Zhou K, Shang X, Wang X Y, Wang X J, Cheng H H, Hu H S, Huang Q J, Pan X F, Xu X, Liang Y B
The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325000, China.
Zhonghua Yan Ke Za Zhi. 2019 Oct 11;55(10):777-784. doi: 10.3760/cma.j.issn.0412-4081.2019.10.009.
To evaluate risk factors for visual field (VF) loss progression in primary open-angle glaucoma patients. A prospective nested case-control study. Patients were collected from the Wenzhou glaucoma progression study in the Eye Hospital of Wenzhou Medical University during March 2014 and April 2018. In this study, the eyes were divided into a progression group and a non-progression group using the glaucoma progression analysis methods to analyze the risk factors for glaucomatous VF loss progression. Axial length (AL) and central corneal thickness (CCT) were measured using the Lenstar LS900. The baseline, fluctuation (standard deviation), mean, maximum, minimum and range of intraocular pressure (IOP) during the follow-up period were determined based on IOP measured at each follow-up. The IOP measurements were included from the baseline to the last visit (for the non-progression group), or to the visit at which VF loss progression was determined (for the progression group). The independent sample -test, Mann-Whitney inspection and Cox proportional hazards models were used for statistical analysis. A total of 140 patients (140 eyes) were enrolled, including 67 males and 73 females. There were 19.3% of the eyes (27 of 140 eyes) showing VF loss progression. The median time to the endpoint for progression was 24.0 (16.0, 40.0) months. The AL in the progression group and non-progression group were 23.58 (23.05, 24.24) mm and 23.91 (23.10, 24.91) mm (0.111). The CCT in the two groups were 531.0 (512.0, 565.0) μm and 535.0 (518.5, 552.0) μm, respectively (0.897). The baseline age in the progression group and non-progression group was 71.0 (68.0, 74.0) years and 68.0 (58.0, 72.0) years, respectively (-2.872, 0.004). The slope of visual field index in the two groups was -3.50 (-7.10, -1.80)%/year and 0.40 (-0.60, 1.40)%/year, respectively (-6.823, 0.01). The mean IOP during the follow-up was (16.2±2.7) mmHg (1 mmHg=0.133 kPa) in the progression group and (15.1±2.4) mmHg in the non-progression group (-2.215, 0.028). The IOP fluctuation in the progression group and non-progression group was (2.6±1.3) mmHg and (2.0±0.7) mmHg, respectively (-2.175, 0.038). In the multivariate model, older baseline age (=1.080; 95:1.019-1.143), higher baseline IOP (=1.120; 95:1.016-1.236), higher mean IOP (=1.145; 95:1.001-1.309) and higher IOP fluctuation (=1.750; 95:1.193-2.566) were all significantly predictive risk factors for glaucomatous VF loss progression. Longer AL (=0.725; 95:0.532-0.988) was a protective factor against VF loss progression. However, CCT was found to be not associated with VF loss progression. Baseline age, baseline IOP, mean IOP, IOP fluctuation and shorter AL are found to be risk factors for glaucomatous VF loss progression among eyes with primary open-angle glaucoma in Wenzhou. .
评估原发性开角型青光眼患者视野(VF)丧失进展的危险因素。一项前瞻性巢式病例对照研究。研究对象来自2014年3月至2018年4月温州医科大学附属眼视光医院的温州青光眼进展研究。本研究采用青光眼进展分析方法将研究对象的眼睛分为进展组和非进展组,分析青光眼性VF丧失进展的危险因素。使用Lenstar LS900测量眼轴长度(AL)和中央角膜厚度(CCT)。根据每次随访时测量的眼压确定随访期间眼压的基线、波动(标准差)、平均值、最大值、最小值和范围。眼压测量值涵盖从基线到最后一次随访(非进展组),或到确定VF丧失进展的那次随访(进展组)。采用独立样本t检验、Mann-Whitney检验和Cox比例风险模型进行统计分析。共纳入140例患者(140只眼),其中男性67例,女性73例。有19.3%的眼睛(140只眼中的27只)出现VF丧失进展。进展组达到终点的中位时间为24.0(16.0,40.0)个月。进展组和非进展组的AL分别为23.58(23.05,24.24)mm和23.91(23.10,24.91)mm(P = 0.111)。两组的CCT分别为531.0(512.0,565.0)μm和535.0(518.5,552.0)μm(P = 0.897)。进展组和非进展组的基线年龄分别为71.0(68.0,74.0)岁和68.0(58.0,72.0)岁(P = -2.872,0.004)。两组视野指数的斜率分别为-
3.50(-7.10,-1.80)%/年和0.40(-0.60,1.40)%/年(P = -6.823,0.01)。进展组随访期间的平均眼压为(16.2±2.7)mmHg(1 mmHg = 0.133 kPa),非进展组为(15.1±2.4)mmHg(P = -2.215,0.028)。进展组和非进展组的眼压波动分别为(2.6±1.3)mmHg和(2.0±0.7)mmHg(P = -2.175,0.038)。在多变量模型中,较高的基线年龄(P = 1.080;95%CI:1.019 - 1.143)、较高的基线眼压(P = 1.120;95%CI:1.016 - 1.236)、较高的平均眼压(P = 1.145;95%CI:1.001 - 1.309)和较高的眼压波动(P =
1.750;95%CI:1.193 - 2.566)均为青光眼性VF丧失进展的显著预测危险因素。较长的AL(P = 0.725;95%CI:0.532 - 0.988)是预防VF丧失进展的保护因素。然而,发现CCT与VF丧失进展无关。在温州原发性开角型青光眼患者中,基线年龄、基线眼压、平均眼压、眼压波动和较短的AL是青光眼性VF丧失进展的危险因素。