Diniz-Filho Alberto, Abe Ricardo Y, Zangwill Linda M, Gracitelli Carolina P B, Weinreb Robert N, Girkin Christopher A, Liebmann Jeffrey M, Medeiros Felipe A
Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California.
Ophthalmology. 2016 Oct;123(10):2058-65. doi: 10.1016/j.ophtha.2016.07.006. Epub 2016 Aug 20.
To evaluate the relationship between intraocular pressure (IOP) and rates of retinal nerve fiber layer (RNFL) thickness change over time measured by spectral-domain (SD) optical coherence tomography (OCT).
Observational cohort study.
The study involved 547 eyes of 339 patients followed up for an average of 3.9±0.9 years. Three hundred eight (56.3%) had a diagnosis of glaucoma and 239 (43.7%) were considered glaucoma suspects.
All eyes underwent imaging using the Spectralis SD OCT (Heidelberg Engineering GmbH, Heidelberg, Germany), along with IOP measurements and standard automated perimetry (SAP). Glaucoma progression was defined as a result of "Likely Progression" from the Guided Progression Analysis software for SAP. Linear mixed models were used to investigate the relationship between average IOP during follow-up and rates of RNFL thickness change, while taking into account potential confounding factors such as age, race, corneal thickness, and baseline disease severity.
The association between IOP and rates of global and sectorial RNFL thickness loss measured by SD OCT.
Forty-six eyes (8.4%) showed progression on SAP during follow-up. Rates of global RNFL thickness change in eyes that progressed by SAP were faster than in those that did not progress (-1.02 vs. -0.61 μm/year, respectively; P = 0.002). For progressing eyes, each 1-mmHg higher average in IOP during follow-up was associated with an additional average loss of 0.20 μm/year (95% confidence interval [CI]: 0.08 to 0.31 μm/year; P < 0.001) of global RNFL thickness versus only 0.04 μm/year (95% CI: 0.01 to 0.07 μm/year; P = 0.015) for nonprogressing eyes. The largest associations between IOP and rates of RNFL change were seen for measurements from the temporal superior and temporal inferior sectors, whereas the smallest association was seen for measurements from the nasal sector.
Higher levels of IOP during follow-up were associated with faster rates of RNFL loss over time measured by SD OCT. These findings support the use of SD OCT RNFL thickness measurements as biomarkers for the evaluation of the efficacy of IOP-lowering therapies to slow down the rate of disease progression.
评估眼内压（IOP）与通过光谱域（SD）光学相干断层扫描（OCT）测量的视网膜神经纤维层（RNFL）厚度随时间变化率之间的关系。
观察性队列研究。
该研究纳入了339例患者的547只眼睛，平均随访3.9±0.9年。其中308例（56.3%）被诊断为青光眼，239例（43.7%）被视为青光眼疑似患者。
所有眼睛均使用Spectralis SD OCT（德国海德堡海德堡工程有限公司）进行成像，并测量眼压和进行标准自动视野检查（SAP）。青光眼进展通过SAP的引导进展分析软件判定为“可能进展”。采用线性混合模型研究随访期间平均眼压与RNFL厚度变化率之间的关系，同时考虑年龄、种族、角膜厚度和基线疾病严重程度等潜在混杂因素。
通过SD OCT测量的眼压与整体及各象限RNFL厚度损失率之间的关联。
46只眼睛（8.4%）在随访期间经SAP检查显示有进展。经SAP检查显示进展的眼睛，其整体RNFL厚度变化率比未进展的眼睛更快（分别为-1.02 vs. -0.61μm/年；P = 0.002）。对于进展性眼睛，随访期间眼压每升高1mmHg，整体RNFL厚度平均每年额外损失0.20μm（95%置信区间[CI]：0.08至0.31μm/年；P < 0.001），而对于非进展性眼睛仅为0.04μm/年（95%CI：0.01至0.07μm/年；P = 0.015）。眼压与RNFL变化率之间的最大关联见于颞上象限和颞下象限的测量，而最小关联见于鼻侧象限的测量。
随访期间较高的眼压水平与通过SD OCT测量的RNFL随时间更快的损失率相关。这些发现支持将SD OCT RNFL厚度测量用作生物标志物，以评估降低眼压治疗减缓疾病进展速度的疗效。
