Sihota Ramanjit, Selvan Harathy, Sharma Ajay, Gupta Amisha, Gupta Viney, Dada Tanuj, Upadhyay Ashish Datt
Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India.
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Int Ophthalmol. 2019 Apr;39(4):803-812. doi: 10.1007/s10792-018-0872-8. Epub 2018 Mar 5.
To evaluate the long-term course of primary angle-closure ocular hypertension and primary open-angle ocular hypertension and possible risk factors for progression to glaucoma.
A total of 109 eyes of 109 ocular hypertension (OHT) patients with a minimum follow-up period of 5 years having complete ocular/medical records were evaluated. They were classified into primary angle closure or primary open angle based on gonioscopy at baseline. Baseline and review data of Humphrey field analyser, HFA, and Heidelberg retinal tomography, HRT, were recorded. Guided progression analysis (GPA) and univariate Cox regression were used for time to event analysis in identifying progression to glaucoma.
Over a mean follow-up of 12.18 ± 4.8 years, progression to glaucoma was 17.43% (19 eyes), out of whom 5.5% (6 eyes) showed ≥ 3 loci on GPA. Sub-classifying them, progression to primary angle-closure glaucoma was 19.72%, and that of primary open-angle glaucoma was 13.16%. The mean time to progression was 9.34 ± 3.6 years. Significant risk factors included small disc area (≤ 1.99 sq.mm on HRT), requirement of ≥ 2 drugs to maintain target IOP and those engaged in activities yielding a Valsalva effect in daily life. Coronary artery disease (CAD) and systemic use of steroids were associated with increased severity.
Overall progression of OHT to glaucoma was 17.43% over a mean of 9 years, with target IOP of ≤ 18 mm Hg. Patients with smaller discs, CAD, exercising Valsalva type activities and using ≥ 2 glaucoma medications or systemic steroids should be closely monitored.
评估原发性闭角型高眼压症和原发性开角型高眼压症的长期病程以及进展为青光眼的可能危险因素。
对109例高眼压症（OHT）患者的109只眼进行评估，这些患者的眼部/医疗记录完整，随访期至少5年。根据基线时的前房角镜检查将其分为原发性闭角型或原发性开角型。记录Humphrey视野分析仪（HFA）和海德堡视网膜断层扫描（HRT）的基线和复查数据。采用引导性进展分析（GPA）和单变量Cox回归进行事件发生时间分析，以确定是否进展为青光眼。
平均随访12.18±4.8年，进展为青光眼的比例为17.43%（19只眼），其中5.5%（6只眼）在GPA上显示≥3个位点。将其进一步分类，进展为原发性闭角型青光眼的比例为19.72%，原发性开角型青光眼为13.16%。进展的平均时间为9.34±3.6年。显著的危险因素包括小视盘面积（HRT上≤1.99平方毫米）、需要≥2种药物来维持目标眼压以及日常生活中从事会产生瓦尔萨尔瓦效应的活动。冠状动脉疾病（CAD）和全身使用类固醇与病情严重程度增加有关。
在平均9年的时间里，OHT进展为青光眼的总体比例为17.43%，目标眼压≤18mmHg。视盘较小、患有CAD、进行瓦尔萨尔瓦式活动以及使用≥2种青光眼药物或全身类固醇的患者应密切监测。
