Lee Jihei Sara, Park Sungeun, Seong Gong Je, Kim Chan Yun, Lee Sang Yeop, Choi Wungrak, Bae Hyoung Won
Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine.
Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Glaucoma. 2022 May 1;31(5):310-316. doi: 10.1097/IJG.0000000000002011. Epub 2022 Mar 11.
Intraocular pressure (IOP) fluctuations increase the risk of visual field progression of primary open-angle glaucoma (POAG) in the advanced stage even when IOP is maintained low on average.
The purpose of this study was to identify risk factors associated with the progression of visual field defect in patients with advanced POAG.
A retrospective review of medical records was conducted to identify patients who met the Hodapp-Parrish-Anderson criteria for advanced POAG. A total of 122 eyes of 122 patients had undergone IOP measurement with Goldmann applanation tonometer, standard automated perimetry, Cirrus optical coherence tomography, and fundus photography at 6-month intervals. Visual field progression was defined as the deterioration of a minimum of 3 visual field locations more than baseline at 5% levels in 4 consecutive visual fields with 24-2 SITA testing.
Thirty-six eyes of 122 eyes (29.5%, 51.9±13.9 y old) showed visual field progression during 100.7±44.2 months of follow-up. The progression group showed greater long-term IOP fluctuations (2.6±1.4 mm Hg) than the no progression group (53.5±13.5 y; 2.0±1.0 mm Hg, P=0.008). Disc hemorrhage was detected more frequently in the progression group (40.5% vs. 17.4%, P=0.005). Multivariate Cox regression analysis revealed long-term IOP fluctuations [hazard ratio (HR)=2.567, 95% confidence interval (CI): 1.327-5.370, P=0.012] and disc hemorrhage (HR=2.351, 95% CI: 1.120-4.931, P=0.024) to be independent risk factors of visual field progression. Patients who showed both disc hemorrhage and long-term IOP fluctuations were at greater risks of progression (HR=2.675, 95% CI: 1.072-6.457, P=0.035).
Long-term IOP fluctuations and disc hemorrhage are independent and additive risk factors of visual field progression in advanced glaucoma even at low IOPs. Patients in whom these risk factors are identified require close monitoring and vigorous treatment.
即使平均眼压维持在较低水平，眼压波动仍会增加晚期原发性开角型青光眼（POAG）视野进展的风险。
本研究旨在确定晚期POAG患者视野缺损进展的相关危险因素。
对符合晚期POAG的Hodapp-Parrish-Anderson标准的患者病历进行回顾性分析。122例患者的122只眼每6个月接受一次Goldmann压平眼压计测量眼压、标准自动视野计检查、Cirrus光学相干断层扫描和眼底照相。视野进展定义为在连续4次24-2 SITA检测中，至少有3个视野位置在5%水平上比基线恶化。
在100.7±44.2个月的随访期间，122只眼中有36只眼（29.5%，年龄51.9±13.9岁）出现视野进展。进展组的长期眼压波动（2.6±1.4 mmHg）大于无进展组（年龄53.5±13.5岁；2.0±1.0 mmHg，P=0.008）。进展组中视盘出血的检出率更高（40.5%对17.4%，P=0.005）。多因素Cox回归分析显示，长期眼压波动[风险比（HR）=2.567，95%置信区间（CI）：1.327-5.370，P=0.012]和视盘出血（HR=2.351，95% CI：1.120-4.931，P=0.024）是视野进展的独立危险因素。同时出现视盘出血和长期眼压波动的患者进展风险更高（HR=2.675，95% CI：1.072-6.457），P=0.035。
即使眼压较低，长期眼压波动和视盘出血仍是晚期青光眼视野进展的独立且相加的危险因素。识别出这些危险因素的患者需要密切监测和积极治疗。
