Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int Ophthalmol. 2021 Aug;41(8):2797-2804. doi: 10.1007/s10792-021-01836-8. Epub 2021 Apr 5.
To evaluate the incidence of non-glaucomatous ocular disease in patients with asymmetric optic disc cupping.
A retrospective case series, including consecutive patients with cup-to-disc ratio (CDR) asymmetry greater than 0.2. All patients underwent a complete neuro-ophthalmological examination, automated perimetry with the Humphrey 24-2 visual fields program. Retinal nerve fibre layer thickness was measured by optical coherence tomography (OCT). The results of neuroimaging, macular OCT and blood tests were recorded as well. Patients were assigned a diagnosis of glaucomatous optic neuropathy (GON) or non-glaucomatous disease (NGD). The main outcome measure was the rate of non-glaucomatous ocular disease.
A total of 120 (67 males) patients with a mean age of 71.1 ± 12.5 years met the inclusion criteria and were included in this study. The mean asymmetry in CDR between the eyes was 0.3 ± 0.13 (range, 0.2-0.9). Twenty patients (16.6%) had a visual field defect not typical for glaucoma and positive relative afferent pupillary defect was found in 24 patients (20%). Six patients were found to have newly diagnosed non-glaucomatous ocular disease: maculopathy in three patients, retinopathy in one patient and traumatic optic neuropathy in two patients. Patients with NGD were significantly younger than the patients with GON (59.8 ± 23.3 vs. 71.3 ± 11.5 years, P = 0.001). Optic disc pallor was found in 4/93 patients with glaucoma compared to 3/6 with newly diagnosed non-glaucomatous disease (4.7% vs. 50.0%, P = 0.03).
Asymmetric optic disc cupping can be associated with non-glaucomatous disease and may warrant neuro-ophthalmological evaluation, especially in younger patients or those with optic disc pallor.
评估视盘杯盘比（CDR）不对称大于 0.2 的患者中非青光眼性眼病的发生率。
这是一项回顾性病例系列研究，纳入了 CDR 不对称大于 0.2 的连续患者。所有患者均接受了完整的神经眼科检查、Humphrey 24-2 视野程序的自动视野检查、光学相干断层扫描（OCT）测量视网膜神经纤维层厚度。记录神经影像学、黄斑 OCT 和血液检查的结果。将患者诊断为青光眼性视神经病变（GON）或非青光眼性疾病（NGD）。主要观察指标是非青光眼性眼病的发生率。
共有 120 名（67 名男性）平均年龄为 71.1±12.5 岁的患者符合纳入标准并纳入本研究。双眼 CDR 的平均不对称性为 0.3±0.13（范围 0.2-0.9）。20 名患者（16.6%）出现了不符合青光眼的视野缺损，24 名患者（20%）发现相对传入瞳孔缺陷阳性。6 名患者被诊断为新发非青光眼性眼病：3 名患者患有黄斑病变，1 名患者患有视网膜病变，2 名患者患有外伤性视神经病变。NGD 患者明显比 GON 患者年轻（59.8±23.3 岁 vs. 71.3±11.5 岁，P=0.001）。与新诊断的非青光眼性疾病（4.7% vs. 50.0%，P=0.03）相比，青光眼患者中有 4/93 例出现视盘苍白，而新诊断的非青光眼性疾病患者中有 3/6 例出现视盘苍白。
不对称性视盘杯盘比可能与非青光眼性疾病相关，可能需要进行神经眼科评估，尤其是在年轻患者或视盘苍白的患者中。
