Soltani Ghazaleh, Nishida Takashi, Moghimi Sasan, Tran Elaine, Yamane Maya, Girkin Christopher, Zangwill Linda M, Weinreb Robert N
From the Viterbi Family Department of Ophthalmology (G.S., T.N., S.M., E.T., M.Y., C.G., L.M.Z., and R.N.W.), Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.
From the Viterbi Family Department of Ophthalmology (G.S., T.N., S.M., E.T., M.Y., C.G., L.M.Z., and R.N.W.), Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.
Am J Ophthalmol. 2025 Jun 20;278:108-114. doi: 10.1016/j.ajo.2025.06.024.
To investigate the association between baseline optic nerve head prelaminar schisis and the rates of visual field mean deviation (VF MD) slopes in glaucoma.
Retrospective clinical cohort study.
This study included 563 eyes (446 with primary open-angle glaucoma and 117 glaucoma suspect eyes) from 332 patients. Two independent graders evaluated the baseline presence and severity of prelaminar schisis using optical coherence tomography radial scans. The severity was graded on a four-point ordinal scale: 0 (none), 1 (mild), 2 (moderate), and 3 (severe). The interrater reliability was assessed using weighted kappa. Two linear mixed-effect models were employed to assess the association between the presence of schisis (model 1) and schisis severity (model 2) with VF MD slopes, while adjusting for relevant demographic and ocular characteristics.
Prelaminar optic nerve head schisis was observed in 258 eyes (45.8%). Among these, grade 1 was identified in 36 eyes (14.0%), grade 2 in 181 eyes (70.2%), and grade 3 in 41 eyes (15.9%). The weighted kappa was 0.66. In multivariable models, the presence of schisis was associated with a faster VF MD slope (-0.22 dB/y; 95% confidence interval [CI]: -0.30, -0.13 P ≤ .001). Compared to eyes without prelaminar schisis (grade 0), those with schisis were associated with faster VF MD slopes. This was more significant with grade 3 (-0.40 dB/y; 95% CI: -0.63, -0.18; P < .001) than with grade 1 (-0.18 dB/y; 95% CI: -0.34, -0.03; P = .023), or grade 2 (-0.18 dB/y; 95% CI: -0.26, -0.09; P < .001). Age and baseline VF MD were also independently associated with VF progression in both models.
The presence and severity of severe prelaminar schisis were associated with faster VF progression, suggesting its potential as a biomarker to identify patients at higher risk of progression and to guide clinical management in glaucoma.
研究青光眼患者基线视神经乳头层前劈裂与视野平均偏差（VF MD）斜率变化率之间的关联。
回顾性临床队列研究。
本研究纳入了332例患者的563只眼（446只原发性开角型青光眼眼和117只青光眼疑似眼）。两名独立的分级人员使用光学相干断层扫描径向扫描评估层前劈裂的基线存在情况和严重程度。严重程度按四点顺序量表分级：0（无）、1（轻度）、2（中度）和3（重度）。使用加权kappa评估评分者间信度。采用两个线性混合效应模型评估劈裂的存在（模型1）和劈裂严重程度（模型2）与VF MD斜率之间的关联，同时对相关人口统计学和眼部特征进行校正。
在258只眼（45.8%）中观察到层前视神经乳头劈裂。其中，1级36只眼（14.0%），2级181只眼（7 .2%），3级41只眼（15.9%）。加权kappa为0.66。在多变量模型中，劈裂的存在与更快的VF MD斜率相关（-0.22 dB/年；95%置信区间[CI]：-0.30，-0.13；P≤0.001）。与无层前劈裂（0级）的眼相比，有劈裂的眼与更快的VF MD斜率相关。3级（-0.40 dB/年；95%CI：-0.63，-0.18；P<0.001）比1级（-0.18 dB/年；95%CI：-0.34，-0.03；P=0.023）或2级（-0.18 dB/年；95%CI：-0.26，-0.09；P<0.001）更显著。在两个模型中，年龄和基线VF MD也与VF进展独立相关。
严重的层前劈裂的存在和严重程度与更快的VF进展相关，提示其有可能作为一种生物标志物，用于识别进展风险较高的患者并指导青光眼的临床管理。
