Jammal Alessandro A, Medeiros Felipe A
Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina.
Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina.
Ophthalmol Glaucoma. 2022 Sep-Oct;5(5):483-489. doi: 10.1016/j.ogla.2022.03.006. Epub 2022 Mar 22.
To evaluate the impact of corneal hysteresis (CH) as a risk factor for progressive neuroretinal rim loss in glaucoma, as measured by spectral-domain OCT of the Bruch's membrane opening minimum rim width (MRW).
Prospective, observational cohort study.
The study group included 118 eyes of 70 subjects with glaucoma. The average follow-up time for the cohort was 3.9 ± 1.3 years, with an average of 6.4 ± 2.0 spectral-domain OCT tests, ranging from 4 to 12.
Corneal hysteresis measurements were acquired at baseline using the Ocular Response Analyzer (Reichert Instruments). Linear mixed models were used to investigate the relationship between the rates of MRW loss and baseline CH. Multivariable analyses adjusted for other putative predictive factors for progression, including mean intraocular pressure (IOP), central corneal thickness (CCT), age, race, and baseline disease severity.
Effects of CH on the rate of MRW change over time.
Corneal hysteresis had a significant effect on rates of MRW progression over time. Each 1-mmHg lower CH was associated with -0.38 μm/year faster MRW loss (95% confidence interval [CI], -0.70 to -0.06; P = 0.019), after adjustment for other predictive factors. The mean IOP was also significantly associated with progression, with -0.35 μm/year (95% CI, -0.47 to -0.23 μm/year) faster MRW change for each 1-mmHg higher pressure (P < 0.001). In the analysis of predictive strength, the mean IOP was the strongest predictive factor (R = 23%), followed by CH (R = 14%) and baseline disease severity (R = 6%). Central corneal thickness explained only 3% of the variability in slopes of change in global MRW.
Lower CH measurements were associated with faster loss of the neuroretinal rim in glaucoma, as measured by MRW. The predictive ability of CH was superior to that of CCT. These findings suggest that CH is an important parameter to be considered in assessing the risk of glaucoma progression.
通过对布鲁赫膜开口处最小视盘边缘宽度（MRW）进行光谱域光学相干断层扫描（OCT）测量，评估角膜滞后（CH）作为青光眼患者神经视网膜边缘进行性丢失风险因素的影响。
前瞻性观察性队列研究。
研究组包括70例青光眼患者的118只眼。该队列的平均随访时间为3.9±1.3年，平均进行6.4±2.0次光谱域OCT检查，检查次数从4次到12次不等。
使用眼反应分析仪（Reichert仪器公司）在基线时测量角膜滞后。采用线性混合模型研究MRW丢失率与基线CH之间的关系。多变量分析对其他可能的病情进展预测因素进行了校正，包括平均眼压（IOP）、中央角膜厚度（CCT）、年龄、种族和基线疾病严重程度。
CH对MRW随时间变化率的影响。
角膜滞后对MRW随时间的进展率有显著影响。在对其他预测因素进行校正后，CH每降低1mmHg，MRW丢失速度加快-0.38μm/年（95%置信区间[CI]，-0.70至-0.06；P = 0.019）。平均眼压也与病情进展显著相关，眼压每升高1mmHg，MRW变化速度加快-0.35μm/年（95%CI，-0.47至-0.23μm/年）（P < 0.001）。在预测强度分析中，平均眼压是最强的预测因素（R = 23%），其次是CH（R = 14%）和基线疾病严重程度（R = 6%）。中央角膜厚度仅解释了总体MRW变化斜率变异性的3%。
通过MRW测量发现，较低的CH测量值与青光眼患者神经视网膜边缘更快的丢失相关。CH的预测能力优于CCT。这些发现表明，CH是评估青光眼进展风险时需要考虑的一个重要参数。
