原发性开角型青光眼视神经损害进展与眼压波动及视盘旁萎缩弧扩大的关系

Large intraocular pressure fluctuation and enlargement of beta zone parapapillary atrophy as predictive factors for progression of glaucomatous optic neuropathy

目的分析原发性开角型青光眼(POAG)视神经损害进展的相关危险因素。设计回顾性病例系列。研究对象北京同仁医院眼科门诊确诊的POAG、随访3年以上、眼底照片及眼压资料完整的患者115例(197眼)。方法将患者初次就诊和末次就诊的眼底图片在计算机图像处理软件下进行图像配准,通过叠加闪烁对比观察眼底病变的细微改变。平均随访(56.6±14.8)个月。青光眼视神经损害进展的标准为盘沿丢失进展或伴有视网膜神经纤维层缺损进展。主要指标可能导致青光眼视神经损害进展的多因素Logistic回归分析。结果视神经损害进展98眼,未进展99眼,进展率49.75%。单因素Logistic回归分析显示视神经损害进展与眼压波动(P=0.000)、峰值眼压(P=0.001)及随访时间(P=0.041)有关;卡方检验显示视神经损害进展与盘沿出血(P=0.02)及视盘旁萎缩弧扩大(P=0.000)有关。多因素Logistic回归分析显示视神经损害进展与眼压波动(P=0.000)及视盘旁萎缩弧扩大(P=0.000)有关。视神经损害进展组与未进展组相比,眼压波动明显大,前者眼压波动值平均为(2.87±1.29)(0.89～7.21),后者眼压波动值平均为(2.11±0.94)(0.25～4.97);并且视盘旁萎缩弧扩大的比例明显增高,视神经损害进展组无β区萎缩弧者5眼(5.1%),有β区萎缩弧扩大者75眼(76.53%)。结论除峰值眼压外,过大的眼压波动及β区萎缩弧扩大是POAG视神经损害进展的重要危险因素。

To evaluate the risk factors of the glaucomatous optic neuropathy progression in patients with primary open angle glaucoma （POAG）. Design Retrospective case series. Participants The study included 197 eyes of 115 patients with POAG. All the patients were followed up for at least 3 years in Beijing Tongren Eye Center. Methods Mean followup time was 56.64_＋14.84 months. All the patients had complete fundus photographs and intraocular pressure（lOP） recording. The glaucoma specialists, masked to chronological sequence, examined pairs of optic disc photographs to determine whether the appearance of the optic disc had changed. Progression of glaucoma was defined as loss of neuroretinal rim as detected by disc photographs. Longterm IOP fluctuation was defined as the standard deviation of IOP. Main Outcome Measures Multivariate Logistic regression analysis of the factors which may lead to the progression of the glaucomatous optic neuropathy. Results Progression of glaucomatous optic nerve changes was detected in 98 eyes （49.75%） and 99 （50.25%） eyes were stable. There were statistically significant differences between progressive and nonprogressive eyes for optic disc hemorrhage （1±0.02） and enlargement of beta zone parapapillary atrophy （P=0.000）. In univariate logistic analysis, there were statistically significant differences between progressive and nonprogressive eyes for peak IOP （P=0.001）, IOP fluctuation （P= 0.000） and duration of follow up （P=0.041）. In multivariate logistic regression analysis, there were statistically significant differences between progressive and non-progressive eyes for IOP fluctuation （P=0.000, OR=2.522） and enlargement of beta zone parapapillary atrophy （P=-O.000, OR=25.655）. The IOP fluctuation was larger in patients with glaucomatous optic neuropathy progression （2.87±1.29, 0.89-7.21） than the patients who were stable （2.11±0.94, 0.25-4.97）. There were 75 eyes with enlargement of beta zone parapapillary atrophy in the 98 eyes with glaucomatous optic neuropathy progression （76.53%）. Conclusions Large intraocular pressure fluctuation and enlargement of beta zone parapapillary atrophy are predictive factors for progression of optic neuropatby in POAG. （Ophthalmol CHN, 2012, 21： 39-42）