Department of Ophthalmology and Visual Neurosciences (KWN, MSL, KCF, CMM), University of Minnesota School of Medicine, Minneapolis, Minnesota; and Department of Ophthalmology and Visual Sciences (RAJ, GPVS), Washington University School of Medicine, St. Louis, Missouri.
J Neuroophthalmol. 2018 Jun;38(2):147-150. doi: 10.1097/WNO.0000000000000587.
To determine whether at the time of diagnosis, the intraocular pressure (IOP) in patients with optic nerve head drusen (ONHD) correlates with the perimetric mean deviation (PMD) and the mean retinal nerve fiber layer (RNFL) thickness on optical coherence tomography (OCT).
This retrospective chart review included adults with ONHD from 2 academic medical centers. Inclusion criteria were age older than 18 years, definitive diagnosis of ONHD, measurement of IOP, and an automated visual field (VF) within 3 months of diagnosis. Exclusion criteria were unreliable VFs, use of IOP-lowering therapy, and visually significant ocular comorbidities. Data were collected from the initial visit. Age, IOP, method of diagnosis of ONHD, mean RNFL thickness, and PMD were recorded. Multiple and logistic regression models were used to control for potential confounders in statistical analyses.
Chart review identified 623 patients, of which 146 patients met inclusion criteria. Mean age was 44.2 years (range: 19-82 years). Average PMD of 236 eyes was -5.22 dB (range, -31.2 to +1.21 dB). Mean IOP was 15.7 mm Hg (range: 6-24 mm Hg). Forty eyes (16.9%) underwent RNFL measurement using OCT; mean RNFL thickness was 79.9 μm (range: 43-117 μm). There was no statistically significant association between IOP and PMD (P = 0.13) or RNFL thickness (P = 0.65). Eyes with ocular hypertension tended to have less depressed PMD than those without (P= 0.031). Stratified analyses of visible and buried subgroups yielded similar results.
Lowering IOP in patients with ONHD has been proposed as a means to prevent progression of optic neuropathy. Our study demonstrated that among predominately normotensive eyes, higher IOP was not associated with greater VF loss or thinner RNFL at the time of presentation. This suggests that lowering IOP may not be beneficial in preventing visual loss in normotensive eyes with ONHD.
确定视神经乳头盘状隆起（ONHD）患者的眼压（IOP）是否与视野计平均偏差（PMD）和光学相干断层扫描（OCT）上的平均视网膜神经纤维层（RNFL）厚度相关。
本回顾性图表研究纳入了来自 2 所学术医疗中心的 ONHD 成年患者。纳入标准为年龄大于 18 岁、明确的 ONHD 诊断、IOP 测量以及诊断后 3 个月内的自动视野（VF）检查。排除标准为不可靠的 VF、使用降眼压治疗和有明显的眼部合并症。数据从初始就诊时收集。记录年龄、IOP、ONHD 诊断方法、平均 RNFL 厚度和 PMD。在统计学分析中使用多元和逻辑回归模型来控制潜在的混杂因素。
图表回顾确定了 623 例患者，其中 146 例符合纳入标准。平均年龄为 44.2 岁（范围：19-82 岁）。236 只眼中的平均 PMD 为-5.22 dB（范围：-31.2 至+1.21 dB）。平均 IOP 为 15.7 mm Hg（范围：6-24 mm Hg）。40 只眼（16.9%）进行了 OCT 测量的 RNFL；平均 RNFL 厚度为 79.9 μm（范围：43-117 μm）。IOP 与 PMD（P=0.13）或 RNFL 厚度（P=0.65）之间无统计学显著关联。高眼压眼的 PMD 较非高眼压眼低（P=0.031）。可见和埋藏亚组的分层分析得出了相似的结果。
降低 ONHD 患者的 IOP 被提议作为预防视神经病变进展的一种手段。我们的研究表明，在以正常眼压为主的眼中，较高的眼压与就诊时的视野损失更大或 RNFL 更薄之间没有关联。这表明在正常眼压的 ONHD 眼中，降低眼压可能无法预防视力丧失。
