Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Ophthalmology, Universidade Estadual de Campinas, São Paulo, Brazil.
Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina.
Ophthalmology. 2021 Jan;128(1):48-57. doi: 10.1016/j.ophtha.2020.06.027. Epub 2020 Jun 21.
To investigate the impact of intraocular pressure (IOP) control on rates of change of spectral-domain OCT (SD-OCT) retinal nerve fiber layer (RNFL) thickness in a large clinical population.
Retrospective cohort study.
A total of 85 835 IOP measurements and 60 223 SD-OCT tests from 14 790 eyes of 7844 patients.
Data were extracted from the Duke Glaucoma Registry, a large database of electronic medical records of patients with glaucoma and suspected disease followed over time at the Duke Eye Center and satellite clinics. All records from patients with a minimum of 6 months of follow-up and at least 2 good-quality SD-OCT scans and 2 clinical visits with Goldmann applanation tonometry were included. Eyes were categorized according to the frequency of visits with IOP below cutoffs of 21 mmHg, 18 mmHg, and 15 mmHg over time. Rates of change for global RNFL thickness were obtained using linear mixed models and classified as slow if change was slower than -1.0 μm/year; moderate if between -1.0 and -2.0 μm/year; and fast if faster than -2.0 μm/year. Multivariable models were adjusted for age, gender, race, diagnosis, central corneal thickness, follow-up time, and baseline disease severity.
Rates of change in SD-OCT RNFL thickness according to levels of IOP control.
Eyes had a mean follow-up of 3.5±1.9 years. Average rate of change in RNFL thickness was -0.68±0.59 μm/year. Each 1 mmHg higher mean IOP was associated with 0.05 μm/year faster RNFL loss (P < 0.001) after adjustment for potentially confounding variables. For eyes that had fast progression, 41% of them had IOP <21 mmHg in all visits during follow-up, whereas 20% of them had all visits with IOP <18 mmHg, but only 9% of them had all visits with IOP <15 mmHg.
Intraocular pressure was significantly associated with rates of progressive RNFL loss in a large clinical population. Eyes with stricter IOP control over follow-up visits had a smaller chance of exhibiting fast deterioration. Our findings may assist clinicians in establishing target pressures in clinical practice.
研究在大型临床人群中，眼压（IOP）控制对谱域光学相干断层扫描（SD-OCT）视网膜神经纤维层（RNFL）厚度变化率的影响。
回顾性队列研究。
来自 7844 名患者的 14790 只眼中的 85835 次 IOP 测量值和 60223 次 SD-OCT 检查。
数据从杜克青光眼登记处提取，这是一个大型电子病历数据库，包含在杜克眼中心和卫星诊所随时间随访的青光眼和疑似疾病患者的信息。所有至少随访 6 个月、至少有 2 次高质量 SD-OCT 扫描和 2 次金氏压平眼压计临床就诊的患者记录均包含在内。根据随时间推移 IOP 低于 21mmHg、18mmHg 和 15mmHg 的就诊频率对眼睛进行分类。使用线性混合模型获得全球 RNFL 厚度的变化率，如果变化率慢于-1.0μm/年，则归类为慢；如果变化率在-1.0μm/年和-2.0μm/年之间，则归类为中；如果变化率快于-2.0μm/年，则归类为快。多变量模型调整了年龄、性别、种族、诊断、中央角膜厚度、随访时间和基线疾病严重程度。
根据 IOP 控制水平，SD-OCT RNFL 厚度的变化率。
眼睛的平均随访时间为 3.5±1.9 年。RNFL 厚度的平均变化率为-0.68±0.59μm/年。在调整了潜在混杂变量后，平均 IOP 每升高 1mmHg，RNFL 损失速度就会加快 0.05μm/年（P<0.001）。对于进展较快的眼睛，41%的眼睛在随访期间所有就诊时的 IOP<21mmHg，而 20%的眼睛所有就诊时的 IOP<18mmHg，但只有 9%的眼睛所有就诊时的 IOP<15mmHg。
在大型临床人群中，眼压与进行性 RNFL 损失的速度显著相关。随时间推移就诊时眼压控制更严格的眼睛发生快速恶化的可能性较小。我们的研究结果可能有助于临床医生在临床实践中确定目标眼压。
