Department of Ophthalmology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, South Korea.
Br J Ophthalmol. 2018 Nov;102(11):1527-1532. doi: 10.1136/bjophthalmol-2017-311152. Epub 2018 Feb 2.
To evaluate the progressive change in peripapillary atrophy (PPA) according to its shape and to explore the relationship between PPA progression and glaucoma worsening in myopic eyes.
A total of 159 eyes of 159 patients with myopic (axial length (AXL) >24 mm) glaucoma (mean follow-up 4.4 years, 35 eyes with minimal PPA, 40 concentric-type PPA eyes (>270° around the optic disc) and 84 eccentric-type PPA eyes (<270°)) were included. Sequential stereoscopic colour optic disc photographs were evaluated to qualitatively determine PPA progression. Factors associated with PPA progression were explored by Cox proportional hazard modelling in each PPA group.
Patients with concentric PPA were older than patients with eccentric PPA (54.1±11.7 vs 44.1±11.7 years; P<0.001), and AXL was longer in the eccentric group than in the other groups (25.54±1.68 vs 25.28±1.53 vs 26.41±1.29 mm; P<0.001). Twenty-six eyes (65%) in the concentric group and 36 eyes (42.9%) in the eccentric group showed PPA progression. Older age (hazard ratio (HR) 1.059, P=0.008), worse baseline visual field mean deviation (HR 0.857, P=0.009) and greater baseline PPA area (HR 1.000, P=0.012) were associated with PPA progression in the concentric type. Glaucoma progression (HR 3.690, P=0.002) and longer AXL (HR 1.521, P=0.002) were associated with PPA progression in the eccentric type.
Relationship between glaucoma worsening and PPA progression was strongest in myopic glaucomatous eyes with eccentric type PPA.
根据视盘旁萎缩（PPA）的形状评估其进行性变化，并探讨近视眼中 PPA 进展与青光眼恶化之间的关系。
共纳入 159 名近视（眼轴（AXL）>24mm）青光眼患者的 159 只眼（平均随访时间 4.4 年，最小 PPA 为 35 只眼，同心型 PPA 眼 40 只眼（视盘周围>270°），偏心型 PPA 眼 84 只眼（<270°））。通过序列立体彩色视盘照相术定性评估 PPA 进展。在每个 PPA 组中，通过 Cox 比例风险模型探讨与 PPA 进展相关的因素。
同心型 PPA 患者的年龄大于偏心型 PPA 患者（54.1±11.7 vs 44.1±11.7 岁；P<0.001），偏心型 PPA 患者的 AXL 长于其他两组（25.54±1.68 vs 25.28±1.53 vs 26.41±1.29mm；P<0.001）。同心型组 26 只眼（65%）和偏心型组 36 只眼（42.9%）出现 PPA 进展。年龄较大（危险比（HR）1.059，P=0.008）、基线视野平均偏差较差（HR 0.857，P=0.009）和基线 PPA 面积较大（HR 1.000，P=0.012）与同心型 PPA 进展相关。青光眼进展（HR 3.690，P=0.002）和较长的 AXL（HR 1.521，P=0.002）与偏心型 PPA 进展相关。
偏心型 PPA 的近视性青光眼眼中，青光眼恶化与 PPA 进展之间的关系最强。
