视网膜静脉阻塞患者中原发性开角型青光眼发病比例的研究

Percentage of primary open angle glaucoma in retinal vein occlusion patients

背景 有研究表明,高加索人视网膜静脉阻塞（RVO）与原发性开角型青光眼（POAG）的产生存在关联,但目前鲜见关于亚洲人群RVO患者中POAG发病比例的报道. 目的 观察以医院人群为基础的RVO患者中POAG的发病比例.方法 采用横断面观察性研究设计,连续纳入2011年10月至2013年5月在北京大学第三医院眼科确诊且病程在1年以内的RVO患者375例,患者均接受房角镜检查,POAG的诊断参照国际地域性和流行病学眼科学学会的青光眼诊断标准.根据眼底彩色照片和FFA将RVO分为视网膜中央静脉阻塞（CRVO）型、半侧视网膜静脉阻塞（HRVO）型和视网膜分支静脉阻塞（BRVO）型;按照静脉阻塞的部位分为动静脉交叉RVO（AV-RVO）型、视盘RVO（OC-RVO）型、无视盘水肿的视神经RVO（NONHS-RVO）型及有视盘水肿的视神经RVO（ONHS-RVO）型.分别统计不同RVO类型患者中POAG的发病比例.结果 共317例患者纳入青光眼筛查并完成各检查项目,应答率为84.5％.POAG在RVO患者中的发病比例为8.2％,其中在CRVO型中的比例为7.1％,在HRVO型中为23.5％,在BRVO型中为6.2％.OC-RVO型患者和NONHS-RVO型患者中POAG的发病比例分别为27.9％和13.2％,明显高于AV-RVO和ONHS-RVO中的4.7％和1.3％,差异均有统计学意义（均P＜0.05）. 结论 中国RVO患者中POAG的发病比例是正常人群的3～4倍;OC-RVO型和NONHS-RVO型患者中POAG的发病比例较高,提示RVO的发病可能与POAG的视盘结构改变密切相关.

Background Researches determined that the pathogenesis of retinal vein occlusion （RVO） is associated with primary open angle glaucoma （POAG） in Caucasian population.However,the relationship between RVO and POAG in Asian population is unclear.Objective This study was to survey the percentage of POAG in RVO patients in China.Methods A prospective cross-sectional observational study based on hospital was performed.Three hundred and seventy five patients with newly diagnosed RVO by fluorescein fundus angiography （FFA） were consecutively enrolled in Peking University Third Hospital from October 2011 to May 2013,and gonioscopy was carried out in all the patients.Glaucoma was diagnosed according to the criteria of the International Society of Geographical and Epidemiological Ophthalmology （ISGEO）.RVO was classified into central retinal vein occlusion （CRVO）,hemicentral retinal vein occlusion （HRVO） and branch retinal vein occlusion （BRVO） based on fundus photograph and FFA,or classified into arteriovenous crossing RVO （AV-RVO）,optic cup RVO （OC-RVO）,optic nerve RVO without optical nerve head swelling （NONHS-RVO） and RVO with optical nerve head swelling （ONHS-RVO） based on the sites of venous occlusion.The percentages of POAG in different types of RVO were calculated.This study was approved by Ethic Committee of Peking University Third Hospital,and written informed consent was obtained from each patient before entering study cohort.Results Three hundred and seventeen RVO patients finished screening of glaucoma,with the response rate 84.5%.The percentage of POAG is 8.2% in RVO patients,including 7.1% in the CRVO patients,23.5% in HRVO patients and 6.2% in BRVO patients.The percentage of POAG was significantly higher in OC-RVO patients （27.9%） and NONHS-RVO patients （13.2%） than that in AV-RVO patients （4.7%） and ONHS-RVO patients （1.3%） （all at P〈0.05）.Conclusions The overall percentage of POAG in RVO patients in China is 3-4 times higher than general population.Higher percentage of POAG is found in OC-RVO patients and NONHS-RVO patients,suggesting that pathogenesis of RVO is probably associated with the glaucomatous anatomic changes of optical nerve head.