Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Republic of Korea; Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea.
Am J Ophthalmol. 2020 Nov;219:205-214. doi: 10.1016/j.ajo.2020.07.001. Epub 2020 Jul 8.
To determine baseline clinical features associated with conversion to glaucoma in elderly patients with large optic-disc cupping.
Retrospective cohort study.
Seventy-two eyes of 72 untreated elderly (≥65-year-old) patients with large vertical cup-to-disc ratio (CDR ≥0.7) and without any other glaucomatous findings were included. They had undergone a full ophthalmologic examination twice per year for at least 5 years. The optic nerve head (ONH), peripapillary retinal nerve fiber layer (RNFL), and macular ganglion cell-inner plexiform layer (GCIPL) were imaged with Cirrus high-definition optical coherence tomography (OCT). Presence of temporal raphe sign on the OCT's GCIPL thickness map was assessed as one of the morphologic factors. Conversion to normal-tension glaucoma (NTG) was defined as structural or functional deterioration on either red-free RNFL photography or standard automated perimetry, respectively. The utility of the baseline factors associated with conversion to NTG were identified.
During the 5.5-year follow-up, 19 eyes (26.4%) converted to NTG. There were no significant differences in demographics, systemic factors, intraocular pressure factors, or OCT parameters between the nonconverters and converters. Interestingly, the temporal raphe sign was observed in the converters (18/19, 94.7%) much more frequently than in the nonconverters (3/53, 5.7%, P < .001) at baseline. A Cox proportional hazards model indicated the significant influences of temporal raphe sign positivity (hazard ratio 6.823, 95% confidence interval 2.574, 18.088, P < .001) on conversion to NTG.
In elderly subjects with large CDR, temporal raphe sign positivity on the baseline macular GCIPL thickness map was associated with faster conversion to NTG.
确定与大视盘杯盘比（垂直杯盘比≥0.7）的老年患者青光眼转归相关的基线临床特征。
回顾性队列研究。
共纳入 72 例未经治疗的老年（≥65 岁）患者的 72 只眼，这些患者垂直杯盘比较大（垂直杯盘比≥0.7）且无其他任何青光眼表现。他们每年接受两次全面眼科检查，至少随访 5 年。使用 Cirrus 高清光学相干断层扫描（OCT）对视盘（ONH）、视盘旁视网膜神经纤维层（RNFL）和黄斑神经节细胞内丛状层（GCIPL）进行成像。评估 OCT 的 GCIPL 厚度图上是否存在颞侧条纹征作为形态学因素之一。正常眼压青光眼（NTG）的转归定义为红视力 RNFL 摄影或标准自动视野检查的结构或功能恶化。确定与转归为 NTG 相关的基线因素的效用。
在 5.5 年的随访期间，19 只眼（26.4%）转归为 NTG。在非转归者和转归者之间，在人口统计学、系统因素、眼内压因素或 OCT 参数方面均无显著差异。有趣的是，在基线时，颞侧条纹征在转归者（18/19，94.7%）中比在非转归者（3/53，5.7%，P<0.001）中更为常见。Cox 比例风险模型表明，颞侧条纹征阳性（风险比 6.823，95%置信区间 2.574，18.088，P<0.001）对转归为 NTG 有显著影响。
在大杯盘比的老年患者中，基线黄斑 GCIPL 厚度图上的颞侧条纹征阳性与 NTG 转归较快相关。
