自发性局限性筛板缺损与青光眼视神经损伤进展的关系

摘要

目的 探讨原发性开角型青光眼(POAG)局限性筛板缺损与视神经损伤进展的关系.方法 病例对照研究.纳入2018年6月至2019年1月首都医科大学附属北京同仁医院北京同仁眼科中心就诊的具有5次以上Humphrey视野检查结果的POAG患者,进行视野缺损进展评估,并利用扫频光源相干光层析成像术观察筛板缺损情况.同时记录眼压、视野平均缺损、角膜厚度、眼轴长度等指标,比较视野缺损进展眼与不进展眼中筛板缺损发生情况,统计学分析采用x2或Fisher检验、混合效应模型及Logistic回归法.结果 共纳入受试者32例(64只眼),年龄(47±14)岁,男性17例,女性15例;共45只眼视野缺损不进展.视野缺损不进展眼筛板缺损发生比例为28/45,高于视野缺损进展眼(5/19),差异有统计学意义(x2=6.896,P=0.009),且视野缺损不进展眼眼轴长度[(26.82±1.34)mm]大于视野缺损进展眼[(25.79±1.44) mm]、视野缺损不进展眼单眼筛板缺损总直径[(211 (165～326)μm]大于视野缺损进展眼[114(106～156)μm],差异均有统计学意义(t=6.589,P=O.013;Z=4.797,P=0.042).Logistic回归显示筛板缺损是POAG视野缺损的保护因素(0R=0.217,P=0.012).32例患者中有7例双眼视野缺损进展不对称,其中视野缺损不进展眼中筛板缺损发生比例(7/7)大于对侧视野缺损进展眼(1/7),差异有统计学意义(P=0.002);1只视野缺损进展眼仅发现1个筛板缺损,直径为169μm,小于对侧7只视野缺损不进展眼单眼筛板缺损总直径的中位数269μm.结论 POAG视野缺损不进展眼局限性筛板缺损发生率高,筛板缺损直径足够大可延缓或终止青光眼视神经损伤进展,是POAG视野缺损的保护因素.%Objective To investigate the relationship between the spontaneous focal lamina cribrosa (LC) defect and the progression of visual field defect (VFD) in primary open-angle glaucoma (POAG).Methods Case-control study.The patients who were diagnosed as POAG with at least 5 visual field results had been collected from June 2018 to January 2019 at Beijing Tongren Hospital Affiliated to Capital Medical University.Serial imaging by swept source optical coherence tomography B-Scan of the optic discs were acquired at the end of the follow-up and LC defects status were reviewed.Intraocular pressure,mean defects of visual field,central corneal thickness and axis length were recorded in the follow-up duration.Eyes were classified as having either progressive or nonprogressive VFD,and associating factors were evaluated by x2 or Fisher's test,mixed-effect model analysis and multivariate Logistical regression analysis.Results A total of 32 subjects (64 eyes) were enrolled in the study with mean age of (47± 14)years,the group consisted of 17 males and 15 females.Fourty-five eyes showed nonprogressive VFD.LC defects were more common in eyes without (28/45) rather than with progressive VFD (5/19) (x2=6.896,P=0.009).Eyes with nonprogressive VFD showed longer axis length[(26.82± 1.34) mm vs.(25.79± 1.44) mm;t=6.589,P=0.013] and wider LC defects diameter[211 (165-326) μm vs.114 (106-156) μm;Z=4.797,P=0.042].Multivariate Logistic regression analysis revealed that the presence of LC defect was significantly associated with nonprogressive VFD (odds ratio=0.217,P=0.012).There were 7 subjects with asymmetry VFD and the incedence of LC defects without progression (7/7) is higher than fellow eye with progression (1/7,P=O.002).There was only one patient with progressive VFD showed one LC defect with an smaller diameter (169 μm) than that in the contralateral eyes with stable VFD (269 μm).Conclusions LC defects are more common in eyes with nonprogressive VFD.Spontaneous LC defects are associated with nonprogressive glaucomatous defects and could be a protective factor for POAG.