原发性开角型青光眼患者5年视野缺损进展情况及相关因素

Progression and influencing factors of 5-year visual field damage in patients with primary open-angle glaucoma

目的:了解原发性开角型青光眼(primary open angle glaucoma,POAG)患者视野缺损的进展情况,探讨其发生进展的相关危险因素。方法:回顾性分析2014年1月至2018年7月就诊于北京大学第三医院眼科并有至少4次视野检查的POAG患者。按照患者首次视野检查的平均偏差或平均缺损进行分期。将历次随访视野检查的平均偏差或平均缺损与时间进行线性回归分析,取其斜率(dB/年)。根据平均偏差或平均缺损的斜率将患者分为进展组与无进展组。分析患者视盘周围视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度损害位置、平均随诊间隔时间、基线视野分期等因素与青光眼视野缺损进展的关系。结果:共纳入128例患者(252只眼),其中129眼使用Octopus视野计检查随访,基线视野缺损值为(10.91±5.76)dB;123眼使用Humphrey视野计,基线视野偏差值为(–10.62±6.89)dB。视野缺损早、中、晚期的比例分别为26.19%、36.51%和37.30%。进展组31只眼(12.30%),无进展组221只眼(87.70%)。上下方RNFL都存在重度损害的患者,其视野缺损更易进展(P<0.001)。平均随诊间隔时间≤4个月的患眼,发生进展的比例高于平均随诊间隔时间>4个月的患眼(P=0.058)。基线视野分期、年龄、性别、总随访时间与视野缺损进展未见显著相关性。结论:青光眼患者的视功能损害出现恶化是普遍存在的。上下方RNFL均存在重度损害、随诊间隔时间短与视野缺损进展相关。视神经结构的改变与功能损害具有相关性,结构改变的方位对功能损害进展有提示功能。规律随诊对病情监测有重要意义,对于可能快速进展的患者,应缩短随诊间隔时间。

Objective:To investigate the progression of visual field defect in primary open angle glaucoma(POAG),and to explore the related risk factors for its progression.Methods:A retrospective analysis was performed on patients with POAG who had at least 4 visual field examinations in the Department of Ophthalmology,Peking University Third Hospital from January 2014 to July 2018.The visual field was staged according to the mean deviation or mean defect of the first visual field examination.Linear regression analyses of mean deviation or mean defect were performed against time,and corresponding regression slopes(in decibels per year)were calculated.Patients were divided into progressive and non-progressive groups according to the mean deviation slope or mean defect slope.The relationship between retinal nerve fiber layer(RNFL)thickness lesion location,mean follow-up interval,baseline visual field staging,and the progression of visual field defect in glaucoma were analyzed.Results:A total of 128 patients(252 eyes)were included.Among them,129 eyes were followed up with an Octopus perimeter,and the average mean defect value of the baseline visual field was 10.91±5.76 dB;while the other 123 eyes were followed up with a Humphrey perimeter,and the average mean deviation value of the baseline visual field was-10.62±6.89 dB.The proportion of early,middle and late visual field defects was 26.19%,36.51%and 37.30%.There were 31 eyes(12.30%)in the progressive group and 221 eyes(87.70%)in the non-progressive group.Patients with severe damage to both the upper and lower RNFLs had more visual field defects(P<0.001).Patients with an average follow-up interval≤4 months had a higher rate of progression than those with an average follow-up interval>4 months(P=0.058).There were no significant differences in baseline visual field stage,age,gender,and total follow-up time between the progression and progression-free groups.Conclusion:Deterioration of visual function impairment is common in glaucoma patients.The progression of visual field defects is associated with severe impairments which are present both in the upper and lower RNFLs,and short follow-up intervals.Optic nerve structure changes are related to functional impairment,and the location of structural changes is suggestive of functional impairment progression.Regular follow-up visits are of great significance for disease monitoring.For patients who may progress rapidly,the follow-up interval should be shortened.