Follow‐up of glaucomatous eyes with optic disc haemorrhages: the Beijing Eye Study
Follow‐up of glaucomatous eyes with optic disc haemorrhages: the Beijing Eye Study
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青光眼伴视盘出血的随访：北京眼科研究
DOI：
10.1111/j.1755-3768.2008.01214.x
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发表时间：
2009
影响因子：
3.4
通讯作者：
J. Jonas
中科院分区：
文献类型：
--
作者：
Liang Xu;Y. X. Wang;Hua Yang;J. Jonas
编辑，视盘出血在视神经疾病的眼底镜诊断中起着重要作用(Airaksinen等人)。(1981年)。以前基于医院的研究和基于人群的调查表明，椎间盘出血与青光眼的相关性非常显著(Airaksinen等人。1981年；Leske et al.2003年；Ramakrishnan等人。2003年；布登兹等人。2006)。本研究旨在评估以人群为基础的人群中，视盘出血继发青光眼进展的频率。2001年北京眼研究是一项以人口为基础的研究，研究对象为大北京地区40岁的‡患者，受邀参加的5324名受试者中有4439名。青光眼的定义是视神经头的出现(‘视盘青光眼’[ODG])或根据额外视野缺陷的存在(‘周围性青光眼’[PG])，正如最近详细描述的(Xu等人)。2007)。2001年，221只眼(2.5%)符合诊断标准，134只眼(1.5%)符合PG诊断标准。同年，在221只ODG和134只PG中，16只眼(7.2%)和134只眼(8.2%)在视盘照片上发现视盘出血。在2001年诊断为ODG和视盘出血的16只眼中，11只眼(69%)在2006年重新检查。其中9只眼(56%)获得了可检查的照片。其中7只眼(78%)发展为青光眼，表现为神经视网膜边缘丢失和乳头周围萎缩的β区扩大。在两只眼(22%)中，视盘外观在5年的随访期内没有变化。在2001年诊断为PG和视盘出血的11只眼中，8只眼(73%)在2006年重新检查，其中6只眼(55%)获得了照片。在4只眼(66%)中，视盘外观的改变表明青光眼已经进展，而在2只眼(33%)中，视盘似乎没有变化。这些结果表明，在以人群为基础的背景下，中国成年人青光眼的视盘出血可能伴随着青光眼视神经损害的进展，概率约为70%-80%。这些结果与眼压治疗研究的结果形成对比，该研究发现，尽管在随访期间有视盘出血的高眼压患者经历原发性开角型青光眼终点的可能性是对照组的6倍，但87%有视盘出血的研究参与者在中位数96个月的随访中没有经历青光眼终点(Budenz等人)。2006)。两项研究结果之间的差异可能反映了这样一个事实，即本研究中的大多数患者没有接受治疗，而且眼压治疗研究主要不包括青光眼。
Editor, O ptic disc haemorrhages play an important role in the ophthalmoscopic diagnosis of optic nerve diseases (Airaksinen et al. 1981). Previous hospital-based studies and populationbased investigations have shown that disc haemorrhages are highly significantly associated with glaucoma (Airaksinen et al. 1981; Leske et al. 2003; Ramakrishnan et al. 2003; Budenz et al. 2006). The present study set out to assess how often disc haemorrhages are followed by glaucoma progression in a population-based setting. The Beijing Eye Study 2001, a population-based study on subjects aged ‡ 40 years in Greater Beijing, included 4439 of the 5324 subjects invited to participate. Glaucoma was defined by the appearance of the optic nerve head (‘optic disc glaucoma’ [ODG]) or according to the presence of additional visual field defects (‘perimetric glaucoma’ [PG]), as has recently been described in detail (Xu et al. 2007). In 2001, 221 (2.5%) eyes fulfilled the criteria for the diagnosis of ODG and 134 (1.5%) fulfilled the criteria for PG. In the same year, an optic disc haemorrhage was detected on optic disc photographs in 16 (7.2%) of the 221 eyes with ODG and in 11 (8.2%) of the 134 eyes with PG. Of the 16 eyes with ODG and an optic disc haemorrhage diagnosed in 2001, 11 (69%) returned for re-examination in 2006. Examinable photographs were obtained in nine (56%) of these eyes. In seven (78%) of these eyes, glaucoma had progressed as shown by neuroretinal rim loss and enlargement of the beta zone of peripapillary atrophy. In two (22%) eyes, optic disc appearance appeared unchanged at the 5-year follow-up. Of the 11 eyes with PG and an optic disc haemorrhage diagnosed in 2001, eight (73%) eyes returned for re-examination in 2006 and photographs were obtained in six (55%) of them. In four (66%) eyes, a change in the appearance of the optic disc indicated that glaucoma had progressed, and in two (33%) eyes the optic disc appeared to be unchanged. These results suggest that, in a population-based setting, optic disc haemorrhages in glaucomatous eyes in an adult Chinese population may be followed by a progression of glaucomatous optic nerve damage with a probability of about 70–80%. These results contrast with those of the Ocular Hypertension Treatment Study, which found that although ocular hypertensive subjects with optic disc haemorrhages during follow-up were six times more likely to experience a primary open-angle glaucoma endpoint, 87% of study participants with an optic disc haemorrhage did not experience a glaucoma end-point by a median follow-up of 96 months (Budenz et al. 2006). The discrepancy in findings between the studies may reflect the facts that the majority of patients in the present study were not under treatment and that the Ocular Hypertension Treatment Study did not primarily include glaucomatous eyes.