青光眼合并视盘出血患者中与黄斑旁暗点存在相关的因素。
Factors associated with the presence of parafoveal scotoma in glaucomatous eyes with optic disc hemorrhages.
作者信息
Dias Diego Torres, Almeida Izabela, Sassaki Adriana Miyuki, Juncal Verena Ribeiro, Ushida Michele, Lopes Flavio Siqueira, Alhadeff Paula, Ritch Robert, Prata Tiago Santos
机构信息
Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
Glaucoma Unit, Hospital Medicina dos Olhos - HMO, Osasco, Brazil.
出版信息
Eye (Lond). 2018 Oct;32(10):1669-1674. doi: 10.1038/s41433-018-0159-3. Epub 2018 Jul 4.
PURPOSE
Glaucomatous eyes with disc hemorrhage (DH) have a greater risk of paracentral visual field (VF) loss. However, not every DH eye presents with parafoveal scotoma (PFS), and contributing factors are still to be determined. In the present study, we investigated clinical and ocular factors associated with the presence of PFS in glaucomatous eyes with DH.
METHODS
A case-control study was carried out. One hundred thirty glaucomatous patients with DH were enrolled. They were divided into two groups based on two reliable 24-2 VF tests: those with PFS (defined as ≥3 adjacent points with p < 5% within the central 10 degrees of fixation, ≥1 point with p < 1% lying at the innermost paracentral points, in the same hemifield) and those without PFS. Clinical and ocular data from the time of DH detection were compared between groups. Factors associated with the presence of PFS were investigated through logistic regression.
RESULTS
The PFS group had a higher prevalence of Caucasian patients (82 vs. 47%; p < 0.01). Eyes with PFS had a more negative spherical equivalent and worse VF mean deviation (MD) index (p ≤ 0.01). There was a marginally significant intraocular pressure (IOP) difference between eyes with (15 mmHg) and without PFS (18 mmHg) at the time of DH detection (p = 0.10). Univariable analysis revealed PFS to be significantly associated with Caucasian race (OR, 3.02; p = 0.004), myopia (<-3 diopters; OR, 3.44; p = 0.039), and lower IOP (≤16 mmHg; OR, 2.10; p ≤ 0.047). Multivariable analysis, controlling for VF MD, revealed that only Caucasian race and myopia (as a continuous or categorical variable) remained significant in this model (p ≤ 0.038).
CONCLUSIONS
Caucasian race and the presence and magnitude of myopia were found to be significantly associated with the presence of PFS in glaucomatous eyes with DH. Our results may help clinicians in the identification and surveillance of these eyes at higher risk of central VF loss.
目的
患有视盘出血（DH）的青光眼患者发生旁中心视野（VF）缺损的风险更高。然而，并非每只患有视盘出血的眼睛都会出现黄斑旁暗点（PFS），其相关因素仍有待确定。在本研究中，我们调查了患有视盘出血的青光眼患者中与黄斑旁暗点存在相关的临床和眼部因素。
方法
进行了一项病例对照研究。纳入了130例患有视盘出血的青光眼患者。根据两项可靠的24-2视野测试将他们分为两组：患有黄斑旁暗点的患者（定义为在中央10度注视范围内有≥3个相邻点p<5%，在同一半视野中最内侧旁中心区域有≥1个点p<1%）和没有黄斑旁暗点的患者。比较两组在视盘出血检测时的临床和眼部数据。通过逻辑回归研究与黄斑旁暗点存在相关的因素。
结果
黄斑旁暗点组白种人患者的患病率更高（82%对47%；p<0.01）。患有黄斑旁暗点的眼睛等效球镜度数更负，视野平均缺损（MD）指数更差（p≤0.01）。在视盘出血检测时，患有黄斑旁暗点（15mmHg）和没有黄斑旁暗点（18mmHg）的眼睛眼压存在边缘显著差异（p=0.10）。单因素分析显示黄斑旁暗点与白种人种族（比值比，3.02；p=0.004）、近视（<-3屈光度；比值比，3.44；p=0.039）和较低眼压（≤16mmHg；比值比，2.10；p≤0.047）显著相关。在控制视野MD的多因素分析中，该模型中只有白种人种族和近视（作为连续或分类变量）仍然显著（p≤0.038）。
结论
发现白种人种族以及近视的存在和程度与患有视盘出血的青光眼患者黄斑旁暗点的存在显著相关。我们的结果可能有助于临床医生识别和监测这些有更高中央视野缺损风险的眼睛。
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