De Moraes Carlos G, Susanna Remo, Sakata Lisandro M, Hatanaka Marcelo
*Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Columbia University Medical Center, Edward S. Harkness Eye Institute, New York, NY †Department of Ophthalmology, University of Sao Paulo School of Medicine, Avenue Dr. Enéas de Carvalho Aguiar, São Paulo, SP ‡Department of Ophthalmology, Federal University of Parana School of Medicine, Rua Gen. Carneiro, Curitiba, PR, Brazil.
J Glaucoma. 2017 Sep;26(9):767-773. doi: 10.1097/IJG.0000000000000725.
The purpose of this is to test the hypothesis the intraocular pressure (IOP) peaks during a stress test [the water drinking test (WDT)] can estimate the risk of future visual field progression in treated primary open-angle glaucoma (POAG) patients.
Design: Prospective, longitudinal study.
Clinical practice.
Treated POAG patients whose IOP was ≤18 mm Hg and who had no IOP-lowering interventions between the date of the WDT and the last eligible visual field.
At baseline examination, patients underwent the WDT and were then followed at regular intervals with office-based IOP measurements and visual field testing.
Cox-proportional hazards survival analysis testing the predictive value of IOP peaks during the WDT versus IOP measurements during office hours on visual field progression.
A total of 144 eyes of 96 patients with baseline visual field damage ranging from mild to severe followed for a mean of 28 months were analyzed. In the multivariable analysis adjusting for potential confounders, higher IOP peaks during the WDT were predictive of future visual field progression (hazard ratio=1.11; 95% confidence interval, 1.02 to 1.21; P=0.013). The average and peak IOP during office hours over the same follow-up period were not significantly associated with progression (P=0.651 and 0.569, respectively).
IOP peaks detected with the WDT were predictive of future visual field progression in a treated POAG population. This stress test could be a useful tool for risk assessment in daily practice.
本研究旨在验证以下假设，即在压力测试[饮水试验（WDT）]期间眼内压（IOP）峰值可用于评估接受治疗的原发性开角型青光眼（POAG）患者未来视野进展的风险。
设计：前瞻性纵向研究。
临床实践。
接受治疗的POAG患者，其IOP≤18mmHg，且在WDT日期至最后一次符合条件的视野检查期间未进行降低IOP的干预。
在基线检查时，患者接受WDT，然后定期进行门诊IOP测量和视野测试。
采用Cox比例风险生存分析，测试WDT期间IOP峰值与门诊时间IOP测量值对视野进展的预测价值。
对96例患者的144只眼进行了分析，这些患者基线视野损害程度从轻度到重度不等，平均随访28个月。在对潜在混杂因素进行调整的多变量分析中，WDT期间较高的IOP峰值可预测未来视野进展（风险比=1.11；95%置信区间，1.02至1.21；P=0.013）。在同一随访期内，门诊时间的平均IOP和峰值IOP与进展无显著相关性（P分别为0.651和0.569）。
WDT检测到的IOP峰值可预测接受治疗的POAG患者未来的视野进展。这种压力测试可能是日常实践中进行风险评估的有用工具。
