Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
Ophthalmology. 2018 Jun;125(6):822-831. doi: 10.1016/j.ophtha.2017.12.027. Epub 2018 Feb 9.
To investigate the temporal relationship among progressive macular ganglion cell inner plexiform layer (GCIPL) thinning, progressive parapapillary retinal nerve fiber layer (RNFL) thinning, and visual field (VF) progression in patients with primary open-angle glaucoma (POAG).
Prospective study.
One hundred thirty-six POAG patients (231 eyes) followed up for ≥5 years.
OCT imaging of the macular GCIPL and parapapillary RNFL and perimetry were performed at ∼ 4-month intervals. Progressive GCIPL and RNFL thinning were determined by Guided Progression Analysis (GPA) of serial GCIPL and RNFL thickness maps. The specificities of GPA were calculated from the proportions of eyes with progressive GCIPL or RNFL thinning in 67 eyes of 36 healthy individuals followed up for ≥5 years. Visual field progression (likely or possible) was determined by the Early Manifest Glaucoma Trial criteria.
Hazard ratios for VF progression, progressive RNFL thinning, and progressive GCIPL thinning, as determined by time-varying Cox models.
GPA detected 57 eyes (24.7%) with progressive GCIPL thinning and 66 eyes (28.6%) with progressive RNFL thinning at a specificity of 95.5% and 91.0%, respectively. Thirty-five eyes (15.2%) demonstrated progressive RNFL and GCIPL thinning, whereas 53 eyes (22.9%) demonstrated progressive RNFL or GCIPL thinning. Eyes with progressive GCIPL thinning had a higher risk for progressive RNFL thinning (HR, 5.27; 95% confidence interval [CI], 2.89-9.62), whereas eyes with progressive RNFL thinning were also at a higher risk for progressive GCIPL thinning (HR, 2.99; 95% CI, 1.48-6.02), after adjusting for baseline covariates. The HRs for likely and possible VF progression were 3.48 (95% CI, 1.51-8.01) and 2.74 (95% CI, 1.26-5.98), respectively, on detection of progressive GCIPL thinning and 3.66 (95% CI, 1.68-7.97) and 2.54 (95% CI, 1.23-5.21), respectively, on detection of progressive RNFL thinning after adjusting for baseline covariates. Eyes with VF progression were not at risk of progressive RNFL or GCIPL thinning (P ≥ 0.493).
Progressive macular GCIPL thinning and progressive parapapillary RNFL thinning are mutually predictive. Because progressive RNFL thinning and progressive GCIPL thinning are both indicative of VF progression, integrating macular GCIPL and parapapillary RNFL measurements is relevant to facilitate early detection of disease deterioration in glaucoma patients.
研究原发性开角型青光眼（POAG）患者中进行性黄斑神经节细胞内丛状层（GCIPL）变薄、进行性视盘旁视网膜神经纤维层（RNFL）变薄和视野（VF）进展之间的时间关系。
前瞻性研究。
136 例 POAG 患者（231 只眼），随访时间≥5 年。
使用 OCT 对黄斑 GCIPL 和视盘旁 RNFL 进行成像，并在大约 4 个月的时间间隔内进行检查。通过对一系列 GCIPL 和 RNFL 厚度图进行引导性进展分析（GPA）来确定进行性 GCIPL 和 RNFL 变薄。从 36 名健康个体的 67 只眼（随访时间≥5 年）的进行性 GCIPL 或 RNFL 变薄的比例计算 GPA 的特异性。根据早期显性青光眼试验标准确定 VF 进展（可能或很可能）。
VF 进展、进行性 RNFL 变薄和进行性 GCIPL 变薄的时间变化 Cox 模型的风险比。
GPA 在特异性为 95.5%和 91.0%时，分别检测到 57 只眼（24.7%）的进行性 GCIPL 变薄和 66 只眼（28.6%）的进行性 RNFL 变薄。35 只眼（15.2%）表现为进行性 RNFL 和 GCIPL 变薄，而 53 只眼（22.9%）表现为进行性 RNFL 或 GCIPL 变薄。进行性 GCIPL 变薄的眼发生进行性 RNFL 变薄的风险更高（HR，5.27；95%置信区间[CI]，2.89-9.62），而进行性 RNFL 变薄的眼发生进行性 GCIPL 变薄的风险也更高（HR，2.99；95%CI，1.48-6.02），在调整基线协变量后。在检测到进行性 GCIPL 变薄后，VF 进展（可能或很可能）的 HR 分别为 3.48（95%CI，1.51-8.01）和 2.74（95%CI，1.26-5.98），在检测到进行性 RNFL 变薄后，HR 分别为 3.66（95%CI，1.68-7.97）和 2.54（95%CI，1.23-5.21），在调整基线协变量后。发生 VF 进展的眼不会有进展性 RNFL 或 GCIPL 变薄的风险（P≥0.493）。
进行性黄斑 GCIPL 变薄和进行性视盘旁 RNFL 变薄是相互预测的。由于进行性 RNFL 变薄和进行性 GCIPL 变薄均提示 VF 进展，因此整合黄斑 GCIPL 和视盘旁 RNFL 测量值与早期发现青光眼患者的病情恶化有关。
