原发性青光眼晚期患者视野缺损的相关因素分析

Analysis of related factors of visual field defect in patients with advanced primary glaucoma

目的在我国人群中探讨原发性青光眼晚期患者视野缺损的危险因素。方法回顾性系列病例研究。自2016年3月至2022年6月,总计有574例在我院接受治疗的原发性青光眼晚期患者纳入本课题研究,其中管状视野202例(35.19%),颞侧视岛372例(64.81%)。通过查阅病历,分别采集上述患者的社会人口学和临床资料,包括受试者年龄、性别、眼别分布、初诊年龄、初诊时临床分期、家族史、高度近视、高血压、糖尿病、青光眼类型及随访期眼压等信息,采用单因素和多因素分析探讨上述指标与原发性青光眼晚期患者视野缺损的相关性。结果首先采用单因素分析在管状视野组和颞侧视岛组之间比较各项社会人口学和临床资料的差异,发现两组之间受试者年龄、性别、眼别分布、初诊年龄、家族史、高血压及糖尿病均无显著性差异(均P>0.05),但颞侧视岛组的初诊时临床分期晚期患者比例、高度近视比例、青光眼类型为慢性原发性闭角型青光眼(CPACG)及随访期眼压峰值/平均值均显著高于管状视野组(均P<0.05)。进一步将上述单因素分析中发现有显著性差异的初诊时临床分期晚期、合并高度近视、青光眼类型为CPACG及随访期眼压峰值/平均值同时纳入多因素Logistic回归分析发现合并高度近视(OR 1.672,95%CI 1.564-12.435)、晚期青光眼类型为CPACG(OR 2.052,95%CI 1.062-4.173)及随访期眼压峰值较高(OR 1.137,95%CI 1.031~1.368)是原发性青光眼晚期患者视野缺损进展为颞侧视岛的独立危险因素(均P<0.05)。结论在原发性青光眼晚期患者中,合并高度近视、晚期青光眼类型为CPACG及随访期眼压峰值较高是进展为颞侧视岛的独立危险因素。

Objective To investigate the risk factors of visual field defect in patients with advanced primary glaucoma in Chinese population.Methods A retrospective case series study.A total of 574 patients with advanced primary glaucoma treated in our hospital from March 2016 to June 2022 were collected,including 202 cases of central visual field(35.19%),and 372 cases of temporal peripheral field(64.81%).By consulting the medical records,the socio-demographic and clinical data of the above patients were collected,which including the subjects'age,gender,eye distribution,age of initial diagnosis,baseline clinical stage at initial diagnosis,family history,high myopia,hypertension,diabetes,glaucoma type and intraocular pressure(IOP)during follow-up,etc.Univariate and multivariate analysis were used to explore the correlation between the above indicators and visual field defect in patients with advanced primary glaucoma.Results Univariate analysis was used to compare the differences in socio-demographic and clinical data between the central visual field group and the temporal peripheral field group,it was found that there were no significant differences in subjects'age,gender,eye distribution,age at first diagnosis,family history,hypertension and diabetes between the two groups(all P>0.05),whereas the proportion of patients with later clinical stage,high myopia,chronic primary angle-closure glaucoma(CPACG)and the peak/average IOP in the temporal peripheral field group were significantly higher than that of the central visual field group(all P<0.05).The multivariate logistic regression model showed that complicated with high myopia,CPACG and high peak IOP during follow-up were independent risk factors for the progression of visual field defects in patients with advanced primary glaucoma(all P<0.05).Conclusions In patients with advanced primary glaucoma,high myopia,CPACG and high peak IOP during follow-up are independent risk factors for the progression of visual field defects.