Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada.
Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada.
Ophthalmology. 2017 Sep;124(9):1392-1402. doi: 10.1016/j.ophtha.2017.03.048. Epub 2017 Apr 28.
To determine whether: (1) change in lamina cribrosa depth occurs more frequently than change in neuroretinal parameters in glaucoma, and (2) Bruch's membrane or anterior sclera should be used as a reference plane when measuring laminar depth.
Prospective observational study.
One hundred fifty-five glaucoma patients and 35 healthy controls.
Anterior laminar depth from a Bruch's membrane (LD-BM) or anterior sclera (LD-AS) reference plane were measured with optical coherence tomography. Two neuroretinal parameters, minimum rim width and retinal nerve fiber layer thickness, in addition to peripapillary choroidal thickness were measured. Factors related to laminar depth were determined with mixed-effects modeling. Cutoffs for significant change in each parameter were estimated from variability in healthy controls over 1 year. The occurrences of significant change in laminar depth and neuroretinal parameters were compared with survival models. Because normal aging has a clear effect on neuroretinal parameters, but not on laminar depth, changes in neuroretinal parameters were adjusted for age-related reduction.
Longitudinal changes in laminar depth and neuroretinal parameters.
Glaucoma patients were followed up for a mean of 3.90 years (range, 2.03-5.44 years). The LD-BM was influenced significantly more by choroidal thickness (1.14 μm/μm; 95% confidence interval, 1.07-1.21) than was the LD-AS (0.15 μm/μm; 95% confidence interval, 0.08-0.22). Posterior movement of the lamina (LD-BM increase or LD-AS increase) occurred with the same frequencies as thinning in neuroretinal parameters. Anterior movement of the lamina was detected more frequently with the Bruch's membrane (LD-BM decrease) compared with the anterior sclera (LD-AS decrease) reference plane (hazard ratio, 3.23; P < 0.01). Significant choroidal thinning occurred in most patients (25/28 [89%]) in whom anterior movement of the lamina occurred with the Bruch's membrane, but not the anterior sclera, reference plane (LD-BM decrease without LD-AS decrease). Patients had a wide range of individual rates of change of choroidal thickness, from -20.00 to 17.09 μm/year (mean, -1.62 μm/year).
Lamina cribrosa depth should be measured from an anterior sclera reference plane to reduce the influence of choroidal thickness changes. In glaucoma patients, lamina cribrosa depth changes are detected with similar frequency as neuroretinal parameter changes.
确定以下两点：（1）在青光眼患者中，筛板深度的变化是否比神经视网膜参数的变化更频繁；（2）在测量筛板深度时，应将布鲁赫膜还是前巩膜作为参考平面。
前瞻性观察性研究。
155 名青光眼患者和 35 名健康对照者。
采用光学相干断层扫描测量布鲁赫膜（LD-BM）或前巩膜（LD-AS）参考平面的前筛板深度。此外，还测量了最小边缘宽度和视网膜神经纤维层厚度等两个神经视网膜参数以及视盘周围脉络膜厚度。采用混合效应模型确定与筛板深度相关的因素。根据健康对照者在 1 年内的变异性，估计每个参数发生显著变化的截定点。将筛板深度和神经视网膜参数的显著变化与生存模型进行比较。由于正常衰老对视神经参数有明显影响，但对筛板深度没有影响，因此对神经视网膜参数的变化进行了与年龄相关的校正。
筛板深度和神经视网膜参数的纵向变化。
青光眼患者的平均随访时间为 3.90 年（范围，2.03-5.44 年）。与 LD-AS（0.15 μm/μm；95%置信区间，0.08-0.22）相比，LD-BM 受脉络膜厚度的影响明显更大（1.14 μm/μm；95%置信区间，1.07-1.21）。筛板向后移动（LD-BM 增加或 LD-AS 增加）与神经视网膜参数变薄的发生频率相同。与前巩膜（LD-AS 增加）相比，采用布鲁赫膜（LD-BM 增加）更常检测到筛板向前移动（风险比，3.23；P<0.01）。在大多数患者（25/28 [89%]）中，前筛板移动（LD-BM 下降）而不是前巩膜（LD-AS 下降）参考平面发生了明显的脉络膜变薄，但不是前巩膜（LD-AS 下降）参考平面发生了明显的脉络膜变薄（LD-BM 下降而 LD-AS 下降）。患者的脉络膜厚度个体变化率范围很广，从-20.00 至 17.09 μm/年（平均为-1.62 μm/年）。
为减少脉络膜厚度变化的影响，应从前巩膜参考平面测量筛板深度。在青光眼患者中，筛板深度的变化与神经视网膜参数的变化检测频率相同。
