青光眼伴盘沿出血患者视网膜神经纤维层和节细胞-内丛状层进行性变薄。
Progressive Thinning of Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer in Glaucoma Eyes with Disc Hemorrhage.
机构信息
Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, California.
Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York.
出版信息
Ophthalmol Glaucoma. 2021 Sep-Oct;4(5):541-549. doi: 10.1016/j.ogla.2021.01.003. Epub 2021 Jan 30.
PURPOSE
To evaluate the thinning of the circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) in primary open-angle glaucoma eyes with and without a history of disc hemorrhage (DH).
DESIGN
Observational cohort study.
PARTICIPANTS
Thirty-nine 39 eyes (34 participants) with DH and 117 eyes (104 participants) without DH from the Diagnostic Innovations in Glaucoma Study and the African Decent and Glaucoma Evaluation Study.
METHODS
Participants had at least 1.5 years of follow-up, with a minimum of 3 visits with biannual spectral-domain OCT cpRNFL and mGCIPL thickness measurements and visual fields (VFs). The rates of cpRNFL and mGCIPL thinning were calculated using mixed-effects models. The dynamic range-based normalized rates of cpRNFL and mGCIPL thinning were calculated and compared between the DH and non-DH groups.
MAIN OUTCOME MEASURES
Rates of cpRNFL and mGCIPL thinning.
RESULTS
The rate of mGCIPL thinning was significantly faster in the DH group compared with the non-DH group (-0.62 μm/year vs. -0.38 μm/year; P = 0.024). The rate of cpRNFL thinning in the DH quadrant and rate of mGCIPL thinning in the inferotemporal sector in the DH group were faster than the corresponding regions in the non-DH group after adjusting for intraocular pressure (-1.33 μm/year vs. -0.58 μm/year; P = 0.053) and race (-0.82 μm/year vs. -0.44 μm/year; P = 0.048). In the DH group, percent rate of loss was significantly faster for the mGCIPL than the cpRNFL (-1.59 %/year vs. -1.31 %/year; P = 0.046). Rates of mGCIPL thinning were associated weakly with mean deviation slope, VF index slope, and guided progression analysis (GPA). The areas under the receiver operating characteristic curve for VF progression were 0.75 for mGCIPL and 0.56 for cpRNFL in the DH group.
CONCLUSIONS
The rate of mGCIPL and cpRNFL thinning was faster in DH eyes than non-DH eyes. Compared with cpRNFL, mGCIPL showed higher proportional rates of thinning and greater association with functional progression. In addition to cpRNFL, clinicians should consider incorporating mGCIPL imaging to monitor glaucoma progression, especially in glaucoma eyes with DH.
目的
评估原发性开角型青光眼患者中伴有和不伴有视盘出血（DH）的周边视网膜神经纤维层（cpRNFL）和黄斑神经节细胞-内丛状层（mGCIPL）变薄情况。
设计
观察性队列研究。
参与者
来自诊断性青光眼创新研究和非洲裔美国人青光眼评估研究的 39 只眼（34 名参与者）伴有 DH 和 117 只眼（104 名参与者）不伴有 DH。
方法
参与者至少随访 1.5 年，至少进行 3 次随访，每次随访均进行双眼频域光学相干断层扫描 cpRNFL 和 mGCIPL 厚度测量和视野（VF）检查。使用混合效应模型计算 cpRNFL 和 mGCIPL 变薄率。计算基于动态范围的 cpRNFL 和 mGCIPL 变薄率，并比较 DH 组和非 DH 组之间的差异。
主要观察指标
cpRNFL 和 mGCIPL 变薄率。
结果
DH 组的 mGCIPL 变薄速度明显快于非 DH 组（-0.62μm/年比-0.38μm/年；P=0.024）。DH 组的 cpRNFL 变薄速度在 DH 象限和 mGCIPL 变薄速度在下颞区均快于非 DH 组，调整眼压后（-1.33μm/年比-0.58μm/年；P=0.053）和种族（-0.82μm/年比-0.44μm/年；P=0.048）。DH 组中，mGCIPL 的损失百分比明显快于 cpRNFL（-1.59%/年比-1.31%/年；P=0.046）。mGCIPL 变薄率与平均偏差斜率、VF 指数斜率和引导进展分析（GPA）弱相关。DH 组中 VF 进展的受试者工作特征曲线下面积为 0.75（mGCIPL）和 0.56（cpRNFL）。
结论
DH 眼中的 mGCIPL 和 cpRNFL 变薄速度快于非 DH 眼中。与 cpRNFL 相比，mGCIPL 显示出更高的比例变薄率，与功能进展的相关性更强。除了 cpRNFL，临床医生还应考虑将 mGCIPL 成像纳入监测青光眼进展，特别是在伴有 DH 的青光眼眼中。
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