Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, PRC.
Hamilton Glaucoma Center and the Shiley Eye Center, Department of Ophthalmology, University of California, San Diego, California.
Ophthalmology. 2015 Jul;122(7):1317-29. doi: 10.1016/j.ophtha.2015.02.035. Epub 2015 May 9.
To evaluate long-term, longitudinal displacement of the optic nerve head (ONH) and anterior lamina cribrosa surfaces in glaucoma patients imaged with spectral-domain optical coherence tomography (SD OCT).
Prospective study.
A total of 173 eyes of 108 subjects (88 with glaucoma and 20 normal subjects) followed for a mean of 5.3 years.
The optic disc was imaged with SD OCT at approximately 4-month intervals, and the ONH surface depth (ONHSD), anterior lamina cribrosa surface depth (ALCSD), and prelaminar tissue thickness (PTT) were measured. The reproducibility coefficients of ONHSD, ALCSD, and PTT were calculated from 2 baseline measurements of the glaucoma group. Change in ONHSD/ALCSD/PTT was confirmed when the differences between the first baseline and the latest 2 consecutive follow-up visits were greater than the corresponding reproducibility coefficient. Factors associated with ONHSD and ALCSD changes were identified with linear mixed modeling.
Proportion of eyes with ONHSD/ALCSD change.
Within the glaucoma group, 23.9% (33 eyes) had confirmed ONHSD change (15.2% with posterior and 8.7% with anterior displacement) and 24.6% (34 eyes) had confirmed ALCSD change (12.3% with posterior and 12.3% with anterior displacement). Some 9.4% (13 eyes) showed a decrease in PTT, and 2.2% (3 eyes) showed an increase in PTT. The specificity for detection of ONHSD/ALCSD/PTT change was 91.4% (95% confidence interval [CI], 77.6-97.0), 82.9% (95% CI, 67.3-91.9), and 94.3% (95% CI, 81.4-98.4), respectively. There were no significant differences in the proportion of eyes with visual field progression or history of filtration surgery between the groups with anterior and posterior displacement of ONH/anterior laminar surfaces (P ≥ 0.678). For each millimeter of mercury increase in the average intraocular pressure (IOP) during follow-up, the ONH and anterior laminar surfaces displaced posteriorly by 1.6 μm and 2.0 μm, respectively. An older age was associated with a decrease in magnitude of posterior displacement of the ONH and anterior laminar surfaces (P ≤ 0.009).
The ONH and anterior laminar surfaces displaced not only posteriorly but also anteriorly (with reference to Bruch's membrane opening) in a significant portion of glaucoma patients. The magnitude of change was related to age and the averaged IOP during follow-up.
评估应用谱域光学相干断层扫描（SD OCT）对青光眼患者视神经头（ONH）和前筛板表面进行长期纵向位移的研究。
前瞻性研究。
88 例青光眼患者和 20 例正常对照者共 173 只眼，随访平均 5.3 年。
每隔 4 个月用 SD OCT 对视盘成像，测量 ONH 表面深度（ONHSD）、前筛板表面深度（ALCSD）和前层组织厚度（PTT）。从青光眼组的 2 次基线测量中计算出 ONHSD、ALCSD 和 PTT 的可重复性系数。当第一次基线和最近的 2 次连续随访之间的差异大于相应的可重复性系数时，确认 ONHSD/ALCSD/PTT 的变化。采用线性混合模型确定与 ONHSD 和 ALCSD 变化相关的因素。
ONHSD/ALCSD 变化的眼比例。
在青光眼组中，23.9%（33 只眼）经证实发生了 ONHSD 变化（15.2%为后向移位，8.7%为前向移位），24.6%（34 只眼）经证实发生了 ALCSD 变化（12.3%为后向移位，12.3%为前向移位）。9.4%（13 只眼）出现 PTT 减少，2.2%（3 只眼）出现 PTT 增加。检测 ONHSD/ALCSD/PTT 变化的特异性分别为 91.4%（95%可信区间[CI]，77.6%～97.0%）、82.9%（95% CI，67.3%～91.9%）和 94.3%（95% CI，81.4%～98.4%）。ONH 和前筛板表面发生前向和后向移位的各组间，视野进展或滤过性手术史的比例无显著差异（P≥0.678）。在随访过程中，平均眼内压（IOP）每升高 1 毫米汞柱，ONH 和前筛板表面分别向后和向前移位 1.6 μm 和 2.0 μm。年龄越大，ONH 和前筛板表面向后移位的幅度越小（P≤0.009）。
青光眼患者的视神经头和前筛板表面不仅向后移位（相对于 Bruch 膜开口），而且还向前移位（相对于 Bruch 膜开口）。变化的幅度与年龄和随访期间的平均 IOP 有关。
