【2016.04】青光眼角膜滞后量和进展性视网膜神经纤维层丢失相关

 

【据《AmericanJournalofOphthalmology》2016年4月报道】题:青光眼角膜...



【据《American Journal of Ophthalmology》2016年4月报道】题:青光眼角膜滞后量和进展性视网膜神经纤维层丢失相关(英文题:Corneal hysteresis and progressive retinal nerve fiber layer loss in glaucoma;作者:Zhang C等,作者单位:美国加利福尼亚大学)

角膜的生物力学属性,比如薄中央角膜厚度和低角膜滞后量,已经被确定为原发性开角型青光眼的危险因素。这表明它们可能是青光眼易感性的重要生物标记。虽然测量角膜厚度已经成为临床上青光眼患者和可疑青光眼患者的必查项目,近来的研究发现角膜滞后量可能是青光眼进展的强有力的提示。

角膜滞后量是测量角膜的粘弹阻尼属性,可以通过分析空气脉冲后角膜抵抗变形的能力来评估。角膜滞后量可以通过眼反应分析仪活体评估。文献推测角膜的生物力学属性有可能与眼后段组织(比如筛板和巩膜)的生物力学属性相关。低角膜滞后量的眼有可能其筛板不容易适应压力变化,从而可能增加了眼内压相关压力和青光眼性损伤的易感性。高角膜滞后量眼在一过性眼压升高时视神经表面变形更大也支持这个概念。

与正常眼相比,青光眼的角膜滞后量降低,而且低角膜滞后量患者处于进展性视野丢失的高风险。在一个前瞻性纵向研究中,Medeiros等显示低角膜滞后量比高角膜滞后量有更快的视野丢失速率。然而,虽然以前的纵向研究已经分析了角膜滞后量和青光眼损伤功能性测量之间的关系,就我们所知,还没有报道分析角膜滞后量与视盘进展性结构变化之间的关系。本研究的目的是为了分析在青光眼患者角膜滞后量和进展性视网膜神经纤维层丢失的关系。作者采用前瞻性观察研究的设计。共收集了青光眼患者133例共189眼,平均随访时间:3.8±0.8年,在随访过程平均随访9次。每次随访时采用眼反应分析仪获得角膜滞后量和采用频域OCT得到视网膜神经纤维层厚度。调整混淆因素后,随机系数模型被用于研究基线角膜滞后量、中央角膜厚度、平均眼内压和随访过程中视网膜神经纤维层丢失速率之间的关系。

结果发现平均基线视网膜神经纤维层厚度为76.4±18.1μm和平均基线角膜滞后量为9.2±1.8 mmHg。角膜滞后量对视网膜神经纤维层厚度变化的速率有明显影响。采用单变量模型,仅包含角膜滞后量作为一个随时间的预测指标和它们的互相影响时,每减低1mmHg角膜滞后量与视网膜神经纤维层厚度每年多丢失0.13微米相关(P=0.011)。采用多变量模型包含年龄、种族、平均眼压和中央角膜厚度时,低角膜滞后量和更快的视网膜神经纤维丢失速率有类似的相关性(P=0.015)。

因此作者得出结论:较低的角膜滞后量与更快的视网膜神经纤维丢失速率明显相关。本研究的前瞻性纵向设计提供了进一步证据表明在评估青光眼患者进展风险时,应该考虑到角膜滞后量这个重要的因素。

(陶爱珠 报道)



PURPOSE:

To investigate the relationship between corneal hysteresis (CH) and progressive retinal nerve fiber layer (RNFL) loss in a cohort of patients with glaucoma followed prospectively over time.

DESIGN:

Prospective observational cohort study.

METHODS:

One hundred and eighty-six eyes of 133 patients with glaucoma were followed for an average of 3.8 ± 0.8 years, with a median of 9 visits during follow-up. The CH measurements were acquired using the Ocular Response Analyzer (Reichert Instruments, Depew, New York, USA) and RNFL measurements were obtained at each follow up visit using spectral-domain optical coherence tomography (SDOCT). Random-coefficient models were used to investigate the relationship between baseline CH, central corneal thickness (CCT), average intraocular pressure (IOP), and rates of RNFL loss during follow-up, while adjusting for potentially confounding factors.

RESULTS:

Average baseline RNFL thickness was 76.4 ± 18.1 μm and average baseline CH was 9.2 ± 1.8 mm Hg. CH had a significant effect on rates of RNFL progression. In the univariable model, including only CH as a predictive factor along with time and their interaction, each 1 mm Hg lower CH was associated with a 0.13 μm/year faster rate of RNFL decline (P = .011). A similar relationship between low CH and faster rates of RNFL loss was found using a multivariable model accounting for age, race, average IOP, and CCT (P = .015).

CONCLUSIONS:

Lower CH was significantly associated with faster rates of RNFL loss over time. The prospective longitudinal design of this study provides further evidence that CH is an important factor to be considered in the assessment of the risk of progression in patients with glaucoma.

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