Risk factors for progression of normal-tension glaucoma under β-blocker monotherapy
Risk factors for progression of normal-tension glaucoma under β-blocker monotherapy
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DOI：
10.1111/j.1755-3768.2012.02425.x
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发表时间：
2012-08-01
影响因子：
3.4
通讯作者：
Ohashi, Yasuo
中科院分区：
文献类型：
--
作者：
Araie, Makoto;Shirato, Shiroaki;Ohashi, Yasuo
目的：前瞻性研究局部β受体阻滞剂治疗正常眼压性青光眼（NTG）的预后因素。研究方法：146例146只眼NTG患者，平均未经治疗的眼内压（IOP）为14 mmHg，轻度至中度视野损害，平均等效球镜屈光度为-3.5（-8.0至+2.0）屈光度，随机接受局部尼普拉洛尔或噻吗洛尔治疗，并随访3年。每6个月进行Humphrey全阈值30-2视野检查，每12个月拍摄一次视盘照片。进展定义为视野进展、视盘和/或视乳头周围神经纤维层变化，并使用考克斯比例风险模型评价与进展相关的因素。结果：在3年期间，IOP下降了1.0 mmHg，在此期间，根据上述标准，35%的患者出现进展。视盘出血（风险比[HR] 4.00，p < 0.001）和近视程度较轻（每屈光度，HR 1.15，p = 0.013）是显著的风险因素。当仅通过视野进展定义进展时，近视程度较低再次成为显著风险因素（HR 1.17，p = 0.038）。结论：除视盘出血外，近视程度较低是当前NTG人群中进展的风险因素，其中大多数患者为轻度近视，局部β受体阻滞剂治疗下随访期间的IOP平均为13.2 mmHg。
Purpose: To prospectively study prognostic factors for normal-tension glaucoma (NTG) under treatment with topical beta-blocker. Methods: One hundred and forty-six eyes of 146 patients with NTG with a mean untreated intraocular pressure (IOP) of 14 mmHg, mild to moderate visual field damage and mean spherical equivalent refraction of -3.5 (-8.0 to +2.0) dioptre were randomized to topical nipradilol or timolol and followed for 3 years. The Humphrey full threshold 30-2 visual field test was performed every 6 months, and optic disc photographs were obtained every 12 months. Progression was defined as visual field progression, optic disc and/or peripapillary nerve fibre layer change, and factors relating to progression were evaluated using Cox proportional hazards models. Results: IOP decreased by 1.0 mmHg over the 3-year period, during which 35% showed progression according to the aforementioned criteria. Optic disc haemorrhage (hazard ratio [HR] 4.00, p < 0.001) and less extent of myopia (per dioptre, HR 1.15, p = 0.013) were significant risk factors. When progression was defined by visual field progression only, less extent of myopia was again a significant risk factor (HR 1.17, p = 0.038). Conclusion: Beside optic disc haemorrhage, less extent of myopia was a risk factor for progression in the current NTG population where most patients were mildly myopic and IOP during follow-up averaged 13.2 mmHg under topical beta-blocker.