OBJECTIVE: To assess risk factors for an initial parafoveal scotoma (IPFS) compared with an initial nasal step (INS) in glaucoma. DESIGN: Retrospective, observational study. PARTICIPANTS: Sixty-nine patients with glaucoma with an isolated IPFS and 53 patients with an isolated INS. METHODS: On the basis of 2 reliable, consistent 24-2 Swedish interactive threshold algorithm standard visual fields (VFs), 2 groups of patients with glaucoma were studied: those with an IPFS in 1 hemifield (>/=3 adjacent points with P<5% within the central 10 degrees of fixation, >/=1 point with P<1% lying at the innermost paracentral points, and no VF abnormality outside the central 10 degrees) and those with an INS in 1 hemifield (>/=3 adjacent points with P<5% in the nasal periphery outside 10 degrees of fixation, the nasal-most point with P<1%, and no VF abnormality within the central 10 degrees). Clinical characteristics and systemic factors were recorded from charts and compared between the 2 groups. MAIN OUTCOME MEASURES: Maximum untreated intraocular pressure (IOP), disc hemorrhage (DH) detection during follow-up, systemic risk factors, and VF mean deviation (MD) and pattern standard deviation (PSD). RESULTS: Maximum untreated IOP (21.6+/-4.5 vs. 28.3+/-9.6 mmHg; P<0.001) was significantly lower, and frequency of DH detection (44% vs. 17%; P=0.001) and systemic risk factors (hypotension, migraine, Raynaud's phenomenon, and sleep apnea; 16%, 23%, 24%, and 9% vs. 0%, 4%, 9%, and 0%; P=0.001, 0.002, 0.025, and 0.030, respectively) were significantly higher in patients with an IPFS than in patients with an INS. There were no significant differences in age, gender, family history of glaucoma, refractive error, central corneal thickness, and disc area between the 2 groups (all P>0.1). Mean deviation was similar between the 2 groups (P=0.346), but PSD was significantly greater in the IPFS group than in the INS group (P=0.043). CONCLUSIONS: Eyes with an IPFS differ from those with an INS. These findings may help clinicians identify patients at higher risk of early central field loss.
展开▼
机译：目的：评估青光眼中最初的中央凹旁阴囊（IPFS）与最初的鼻腔阶梯（INS）相比的危险因素。设计：回顾性观察研究。参与者：69例青光眼患者，孤立的IPFS和53例患者，孤立的INS。方法：在2个可靠，一致的24-2瑞典交互式阈值算法标准视野（VFs）的基础上，研究了2组青光眼患者：IPFS在1个半视野内（> / = 3个相邻点，P <中心10度内5％，> / = 1点，P <1％位于最内侧的中央点，中心10度外无VF异常），而INS在1个半视野内（> / = 3固定点10度以外的鼻周边中P <5％的相邻点，P <1％的最鼻端，并且在中心10度以内没有VF异常）。从图表中记录临床特征和全身因素，并在两组之间进行比较。主要观察指标：最大未治疗眼内压（IOP），随访期间发现椎间盘出血（DH），全身性危险因素以及VF平均偏差（MD）和模式标准偏差（PSD）。结果：未治疗的最大眼压（21.6 +/- 4.5 vs. 28.3 +/- 9.6 mmHg; P <0.001）显着降低，DH检出频率（44％vs. 17％; P = 0.001）和系统性危险因素（低血压，偏头痛，雷诺现象和睡眠呼吸暂停;分别为16％，23％，24％和9％，分别为0％，4％，9％和0％; P = 0.001、0.002、0.025和0.030 IPFS患者的）明显高于INS患者。两组之间在年龄，性别，青光眼家族史，屈光不正，角膜中央厚度和椎间盘面积方面无显着差异（均P> 0.1）。两组之间的平均偏差相似（P = 0.346），但IPFS组的PSD显着大于INS组（P = 0.043）。结论：IPFS眼与INS眼不同。这些发现可能有助于临床医生确定早期中央视野丧失风险较高的患者。
展开▼
