Corneal thickness measurement in the management of primary open-angle glaucoma
Corneal thickness measurement in the management of primary open-angle glaucoma
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DOI：
10.1016/j.ophtha.2007.04.068
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发表时间：
2007-09-01
期刊：
影响因子：
13.7
通讯作者：
Schuman, Joel S.
中科院分区：
文献类型：
--
作者：
Dueker, David K.;Singh, Kuldev;Schuman, Joel S.
目的：为了评估已发表的文献，以评估中央角膜厚度（CCT）是否是一个危险因素的存在，发展，或原发性开角型青光眼（POAG）相关的青光眼视神经损伤的进展：方法：PubMed文献检索有限的英语文章进行了2004年11月15日检索195篇文章。作者审查了这些摘要，并选择了57篇进行全文审查，以确定与评估问题的相关性。通过定期更新文献检索、文献监测和综述文章的参考文献列表，确定了另外24项关注的研究。从确定的81份已发表报告中，第一作者应用了特定的选择标准，由于与评估问题相关，产生了37篇文章进行方法学审查。由专门小组方法学家根据证据强度对文章进行评级。I级评级被分配给设计良好、适当进行的随机临床试验或类似的质量验证队列研究，并有适当的参考标准。II级评级被分配给设计良好的病例对照研究、探索性队列研究和其他缺乏一致应用参考标准的非随机临床研究。III级评级保留给设计不良的病例对照研究、病例系列和仅包含专家意见而无支持证据的论文。此外，每项研究被评为积极的，如果它支持的CCT与有或发展成青光眼性视神经损伤的风险或负面的统计关联，如果没有这样的关联被发现。结果：有强有力的和一致的I级和II级的证据表明，CCT是一个危险因素的进展，从高眼压症POAG。被评为提供最高质量证据的研究显示，青光眼患病率的结果好坏参半。一项以人群为基础的研究（II级）显示了积极的关联，另一个更大的研究（I级）揭示了边缘意义的关联，3项研究（所有I级）发现CCT与POAG患病率没有关联。结论：有强有力的证据表明，测量CCT是一个完整的眼部检查的重要组成部分，特别是对患者正在评估发展POAG的风险。因此，所有高眼压患者的检查中都应包括CCT测量。尽管支持将CCT测量作为POAG筛查的一部分或作为青光眼进展的风险因素的必要性的证据并不那么强，但眼内压（IOP）是青光眼治疗中唯一可改变的风险因素，CCT有可能显著影响所有患者通过压平眼压计测量的IOP。Ophthalmology 2007;14：1779-1787（c）2007，美国眼科学会。
Objective: To evaluate published literature to assess whether central corneal thickness (CCT) is a risk factor for the presence, development, or progression of glaucomatous optic nerve damage related to primary openangle glaucoma (POAG).Methods: A PubMed literature search limited to English language articles conducted on November 15, 2004 retrieved 195 articles. The authors reviewed these abstracts and selected 57 to review in full text to determine relevance to the assessment questions. A further 24 studies of interest were identified from periodic updates to the literature search, surveillance of the literature, and reference lists of reviewed articles. From the 81 published reports identified, the first author applied specified selection criteria that yielded 37 articles for methodological review because of relevance to the assessment questions. The articles were rated according to the strength of evidence by the panel methodologist. A level I rating was assigned to well-designed properly conducted randomized clinical trials or similar quality-validated cohort studies with appropriate reference standards. A level II rating was assigned to well-designed case-control studies, exploratory cohort studies, and other nonrandomized clinical studies lacking consistently applied reference standards. A level III rating was reserved for poorly designed case-control studies, case series, and papers consisting only of expert opinion without supporting evidence. In addition, each study was graded as positive if it supported a statistical association of CCT with the risk of having or developing glaucomatous optic nerve damage or as negative if no such association was found.Results: There is strong and consistent level I and level II evidence that CCT is a risk factor for progression from ocular hypertension to POAG. Studies that were rated as providing the highest quality of evidence revealed mixed results with respect to glaucoma prevalence. One population-based study (level II) showed a positive association, another larger study (level I) revealed an association of marginal significance, and 3 studies (all level I) found no association of CCT with POAG prevalence.Conclusions: There is strong evidence that measuring CCT is an important component of a complete ocular examination, particularly for patients being evaluated for the risk of developing POAG. Therefore, CCT measurement should be included in the examination of all patients with ocular hypertension. Although the evidence supporting the necessity of measuring CCT as part of screening for POAG or as a risk factor for glaucoma progression is not as strong, intraocular pressure (IOP) is the only modifiable risk factor in the treatment of glaucoma, and CCT has the potential to significantly impact IOP measurement by applanation tonometry in all patients. Ophthalmology 2007;14:1779-1787 (c) 2007 by the American Academy of Ophthalmology.