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Zhang X, Dastiridou A, Francis BA, et al.

期刊名称:American Journal of Ophthalmology



目的:旨在确定预测开角型青光眼患者视野(VF)损失进展的基线结构参数。设计:多中心队列研究。方法:招募青光眼高级成像(AIG)研究的参与者,并进行随访。 VF进展定义为Humphrey进展分析上确认的进展事件或VF指数(VFI)明显负斜率(P <0.05)。傅里叶域光学相干断层扫描(FDOCT)用于测量视神经乳头,视乳头周围视网膜神经纤维层(NFL)和黄斑神经节细胞复合体(GCC)厚度参数。结果:共对188名参与者的277只眼进行了3.7±2.1年的随访。83只眼观察到VF进展(30%)。研究人员发现几个基线NFLGCC参数,但无视盘参数,是单变量Cox回归分析进展的重要预测因子。最准确的单一预测因子是GCC聚焦损失体积(FLV),紧随其后是NFL-FLV。基线GCC-FLV异常(风险比3.1)提示进展风险增加。多变量Cox分析显示,在称为“青光眼复合进展指数”(GCPI)的综合指数中,年龄和中心角膜厚度与GCC-FLV组合可进一步提高进展预测的准确性。研究人员发现GCC-FLVGCPI明显与VFI的年变化率相关。结论:通过FDOCT测量的局灶性GCCNFL损失是考虑的指标中VF进展的最强预测因子。使用复合风险模型,老龄和较薄的中心角膜厚度可增强预测能力。

PURPOSE:To identify baseline structural parameters that predict the progression of visual field (VF) loss in patients with open-angle glaucoma.DESIGN:Multicenter cohort study.METHODS:Participants from the Advanced Imaging for Glaucoma (AIG) study were enrolled and followed up. VF progression is defined as either a confirmed progression event on Humphrey Progression Analysis or a significant (P < .05) negative slope for VF index (VFI). Fourier-domain optical coherence tomography (FDOCT) was used to measure optic disc, peripapillary retinal nerve fiber layer (NFL), and macular ganglion cell complex (GCC) thickness parameters.RESULTS:A total of 277 eyes of 188 participants were followed up for 3.7 ± 2.1 years. VF progression was observed in 83 eyes (30%). Several baseline NFL and GCC parameters, but not disc parameters, were found to be significant predictors of progression on univariate Cox regression analysis. The most accurate single predictors were the GCC focal loss volume (FLV), followed closely by NFL-FLV. An abnormal GCC-FLV at baseline increased risk of progression by a hazard ratio of 3.1. Multivariate Cox analysis showed that combining age and central corneal thickness with GCC-FLV in a composite index called "Glaucoma Composite Progression Index" (GCPI) further improved the accuracy of progression prediction. GCC-FLV and GCPI were both found to be significantly correlated with the annual rate of change in VFI.CONCLUSION:Focal GCC and NFL loss as measured by FDOCT are the strongest predictors for VF progression among the measurements considered. Older age and thinner central corneal thickness can enhance the predictive power using the composite risk model.


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