Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea.
PLoS One. 2020 May 18;15(5):e0233270. doi: 10.1371/journal.pone.0233270. eCollection 2020.
To investigate whether the position of the central vascular trunk, as a surrogate of lamina cribrosa (LC) shift, is associated with the initial hemisphere of visual field defect in myopic high-tension glaucoma (HTG) eyes.
The deviation of the central vascular trunk was measured from the center of the Bruch's membrane opening (BMO), which was delineated by OCT imaging. The angular deviation was measured with the horizontal nasal midline as 0° and the superior location as a positive value. The initial hemisphere developing visual field defect was defined as three connected abnormal points (having a P value with less than 0.5% probability of being normal) appearing in only one hemisphere in pattern deviation plots. If those points were observed in both hemispheres initially, the eye was classified as bi-hemispheric visual field defect.
Initially, 36 eyes (44%) had superior visual field defects, 27 (33%) inferior visual field defects, and 18 (22%) bi-hemispheric visual field defects. After a mean follow-up of 5 years, the number of bi-hemispheric visual field defects had increased to 34 (42%). A logistic regression analysis revealed that inferior deviation of vascular trunk was the only factor associated with initial inferior visual field defect (P = 0.001), while initial bi-hemispheric visual field defects were associated with worse mean deviation at initial visits (P<0.001). A conditional inference tree analysis showed that both the angular deviation (P<0.001) and initial mean deviation (P = 0.025) determined the initial hemispheres developing visual field defect.
Although both hemispheres were involved as glaucoma progression, the axons on the side counter to the vascular trunk deviation were damaged earlier in HTG. This finding implies the LC shift could add additional stress to axons exposed to high intraocular pressure.
研究中央血管主干的位置（作为筛板移位的替代指标）与近视性高压性青光眼（HTG）眼初始半球视野缺损之间的关系。
使用 OCT 成像描绘的 Bruch 膜开口（BMO）中心，测量中央血管主干的偏斜。角度偏差以水平鼻中线为 0°，上方位置为正值进行测量。初始半球出现视野缺损定义为仅在一个半球的模式偏差图中出现三个连续异常点（具有小于 0.5%概率为正常的 P 值）。如果这些点最初在两个半球中均被观察到，则将该眼归类为双侧半球视野缺损。
最初，36 只眼（44%）有上半视野缺损，27 只眼（33%）有下半视野缺损，18 只眼（22%）有双侧半球视野缺损。平均随访 5 年后，双侧半球视野缺损的数量增加到 34 只（42%）。逻辑回归分析显示，血管主干的下偏是与初始下半视野缺损相关的唯一因素（P=0.001），而初始双侧半球视野缺损与初始就诊时平均偏差更差相关（P<0.001）。条件推理树分析表明，角度偏差（P<0.001）和初始平均偏差（P=0.025）均决定了初始半球发生视野缺损。
尽管随着青光眼的进展，两个半球都被累及，但血管主干偏斜侧的轴突更早受损。这一发现表明，LC 移位可能会给暴露于高眼压下的轴突增加额外的压力。
