 30-2 Humphrey 视野中 4 个最内点中有≥1 个在 P<1%水平下降；（2）无 TTF 组，定义为仅在 4 个最内点之外的 VFL。通过逻辑回归分析比较两组患者视力丧失（VA）和青光眼盲的终生风险。采用匹配技术调整就诊时疾病阶段的差异。通过 Kaplan-Meier 法分析 TTF 对两组匹配患者失明风险的相对影响。
最后一次就诊时视力<0.3 和青光眼致盲（世界卫生组织标准）。
诊断时 58.9%的眼检测到 TTF。TTF 的频率随青光眼损失的阶段而增加：平均偏差（MD）>-6.00 分贝（dB）的眼为 28.3%，而 MD<-20.00 dB 的眼为 95.7%。单变量分析表明，与无 TTF 的眼相比，有 TTF 的眼更容易失明（56/182[30.8%]vs.22/127[17.3%]；P=0.008），且更快（从诊断到失明的平均时间，84.6±50.7 与 126.7±51.4 个月；P<0.002）。然而，多变量分析表明，TTF 不是 VA<0.3（比值比，1.43；95%置信区间，0.75-2.74）或失明（比值比，1.03；95%置信区间，0.52-2.01）的独立危险因素。在调整就诊时疾病严重程度的差异后，TTF 组与无 TTF 组的患者生存时间无差异（P=0.934）。
当考虑到 VFL 阶段时，将 TTF 纳入青光眼盲风险评估中并没有提供任何重要信息。
