Cho Hyun-Kyung, Lee Min Gyu, Kee Changwon
Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Republic of Korea.
Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Ophthalmic Res. 2018;60(3):152-160. doi: 10.1159/000486575. Epub 2018 Jun 12.
This study aimed to investigate the association of the frequency of optic disk hemorrhage (DH) and progression of normal tension glaucoma (NTG) between each group based on the location of the initial retinal nerve fiber layer (RNFL) defect.
In this retrospective, observational cohort study, 142 NTG patients who underwent more than 5 reliable visual field tests with initial superior hemifield (group 2, n = 51), inferior hemifield (group 1, n = 44), or both hemifield (group 3, n = 47) defects were included. The number of DHs was inspected in serial optic disk photographs by 2 different ophthalmologists. Progression rates, which are the slope of mean thresholds from the 52 points, were calculated using a linear mixed effect model.
The mean follow-up period was 8.19 ± 3.30 years. DHs related with the initial RNFL defect occurred significantly more frequently in group 2 (35 in inferior hemifield) than in group 1 (6 in superior hemifield) (p = 0.009) or group 3 (6 in inferior hemifield) (p = 0.006). The progression rate in group 2 was significantly faster than in group 1 (p = 0.019) or the superior hemifield of group 3 (p = 0.001). The progression rate of subjects showing recurrent DH was significantly faster than those showing single DH from all groups (-0.5460 vs. -0.2867 dB/year, p = 0.0053).
More careful examination and caution are required when NTG patients show recurrent DH in the inferior hemifield related to the initial RNFL defect.
本研究旨在根据初始视网膜神经纤维层（RNFL）缺损的位置，调查每组中视盘出血（DH）频率与正常眼压性青光眼（NTG）进展之间的关联。
在这项回顾性观察队列研究中，纳入了142例接受了5次以上可靠视野检查的NTG患者，这些患者初始存在上半视野缺损（第2组，n = 51）、下半视野缺损（第1组，n = 44）或双半视野缺损（第3组，n = 47）。由2位不同的眼科医生在连续的视盘照片中检查DH的数量。使用线性混合效应模型计算进展率，即52个点的平均阈值斜率。
平均随访期为8.19±3.30年。与初始RNFL缺损相关的DH在第2组（下半视野35例）中出现的频率明显高于第1组（上半视野6例）（p = 0.009）或第3组（下半视野6例）（p = 0.006）。第2组的进展率明显快于第1组（p = 0.019）或第3组的上半视野（p = 0.001）。所有组中，出现复发性DH的受试者的进展率明显快于出现单次DH的受试者（-0.5460对-0.2867 dB/年，p = 0.0053）。
当NTG患者在与初始RNFL缺损相关的下半视野出现复发性DH时，需要更仔细的检查和谨慎对待。
