Porciatti Vittorio, Feuer William J, Monsalve Pedro, Triolo Giacinto, Vazquez Luis, McSoley John, Ventura Lori M
Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL.
J Glaucoma. 2017 May;26(5):459-465. doi: 10.1097/IJG.0000000000000648.
To obtain pilot data on posture-induced changes of intraocular pressure (IOP), systemic pressure, and pattern electroretinogram (PERG) predictive of future optic nerve tissue loss glaucoma suspects (GSs).
Mean peripapillary retinal fiber layer thickness (RNFLT) was measured with optical coherence tomography 2 times/year in 28 GS aged 58±8.9 years over 5.0±0.73 years. All patients had a baseline PERG, IOP, and brachial blood pressure measurements in the seated and -10 degrees head-down-body-tilt (HDT) position. Outcome measures were seated/HDT PERG amplitude and phase, IOP, mean arterial blood pressure, and estimated ocular perfusion pressure. An additional group of 11 similarly aged controls aged 56.9±13 years was tested for comparison.
Although all GS had initial RNFLT in the normal range, 9/28 of them developed significant (P<0.05) loss of mean RNFLT [thinners (T)] over the follow-up period as opposed to 19/28 who did not [nonthinners (NT)]. Significant (P<0.05) differences between similarly aged controls, NT, and T were found in PERG amplitude, PERG phase, mean arterial blood pressure, IOP, and ocular perfusion pressure. A nominal logistic regression using baseline PERG and hemodynamic variables was able to distinguish T from NT with an area under receiving operator characteristic of 0.89 (SE, 0.07).
Baseline PERG, IOP, and systemic blood pressure, together with their changes upon HDT, may have predictive value for future loss of optic nerve tissue in GS. This study supports the rationale for a full-scale clinical trial to identify patients at high risk of development of glaucoma.
获取有关姿势引起的眼压（IOP）、全身血压和图形视网膜电图（PERG）变化的试验性数据，这些变化可预测未来青光眼可疑患者（GSs）视神经组织的丢失。
在5.0±0.73年的时间里，对28名年龄为58±8.9岁的GS患者，每年用光学相干断层扫描测量2次平均视乳头周围视网膜神经纤维层厚度（RNFLT）。所有患者在坐位和头向下倾斜10度（HDT）体位下进行了基线PERG、IOP和肱动脉血压测量。观察指标为坐位/HDT体位下的PERG振幅和相位、IOP、平均动脉血压以及估计的眼灌注压。另外测试了一组11名年龄相仿的对照者，年龄为56.9±13岁，用于比较。
尽管所有GS患者最初的RNFLT都在正常范围内，但其中9/28的患者在随访期间平均RNFLT出现了显著（P<0.05）丢失[变薄者（T）]，而19/28的患者未出现[未变薄者（NT）]。在年龄相仿的对照者、NT和T之间，在PERG振幅、PERG相位、平均动脉血压、IOP和眼灌注压方面发现了显著（P<0.05）差异。使用基线PERG和血流动力学变量进行的名义逻辑回归能够以0.89（标准误，0.07）的受试者工作特征曲线下面积区分T和NT。
基线PERG、IOP和全身血压及其在HDT时的变化，可能对视神经组织未来在GS患者中的丢失具有预测价值。本研究支持进行全面临床试验以识别青光眼高危患者的理论依据。
