Ocular Biometric Risk Factors for Progression of Primary Angle Closure Disease: The Zhongshan Angle Closure Prevention Trial.
Ocular Biometric Risk Factors for Progression of Primary Angle Closure Disease: The Zhongshan Angle Closure Prevention Trial.
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DOI：
10.1016/j.ophtha.2021.10.003
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发表时间：
2022-03
期刊：
影响因子：
13.7
通讯作者：
He M
中科院分区：
文献类型：
--
作者：
Xu BY;Friedman DS;Foster PJ;Jiang Y;Porporato N;Pardeshi AA;Jiang Y;Munoz B;Aung T;He M
评估从疑似原发性闭角 (PACS) 进展为原发性闭角 (PAC) 或急性闭角 (AAC) 的基线眼部生物特征危险因素。前瞻性观察研究。 643 名年龄 50 至 70 岁的中国大陆未接受 PACS 治疗的患者。作为中山预防房角关闭 (ZAP) 试验的一部分，参与者接受了基线临床检查，包括前房角镜检查、眼前节 OCT (AS-OCT) 成像（Visante OCT、Carl Zeiss Meditec，都柏林，加利福尼亚州）和 A 扫描超声生物测定。 PACS 被定义为无法基于静态前房角镜检查在两个或多个象限中可视化色素小梁网。 PAC 定义为眼内压 (IOP) 升高 > 24 mmHg 或周围性前粘连 (PAS)。进展被定义为 PAC 或急性闭角 (AAC) 发作的发展。开发多变量逻辑回归模型来评估进展的生物特征风险因素。从 PACS 进展到 PAC 或 AAC 需要 6 年时间。 643 名 ZAP 参与者的 643 只未经治疗的眼睛（609 只非进展眼，34 只进展眼）被纳入初步分析。在具有连续参数的多变量模型中，距巩膜刺 500 μm 的较窄水平张开距离（AOD500；OR=1.10 每减少 0.01 mm，p=0.03）、较平坦的水平虹膜曲率（IC；OR=1.96 每减少 0.1 mm，p=0.01）和基线年龄较大（OR=每年增加 1.11，p=0.01）与基线显着相关。进展（AUC=0.73）。当替换多变量模型中的水平 AOD500 时，较小的累积前房角镜评分与进展无关（每 1 次改良 Shaffer 等级降低，OR=1.03；p=0.85）。在具有分类参数的单独多变量模型中，水平 AOD500（OR=3.10，p=0.002）和 IC（OR=2.48，p=0.014）测量值最低四分位的参与者以及基线时年龄为 59 岁及以上（OR=2.68，p=0.01）的参与者有较高的进展几率（AUC=0.72）。眼部生物识别测量可以帮助对早期闭角患者进行更严重疾病的风险分层。描述角度和虹膜的生物特征参数的 AS-OCT 测量可以预测从 PACS 到 PAC 或 AAC 的进展，而房角镜检查等级则不能。房角宽度和虹膜曲率预测原发性闭角怀疑进展为原发性闭角和锐角闭合。眼部生物识别测量有助于对早期闭角患者进行更严重疾病的风险分层。
To assess baseline ocular biometric risk factors for progression from primary angle closure suspect (PACS) to primary angle closure (PAC) or acute angle closure (AAC). Prospective observational study. 643 mainland Chinese aged 50 to 70 years with untreated PACS. Participants received baseline clinical examinations including gonioscopy, anterior segment OCT (AS-OCT) imaging (Visante OCT, Carl Zeiss Meditec, Dublin, CA), and A-scan ultrasound biometry as part of the Zhongshan Angle Closure Prevention (ZAP) Trial. PACS was defined as inability to visualize pigmented trabecular meshwork in two or more quadrants based on static gonioscopy. PAC was defined as development of elevated intraocular pressure (IOP) > 24 mmHg or peripheral anterior synechiae (PAS). Progression was defined as development of PAC or an acute angle closure (AAC) attack. Multivariable logistic regression models were developed to assess biometric risk factors for progression. Progression from PACS to PAC or AAC over 6 years. 643 untreated eyes (609 non-progressors, 34 progressors) of 643 ZAP participants were included in the primary analysis. In a multivariable model with continuous parameters, narrower horizontal angle opening distance 500 μm from the scleral spur (AOD500; OR=1.10 per 0.01 mm decrease, p=0.03), flatter horizontal iris curvature (IC; OR=1.96 per 0.1 mm decrease, p=0.01), and older age (OR=1.11 per year increase, p=0.01) at baseline were significantly associated with progression (AUC=0.73). Smaller cumulative gonioscopy score was not associated with progression (OR=1.03 per 1 modified Shaffer grade decrease; p=0.85) when replacing horizontal AOD500 in the multivariable model. In a separate multivariable model with categorical parameters, participants in the lowest quartile of horizontal AOD500 (OR=3.10, p=0.002) and IC (OR=2.48, p=0.014) measurements and aged 59 years and older (OR=2.68, p=0.01) at baseline had higher odds of progression (AUC=0.72). Ocular biometric measurements can help risk stratify patients with early angle closure for more severe disease. AS-OCT measurements of biometric parameters describing the angle and iris are predictive of progression from PACS to PAC or AAC, whereas gonioscopy grades are not. Angle width and iris curvature predict progression of primary angle closure suspects to primary angle closure and acute angle closure. Ocular biometric measurements help risk stratify patients with early angle closure for more severe disease.
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