视神经乳头形态与早期开角型青光眼结构进展的初始位置相关。
Optic Nerve Head Morphology is Associated with the Initial Location of Structural Progression in Early Open Angle Glaucoma.
作者信息
Park Young Min, Park Jong Woon, Bae Hyoung Won, Kim Chan Yun, Lee Kwanghyun
机构信息
Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
出版信息
J Glaucoma. 2023 Nov 1;32(11):e145-e150. doi: 10.1097/IJG.0000000000002274. Epub 2023 Jul 25.
PRCIS
Glaucoma eyes with a small cup-to-disk ratio (CDR) tend to show retinal nerve fiber layer progression earlier than ganglion cell-inner plexiform layer progression.
PURPOSE
To investigate the effects of clinical variables on the temporal relationship between macular ganglion cell-inner plexiform layer (mGCIPL) loss and peripapillary retinal nerve fiber layer (pRNFL) loss in glaucoma.
METHODS
This retrospective observational study used medical records of patients diagnosed with open angle glaucoma. Structural change was determined using guided progression analysis software of Cirrus optical coherence tomography. Based on the time of detection of pRNFL and mGCIPL changes, eyes showing progressive layer loss were categorized into the pRNFL-first and mGCIPL-first groups. The association between sites of layer thinning and clinical variables such as major retinal arterial angles and several optic disk measurements, including disk area, average CDR, and vertical CDR, were analyzed.
RESULTS
A total of 282 eyes were included in the study, of which 104 showed structural progression either in the mGCIPL or pRNFL. Out of these, 49 eyes showed the first progression in pRNFL, while 37 eyes showed the first progression in mGCIPL. The minimum mGCIPL thickness, pRNFL thickness, average CDR, vertical CDR, and location of progression were significantly different between the 2 groups ( P =0.041, P =0.034, P =0.015, P <0.001, and P <0.001, respectively). In multivariate analysis, average CDR and vertical CDR were significantly associated with the progression site ( P =0.033 and P =0.006, respectively). The structural changes in the inferoinferior area and the superior vulnerability zone were significantly associated with RNFL-first progression ( P <0.001 for both).
CONCLUSION
The location of layer loss and CDR are related to the layer where loss is first detected (either pRNFL or mGCIPL) in open angle glaucoma.
PRCIS
杯盘比（CDR）小的青光眼患者视网膜神经纤维层进展往往早于神经节细胞-内丛状层进展。
目的
研究临床变量对青光眼黄斑神经节细胞-内丛状层（mGCIPL）丢失与视乳头周围视网膜神经纤维层（pRNFL）丢失时间关系的影响。
方法
这项回顾性观察研究使用了被诊断为开角型青光眼患者的病历。使用Cirrus光学相干断层扫描的引导进展分析软件确定结构变化。根据pRNFL和mGCIPL变化的检测时间，将显示层进展性丢失的眼睛分为pRNFL先进展组和mGCIPL先进展组。分析了层变薄部位与主要视网膜动脉角度以及包括视盘面积、平均CDR和垂直CDR在内的几个视盘测量值等临床变量之间的关联。
结果
该研究共纳入282只眼睛，其中104只在mGCIPL或pRNFL中显示出结构进展。其中，49只眼睛pRNFL先出现进展，37只眼睛mGCIPL先出现进展。两组之间最小mGCIPL厚度、pRNFL厚度、平均CDR、垂直CDR和进展部位存在显著差异（分别为P = 0.041、P = 0.034、P = 0.015、P < 0.001和P < 0.001）。在多变量分析中，平均CDR和垂直CDR与进展部位显著相关（分别为P = 0.033和P = 0.006）。下下区域和上脆弱区的结构变化与RNFL先进展显著相关（两者均P < 0.001）。
结论
在开角型青光眼中，层丢失的部位和CDR与首次检测到丢失的层（pRNFL或mGCIPL）有关。
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