Cockerham K P, Pal C, Jani B, Wolter A, Kennerdell J S
Department of Surgery, Walter Reed Army Medical Center, Washington, DC., USA.
Ophthalmology. 1997 Jun;104(6):914-7. doi: 10.1016/s0161-6420(97)30207-3.
The authors determined the prevalence of ocular hypertension and its association with progression to glaucomatous damage in patients with thyroid-associated orbitopathy (TAO).
The charts of 500 consecutive patients with TAO seen at the Allegheny General Hospital (Pittsburgh, PA) between 1985 and 1995 were analyzed. The amount of proptosis, degree and duration of myopathy, exposure to corticosteroids, prior glaucoma treatment, and family history of glaucoma were evaluated.
One hundred twenty (24%) patients with TAO were noted to have an intraocular pressure (IOP) greater than 22 mmHg but less than 30 mmHg. This ocular hypertensive group was composed of 34 men and 86 women with a mean age of 55 years and mean follow-up of 4 years. Seven patients were defined as glaucoma suspects, based on increased but nonprogressive cup-to-disc ratios or nonprogressive, atypical visual field changes in the presence of increased IOP. Two patients demonstrated progressive visual field abnormalities and cupping. Of the factors evaluated, only the duration of active orbital involvement was statistically associated with progression to glaucomatous damage. The mean duration of TAO was 3, 8, and 12 years for ocular hypertensives, glaucoma suspects, and glaucomatous damage, respectively.
Only a prolonged duration of active TAO in association with ocular hypertension correlated with progression to glaucomatous damage. These patients with chronic TAO deserve special attention and close follow-up to prevent optic nerve damage.
作者确定了甲状腺相关眼病（TAO）患者中高眼压的患病率及其与青光眼性损害进展的关联。
分析了1985年至1995年间在阿勒格尼综合医院（宾夕法尼亚州匹兹堡）就诊的500例连续TAO患者的病历。评估了眼球突出程度、肌病的程度和持续时间、皮质类固醇的使用情况、既往青光眼治疗情况以及青光眼家族史。
120例（24%）TAO患者的眼压（IOP）大于22 mmHg但小于30 mmHg。这个高眼压组由34名男性和86名女性组成，平均年龄55岁，平均随访4年。7例患者根据眼压升高但杯盘比无进展或眼压升高时视野改变无进展且不典型被定义为青光眼可疑患者。2例患者出现了进行性视野异常和视盘凹陷。在评估的因素中，只有活跃眼眶受累的持续时间与青光眼性损害的进展在统计学上相关。高眼压患者、青光眼可疑患者和青光眼性损害患者的TAO平均持续时间分别为3年、8年和12年。
只有与高眼压相关的活跃TAO持续时间延长与青光眼性损害的进展相关。这些慢性TAO患者值得特别关注和密切随访，以预防视神经损害。
