Broadway D C, Drance S M
Department of Ophthalmology, University of British Columbia, Vancouver, Canada.
Br J Ophthalmol. 1998 Aug;82(8):862-70. doi: 10.1136/bjo.82.8.862.
AIMS/BACKGROUND: To study the vasoactivity of glaucoma patients with four previously described and distinct disc appearances potentially representative of primary open angle glaucoma subgroups.
Patients with pure examples of four glaucomatous optic disc types--focal ischaemic, myopic glaucomatous, senile sclerotic, and those with generalised cup enlargement, were selected. A detailed ophthalmic, systemic, drug, and smoking history was taken from the patients who, in addition, underwent assessment of peripheral vasospasm with a laser Doppler flowmeter. Differences between the groups were evaluated using an analysis of variance, Student's t test, Pearson's chi 2 test, Fisher's exact test together with Spearman's and Pearson's correlation tests.
38 patients with focal ischaemic, 37 with myopic glaucomatous, 24 with senile sclerotic, and 24 with discs characterised by generalised cup enlargement met the selection criteria. The group of patients with focal ischaemic discs contained more women (66% versus 32%-50% in the other three groups; p = 0.01) and had a higher prevalence of vasospasm (63% versus 25%-49%; p = 0.01), migraine (32% versus 8%-19%; p = 0.02), and cold extremities (66% versus 17%-30%; p = 0.00003). The group of patients with senile sclerotic discs had a higher prevalence of systemic cardiovascular disease (58% versus 21%-30% in the other three groups; p = 0.01) and thyroid disease (21% cf 0%-8%; p = 0.01) and although their mean age was greater (76 years cf 55-65 years; p < 0.00001) the findings were independent of age. Smoking was unrelated to optic disc type.
Vasospasm, previously associated with normal tension glaucoma, and generalised cardiovascular disease both appear to be specific risk factors for the development of particular subgroups of glaucoma and may be independent of absolute intraocular pressure levels exerting effects in patients with both "normal" or "raised" intraocular pressure. The simple assessment as to whether a glaucoma patient suffers from colder extremities than average appeared to be better at distinguishing the focal ischaemic type of glaucoma than the more complex determination of vasospasm using the laser Doppler flowmeter.
目的/背景：研究青光眼患者的血管活性，这些患者具有四种先前描述的、不同的视盘表现，可能代表原发性开角型青光眼亚组。
选取四种青光眼性视盘类型的典型患者——局灶性缺血型、近视性青光眼型、老年性硬化型以及视杯普遍扩大型。详细询问了患者的眼科、全身、用药和吸烟史，此外，还使用激光多普勒血流仪对患者进行了外周血管痉挛评估。采用方差分析、学生t检验、Pearson卡方检验、Fisher精确检验以及Spearman和Pearson相关性检验对组间差异进行评估。
38例局灶性缺血型、37例近视性青光眼型、24例老年性硬化型以及24例视杯普遍扩大型患者符合入选标准。局灶性缺血型视盘患者组中女性更多（66%，而其他三组为32%-50%；p = 0.01），血管痉挛患病率更高（63%，而其他三组为25%-49%；p = 0.01）、偏头痛患病率更高（32%，而其他三组为8%-19%；p = 0.02）以及四肢发冷患病率更高（66%，而其他三组为17%-30%；p = 0.00003）。老年性硬化型视盘患者组全身心血管疾病患病率更高（58%，而其他三组为21%-30%；p = 0.01）以及甲状腺疾病患病率更高（21%，而其他三组为0%-8%；p = 0.01），尽管他们的平均年龄更大（76岁，而其他三组为55-65岁；p < 0.00001），但这些发现与年龄无关。吸烟与视盘类型无关。
血管痉挛，先前与正常眼压性青光眼相关，以及全身性心血管疾病似乎都是特定青光眼亚组发生的特定危险因素，可能独立于绝对眼压水平，在眼压“正常”或“升高”的患者中均有影响。对于青光眼患者是否四肢比常人更怕冷的简单评估，在区分局灶性缺血型青光眼方面似乎比使用激光多普勒血流仪进行的更复杂的血管痉挛测定更好。
