青光眼先进影像学研究中的视野进展率的预测因素。
Predictive Factors for the Rate of Visual Field Progression in the Advanced Imaging for Glaucoma Study.
机构信息
Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA.
Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.
出版信息
Am J Ophthalmol. 2019 Jun;202:62-71. doi: 10.1016/j.ajo.2019.02.015. Epub 2019 Feb 20.
PURPOSE
To investigate predictive factors associated with the rate of visual field (VF) loss in open-angle glaucoma.
DESIGN
Prospective multicenter cohort study.
METHODS
Perimetric glaucoma patients of the Advanced Imaging for Glaucoma study were selected for analysis if they had 9 completed visits. Confirmed rapid significant progression (CRSP) of VF was defined as a significant (P < 0.05) negative VF index (VFI) slope of -1%/year or a mean deviation slope of -0.5 dB/year, confirmed at 2 consecutive follow-up visits. Slow progression was defined as VFI slope greater than -0.5%/year or a mean deviation slope of -0.25 dB/year. Fourier-domain optical coherence tomography (FD-OCT) measured optic disc, peripapillary retinal nerve fiber layer (NFL), and macular ganglion cell complex (GCC) thicknesses. Logistic regression was used to identify baseline predictors for CRSP and slow progression. Linear regression was used to identify baseline predictors for the VFI and mean deviation slope.
RESULTS
Eyes (n = 150) of 103 participants were included. Slow progression was observed in 80 eyes (53.3%) and CRSP in 23 eyes (15.3%). Larger NFL and GCC baseline focal loss volume (FLV), thinner central corneal thickness, and lower VFI were significant (P < 0.05) baseline predictors of more rapid progression on univariate analysis. The predictor with the highest odds ratio (OR) was NFL-FLV, which was also the most significant non-VF predictor in the multivariate analysis. Eyes with NFL-FLV >8.5% had an OR of 2.67 for CRSP and 0.42 for slow progression. Disc hemorrhage during the follow-up was also important, with an OR of 2.61 for CRSP and 0.23 for slow progression for each occurrence.
CONCLUSIONS
Focal loss measured by FD-OCT or VF along with CCT are strong baseline predictors for the rate of glaucoma progression.
目的
研究与开角型青光眼视野（VF）丧失率相关的预测因素。
设计
前瞻性多中心队列研究。
方法
选择 Advanced Imaging for Glaucoma 研究中的视野计青光眼患者进行分析，如果他们完成了 9 次就诊。确认快速显著进展（CRSP）的 VF 定义为显著（P < 0.05）负 VFI 斜率为-1%/年或平均偏差斜率为-0.5 dB/年，在 2 次连续随访中确认。进展缓慢定义为 VFI 斜率大于-0.5%/年或平均偏差斜率为-0.25 dB/年。傅里叶域光学相干断层扫描（FD-OCT）测量视盘、视盘周围视网膜神经纤维层（NFL）和黄斑神经节细胞复合体（GCC）厚度。使用逻辑回归确定 CRSP 和缓慢进展的基线预测因素。使用线性回归确定 VFI 和平均偏差斜率的基线预测因素。
结果
纳入了 103 名参与者的 150 只眼。80 只眼（53.3%）观察到缓慢进展，23 只眼（15.3%）观察到 CRSP。更大的 NFL 和 GCC 基线局灶性丢失体积（FLV）、更薄的中央角膜厚度和更低的 VFI 是单变量分析中更快速进展的显著（P < 0.05）基线预测因素。具有最高优势比（OR）的预测因素是 NFL-FLV，它也是多变量分析中最重要的非 VF 预测因素。NFL-FLV >8.5%的眼发生 CRSP 的 OR 为 2.67，发生缓慢进展的 OR 为 0.42。随访期间的盘状出血也很重要，每次发生 CRSP 的 OR 为 2.61，发生缓慢进展的 OR 为 0.23。
结论
FD-OCT 或 VF 以及 CCT 测量的局灶性丢失是青光眼进展速度的强有力基线预测因素。
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