原发性开角型青光眼非对称性视野损害的影响因素

doi:10.3760/cma.j.cn115909-20190618-00174

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Abstract Objective: To explore factors relating to asymmetry in visual field loss in primary open-angle glaucoma (POAG) and to compare inter-eye parameters in asymmetric visual field loss. Methods: In this descriptive cross-sectional study, POAG patients were enrolled from the Wenzhou glaucoma progression study between January 2014 and December 2018 and their binocular data from medical examination were collected. The criterion for asymmetry in the visual field was a 5 dB difference in mean deviation (MD).Intraocular pressure (IOP), axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), MD, average retinal nerve fiber layer thickness (RNFLT), disc edge thickness, optic disc area, cup-to-disk ratio, and cup volume were obtained from each patient. Patients were divided into a symmetric group and asymmetric group, and the associations between their binocular absolute difference and asymmetric field loss were analyzed. Inter-eye parameters of the asymmetric group were further compared. Data were analyzed by methods such as an independent sample t test, Mann-Whitney U test, paired t test, Wilcoxon test, and logistic regression analysis. Results: One hundred forty-two POAG patients were included in the study. Ninety-two people were in the symmetric group (mean age: 65.3±1.0), and among them, 39 were male. Fifty people were in the asymmetric group (mean age: 67.6±9.1), and among them, 32 were male. Male gender (OR=4.52, 95%CI: 1.90-10.73, P=0.001), a thinner CCT in the worse eye (OR=0.97, 95%CI: 0.95-0.99, P=0.003) and binocular average RNFLT difference (OR=1.10, 95%CI: 1.04-1.15, P<0.001) were risk factors for asymmetrical visual field loss. Compared with the contralateral eyes, the worse eyes (severe visual field loss) in the asymmetric group had a thinner average RNFLT (Z=-7.80, P<0.001), narrower disc edge (t=-4.97, P<0.001), larger optic disc (t=2.38, P=0.02) and cup volume (Z=-3.31, P<0.001), larger average cup-to-disk ratio (Z=-4.63, P<0.001) and vertical cupto-disk ratio (Z=5.16, P<0.001). There were no significant differences in IOP, SE, AL, CCT, LT, or ACD between the eyes in the asymmetric group. Conclusions: Male, thinner CCT and a larger mean RNFLT difference are risk factors for asymmetric visual field loss in POAG patients. Mean while, a larger optic disc area is more susceptible to glaucomatous optic nerve damage.

Key words： primary open-angle glaucoma asymmetry visual field retinal nerve fiber thickness optic disc area

Received: 18 June 2019

Fund:Zhejiang Province Health Innovation Talents Project (2016025)

Corresponding Authors: Jia Qu, Department of Ophthalmology, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China (Email: qujia@eye.ac.cn)

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https://www.cjoovs.com/EN/10.3760/cma.j.cn115909-20190618-00174 OR https://www.cjoovs.com/EN/Y2020/V22/I7/511

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