鸟枪弹样视网膜脉络膜病变患者的不良预后因素

POOR PROGNOSTIC FACTORS IN PATIENTS WITH BIRDSHOT RETINOCHOROIDOPATHY.

作者信息

Silpa-Archa Sukhum, Lee Joan J, Boonsopon Sutasinee, Lizárraga Marisol T, Preble Janine M, Sujirarat Dusit, Patel Pranav, Foster C Stephen

机构信息

*Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; †Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts; ‡Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand; §Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; ¶Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand; and **Harvard Medical School, Boston, Massachusetts.

出版信息

Retina. 2016 Nov;36(11):2220-2226. doi: 10.1097/IAE.0000000000001051.

DOI:10.1097/IAE.0000000000001051

PMID:27115993

Abstract

PURPOSE

To identify prognostic factors for poor visual outcome in patients with birdshot retinochoroidopathy.

METHODS

A case-control study of 98 patients with birdshot retinochoroidopathy (196 eyes) was evaluated with a follow-up period of at least 12 months. After exclusion of glaucoma, optic atrophy, and macular scar, the remaining eligible patients were categorized into two groups: poor visual outcomes and good visual outcomes. Poor visual outcome was defined as less than -6 mean deviation score on Swedish interactive threshold algorithm (SITA) short-wavelength automated perimetry (SWAP) test and abnormality (amplitude or implicit time) of 30 Hz flicker electroretinogram at 4-year follow-up and at the most recent visit for separate analysis. Potential factors between both groups were statistically analyzed by Chi-square test and logistic regression model.

RESULTS

After the aforementioned exclusion, the remaining 77 patients with an average follow-up period of 52 ± 29 months (335 person-years, 36% with follow-up of more than 5 years) were divided into two groups. Sixteen patients were categorized as having poor visual outcome. Univariate analysis identified significant association of abnormal 30 Hz flicker electroretinogram amplitude (P = 0.004), implicit time (P = 0.002), and SITA SWAP mean deviation at the initial visit (P < 0.001) in the poor visual outcome group. Multivariate logistic regression analysis identified only SITA SWAP mean deviation to be associated with poor visual outcome (adjusted odds ratio, 32.50; 95% confidence interval [3.84-275.32]; P = 0.001) at the initial visit. To verify the model validity, an analysis of 42 patients at 4-year follow-up was performed and the outcome was confirmed (adjusted odds ratio, 8.80; 95% confidence interval [1.58-49.16]; P = 0.013).

CONCLUSION

Worse SITA SWAP mean deviation at the initial visit is a predictor of poor visual outcome in patients with birdshot retinochoroidopathy, and may serve as a proxy marker for delayed effective steroid sparing therapy in patients with birdshot retinochoroidopathy.

摘要

目的

确定鸟枪弹样视网膜脉络膜病变患者视力预后不良的预测因素。

方法

对98例鸟枪弹样视网膜脉络膜病变患者（196只眼）进行病例对照研究，随访期至少12个月。排除青光眼、视神经萎缩和黄斑瘢痕后，将其余符合条件的患者分为两组：视力预后不良组和视力预后良好组。视力预后不良定义为在瑞典交互式阈值算法（SITA）短波自动视野计（SWAP）测试中平均偏差得分低于-6，以及在4年随访时和最近一次单独分析就诊时30Hz闪烁视网膜电图异常（振幅或隐含时间）。两组之间的潜在因素通过卡方检验和逻辑回归模型进行统计学分析。

结果

经过上述排除后，其余77例患者平均随访期为52±29个月（335人年，36%随访超过5年），分为两组。16例患者被归类为视力预后不良。单因素分析发现，视力预后不良组中30Hz闪烁视网膜电图振幅异常（P = 0.004）、隐含时间异常（P = 0.002）以及初次就诊时SITA SWAP平均偏差异常（P < 0.001）之间存在显著关联。多因素逻辑回归分析仅发现初次就诊时SITA SWAP平均偏差与视力预后不良相关（调整优势比，32.50；95%置信区间[3.84 - 275.32]；P = 0.001）。为验证模型有效性，对42例患者进行了4年随访分析，结果得到证实（调整优势比，8.80；95%置信区间[1.58 - 49.16]；P = 0.013）。