Jin Sang Wook, Seo Hong Ryung, Rho Seung Soo, Rho Sae Heun
a Department of Ophthalmology , Dong-A University Hospital , Busan , Republic of Korea.
b Department of Ophthalmology , Wallace Memorial Baptist Hospital , Busan , Republic of Korea.
Semin Ophthalmol. 2017;32(4):504-510. doi: 10.3109/08820538.2015.1123733. Epub 2016 Apr 29.
To evaluate the effect of nocturnal dip and blood pressure (BP) variability on paracentral scotoma in early open-angle glaucoma.
The present study included 72 early normal-tension glaucoma (NTG) patients and 34 early primary open-angle glaucoma (POAG) patients. Nocturnal dip and weighted standard deviation (wSD) were determined by 24-hour ambulatory BP monitoring (24-hr ABPM). The mean deviation (MD) and pattern deviation (PD) were measured with visual field. Correlations between nocturnal dip and/or BP variability and paracentral scotoma were assessed using Student's t-test, Pearson's correlation test, and linear logistic regression analysis.
The systolic and diastolic nocturnal dip and paracentral scotoma occurrence demonstrated a statistically significant correlation in the early NTG group (systolic nocturnal dip: p=0.047, diastolic nocturnal dip: p=0.011). In the early NTG group, the subgroup with paracentral scotoma had a greater nocturnal dip than those patients without paracentral scotoma (systolic nocturnal dip: p=0.000; diastolic nocturnal dip: p=0.000). In the early NTG group, the subgroup with paracentral scotoma had higher wSD of SBP than the patients without paracentral scotoma (p=0.003). In the logistic regression analysis of the factors that can affect paracentral scotoma SBP dip and SBP, wSD appeared to significantly affect the occurrence of paracentral scotoma in the early NTG group.
Early NTG patients with paracentral scotoma have nocturnal dip and large BP variability. Therefore, in early glaucoma patients, particularly in early NTG with paracentral scotoma, nocturnal dip and BP variability should be assessed with 24-hr ABPM.
评估夜间血压下降及血压（BP）变异性对早期开角型青光眼中心旁暗点的影响。
本研究纳入72例早期正常眼压性青光眼（NTG）患者和34例早期原发性开角型青光眼（POAG）患者。通过24小时动态血压监测（24小时ABPM）测定夜间血压下降及加权标准差（wSD）。用视野检查测量平均偏差（MD）和模式偏差（PD）。采用Student t检验、Pearson相关检验和线性逻辑回归分析评估夜间血压下降和/或血压变异性与中心旁暗点之间的相关性。
在早期NTG组中，收缩压和舒张压的夜间血压下降与中心旁暗点的发生呈现出统计学上的显著相关性（收缩压夜间血压下降：p = 0.047，舒张压夜间血压下降：p = 0.011）。在早期NTG组中，有中心旁暗点的亚组比没有中心旁暗点的患者有更大的夜间血压下降（收缩压夜间血压下降：p = 0.000；舒张压夜间血压下降：p = 0.000）。在早期NTG组中，有中心旁暗点的亚组的收缩压wSD高于没有中心旁暗点的患者（p = 0.003）。在对可影响中心旁暗点的收缩压下降和收缩压的因素进行的逻辑回归分析中，wSD似乎对早期NTG组中心旁暗点的发生有显著影响。
有中心旁暗点的早期NTG患者存在夜间血压下降和较大的血压变异性。因此，在早期青光眼患者中，特别是在有中心旁暗点的早期NTG患者中，应通过24小时ABPM评估夜间血压下降和血压变异性。
