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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摘要目的：探讨原发性开角型青光眼（POAG）非对称性视野损害的相关因素，并了解非对称性视野损害者双眼间眼部参数的差异。方法：横断面研究。收集2014年1月至2018年12月温州青光眼进展研究（WGPS）中确诊的POAG患者，分析双眼眼部参数，包括眼压、眼轴长度（AL）、中央角膜厚度（CCT）、前房深度（ACD）、晶状体厚度（LT）、视野平均偏差（MD）、视网膜神经纤维层厚度（RNFLT）、盘沿面积、视盘面积、杯盘比、视杯容积。非对称性视野损害定义为双眼视野MD的绝对差值≥5 dB，根据此标准将受检者分为对称组和非对称组，分析2组眼部参数与非对称性视野损害的关系。非对称组进一步行双眼间眼部参数的比较。采用独立样本t检验、Mann-Whitney U检验、配对t检验、 Wilcoxon检验、Logistic回归分析对数据进行分析。结果：共纳入POAG患者142例（284眼），对称组 92例（64.8%），男39例（42.4%），年龄（65.3±1.0）岁；非对称组50例（35.2%），男32例（64.0%），年龄（67.6±9.1）岁。男性[OR=4.52，95%可信区间（CI）：1.90～10.73，P=0.001]、较差眼的CCT较薄（OR=0.97，95%CI：0.95～0.99，P=0.003）、双眼平均RNFLT差值增大（OR=1.10，95%CI：1.04～1.15， P<0.001）为非对称性视野损害的危险因素。非对称组中，视野损害较重眼相比对侧眼，其平均 RNFLT较薄（Z=-7.80，P<0.001），盘沿较窄（t=-4.97，P<0.001），视盘面积较大（t=2.38，P=0.02），平均杯盘比（Z=-4.51，P<0.001）和垂直杯盘比（Z=5.16，P<0.001）均较大，视杯容积较大（Z=-3.31， P<0.001），但双眼间眼压、等效球镜度（SE）、AL、CCT、LT和ACD的差异均无统计学意义。结论：男性、CCT较薄、双眼平均RNFLT差值增大为POAG非对称性视野损害的独立危险因素，而非对称性视野损害者其双眼中的较大视盘眼，更容易发生视神经损害。

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关键词 ：原发性开角型青光眼, 非对称性视野, 视神经纤维层厚度, 视盘面积

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

收稿日期: 2019-06-18

基金资助:浙江省卫生高层次创新人才计划（2016025）

通讯作者: 瞿佳（ORCID：0000-0003-1678-966X），Email：qujia@eye.ac.cn

引用本文:

李林珊戈正妍梁远波周堃潘霞飞瞿佳. 原发性开角型青光眼非对称性视野损害的影响因素[J]. 中华眼视光学与视觉科学杂志, 2020, 22(7): 511-517. Linshan Li, Zhengyan Ge, Yuanbo Liang, Kun Zhou, Xiafei Pan, Jia Qu. Factors Associated with Asymmetric Visual Field Loss for Primary Open-Angle Glaucoma in a Chinese Population. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(7): 511-517. DOI: 10.3760/cma.j.cn115909-20190618-00174

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

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