青光眼患者角膜滞后量与视网膜神经纤维层厚度之间的关系

Relationship between corneal hysteresis and retinal nerve fiber layer thickness in glaucoma

目的 探讨青光眼患者角膜滞后量(CH)与视网膜神经纤维层(RNFL)厚度之间的关系。方法 选取我院眼科收治的开角型青光眼患者133例(186眼)作为研究对象,随访时间为(3.8±0.8)年,平均随访9次。采用眼反应分析仪测量患者CH,在每次随访时采用SD-OCT测量患者RNFL厚度。采用Stata软件进行数据分析。年龄、基线CH、眼压和中央角膜厚度(CCT)与RNFL厚度的关系用单变量和多变量线性回归模型进行统计分析。结果 本组186眼,基线CH为(9.2±1.8)mmHg(1 kPa=7.5 mmHg),RNFL厚度为(76.4±18.1)μm,眼压为(13.8±3.7)mmHg, CCT为(533±42)μm。单变量模型分析结果显示,在随访期间基线CH与RNFL厚度具有正相关关系(P<0.05),CH越低,RNFL越薄,CH每降低1 mmHg, RNFL厚度减少0.13μm,提示低CH可能参与青光眼的发生和进展。单变量模型分析结果还显示,眼压与RNFL厚度具有显著负相关性(P<0.05),眼压越高,RNFL越薄。但年龄和CCT与RNFL厚度均无明显相关关系(均为P>0.05)。多变量模型分析结果显示,排除年龄、眼压和CCT影响后,在随访期间基线CH仍然与RNFL厚度具有显著正相关性(P<0.05)。CH每降低1 mmHg, RNFL厚度同样减少0.13μm。结论 青光眼患者基线CH与RNFL厚度具有正相关关系,CH越低,RNFL越薄,低CH可能参与青光眼的发生和进展。

Objective To investigate the relationship between corneal hysteresis(CH)and retinal nerve fiber layer(RNFL)thickness in patients with glaucoma.Methods In this study,186 eyes of 133 patients with open-angle glaucoma who attended the ophthalmology department of our hospital were included,with a follow-up of(3.8±0.8)years and an average of 9 visits.The CH measurements were acquired using the Ocular Response Analyzer,and RNFL thickness was measured at each follow-up using spectral domain optical coherence tomography.All statistical analyses were performed with Stata software.Univariate and multivariable linear regression models were used to investigate the relationship between age,baseline CH,intraocular pressure(IOP),central corneal thickness(CCT)and RNFL thickness.Results The average baseline CH was(9.2±1.8)mmHg(1 kPa=7.5 mmHg),average baseline RNFL thickness was(76.4±18.1)μm,the average baseline IOP was(13.8±3.7)mmHg,and the average baseline CCT was(533±42)μm.Univariate model analysis showed that the baseline CH had a positive correlation with RNFL thickness(P<0.05).The lower the CH,the thinner the RNFL.For every 1 mmHg reduction in CH,the thickness of RNFL was reduced by 0.13μm,indicating that CH may be involved in the occurrence and development of glaucoma.The univariate model analysis also showed that there was a negative correlation between IOP and RNFL thickness(P<0.05).The higher the IOP,the thinner the RNFL.However,there was no significant correlation between age,CCT and RNFL thickness(both P>0.05).The multivariate model analysis showed that there was a positive correlation between baseline CH and RNFL thickness during the follow-up,excluding the influence of age,IOP and CCT(P<0.05).For every 1 mmHg reduction in CH,the thickness of RNFL was reduced by 0.13μm.Conclusion There is a positive correlation between baseline CH and RNFL thickness in glaucoma.The lower the CH,the thinner the RNFL.Low CH may be a risk factor for the progression of glaucoma.