Kwon Junki, Sung Kyung Rim, Park Ji Min
Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea.
Br J Ophthalmol. 2017 Dec;101(12):1618-1622. doi: 10.1136/bjophthalmol-2016-309914. Epub 2017 Apr 10.
To compare the clinical courses of patients with myopic primary open angle glaucoma (POAG) with and without optic disc shape alterations.
In this longitudinal retrospective study, 146 eyes from 146 patients with myopic (axial length(AXL), >24 mm) POAG were classified according to optic disc shape alterations defined by optic disc tilt and/or rotation. Glaucomatous progression was determined by either serial optic disc/retinal nerve fibre layer photographs or visual field (VF) exams. Rate of progression was calculated from serial VF mean deviation (MD) and visual field index values.
Mean age, AXL and follow-up duration were 50.1±12.7 years, 26.1±1.6 mm and 4.6±1.3 years, respectively. The progression rate was faster in eyes with a non-tilted optic disc than with a tilted optic disc (-0.30(95% CI; -0.42 to -0.16) vs 0.05(-0.07 to 0.17) dB/year, -0.85(-1.20 to -0.49) vs -0.35(-0.68 to -0.03) %/year, all p<0.05). Twenty eyes (21.3%) in the non-tilted group but only one eye (1.9%) in the tilted group showed VF progression in both superior and inferior hemifields. By logistic regression analysis, worse initial VF MD and less optic disc tilt were significantly associated with both superior and inferior VF progression (OR=0.909 and 0.561 (for 0.1 tilt ratio); p=0.020 and 0.018, respectively).
Significant differences in glaucomatous progression were found between eyes with and without optic disc shape alterations, particularly disc tilt. More localised and stable courses of glaucoma progression were observed in eyes with tilted optic discs.
比较有和没有视盘形态改变的近视性原发性开角型青光眼（POAG）患者的临床病程。
在这项纵向回顾性研究中，对146例近视（眼轴长度[AXL]＞24mm）POAG患者的146只眼睛，根据视盘倾斜和/或旋转所定义的视盘形态改变进行分类。青光眼进展通过系列视盘/视网膜神经纤维层照片或视野（VF）检查来确定。进展率根据系列VF平均偏差（MD）和视野指数值计算得出。
平均年龄、眼轴长度和随访时间分别为50.1±12.7岁、26.1±1.6mm和4.6±1.3年。非倾斜视盘的眼睛进展率比倾斜视盘的眼睛更快（-0.30（95%CI：-0.42至-0.16）对0.05（-0.07至0.17）dB/年，-0.85（-1.20至-0.49）对-0.35（-0.68至-0.03）%/年，所有p＜0.05）。非倾斜组中有20只眼睛（21.3%），但倾斜组中只有1只眼睛（1.9%）在上下半视野均显示VF进展。通过逻辑回归分析，较差的初始VF MD和较小的视盘倾斜与上下VF进展均显著相关（OR = 0.909和0.561（对于0.1的倾斜率）；p分别为0.020和0.018）。
有和没有视盘形态改变的眼睛之间，尤其是视盘倾斜，在青光眼进展方面存在显著差异。在视盘倾斜的眼睛中观察到更局限和稳定的青光眼进展过程。
