Health screening program revealed risk factors associated with development and progression of papillomacular bundle defect
Health screening program revealed risk factors associated with development and progression of papillomacular bundle defect
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DOI：
10.1007/s13167-021-00235-4
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发表时间：
2021-03-04
期刊：
影响因子：
6.5
通讯作者：
Choi, Hyuk Jin
中科院分区：
文献类型：
--
作者：
Baek, Sung Uk;Lee, Won June;Choi, Hyuk Jin
乳头状黄斑束（PMB）区是与中心视觉相关的重要解剖部位。随着预防医学和健康筛查检查现在变得普遍，眼底照相中乳头状黄斑束缺陷（PMBD）的偶然检测一直在增加。然而，到目前为止，偶发性PMBD的临床意义尚未得到很好的记录。因此，通过长期和纵向观察，我们的目的是研究PMBD的发展和进展的危险因素及其与系统性疾病和青光眼相关的预测作用。方法采用纵向研究方法，对参加过标准化健康筛查的受试者进行研究。我们回顾性分析了眼底照相检测到PMBD的患者，并随访了5年以上。为了进行比较分析，选择年龄和性别匹配的健康对照的非PMBD组。结果8.0年共分析眼底照片67,000张，发现PMBD 587只眼，其中234例眼底照片拍摄时间超过5年的患者234只眼最终纳入研究。共有216只眼（92.3%）在8.1 +/- 2.7年内没有进展，而18只眼（7.7%）在首次检测后7.6 +/- 2.9年时显示进展。对224名非PMBD健康对照者进行多因素Logistic回归分析，结果显示低体重指数（BMI < 20 kg/m2）、全身性高血压和视网膜动脉硬化改变是PMBD发生的重要危险因素。关于PMBD进展，低BMI、非PMB部位伴发视网膜神经纤维层缺损（RNFLD）、视盘出血和较高的垂直杯/盘比是个体显著风险因素。结论PMBD与缺血效应有关。虽然大多数PMBD没有进展，但有些病例与长期的昏迷性损害有关。PMBD可能是反映缺血相关疾病的个体化指标，也是青光眼诊断和预防的预测因子。
Background/aims The papillomacular bundle (PMB) area is an important anatomical site associated with central vision. As preventive medicine and health screening examinations are now becoming commonplace, the incidental detection of papillomacular bundle defect (PMBD) on fundus photography has been increasing. However, clinical significance of incidental PMBD has not been well documented to date. Thus, through long-term and longitudinal observation, we aimed to investigate the risk factors for the development and progression of PMBD and its predictive role associated with systemic diseases and glaucoma. Methods This longitudinal study included subjects who had undergone standardized health screening. We retrospectively reviewed patients for whom PMBD had been detected in fundus photography and followed up for more than 5 years. For a comparative analysis, non-PMBD groups of age- and gender-matched healthy controls were selected. Results A total of about 67,000 fundus photographs were analyzed for 8.0 years, and 587 PMBD eyes were found. Among them, 234 eyes of 234 patients who had had fundus photographs taken for more than 5 years were finally included. A total of 216 eyes (92.3%) did not progress during the 8.1 +/- 2.7 years, whereas 18 eyes (7.7%) showed progression at 7.6 +/- 2.9 years after initial detection. A multivariate logistic regression analysis using 224 non-PMBD healthy controls revealed low body mass index (BMI < 20 kg/m(2)), systemic hypertension, and sclerotic changes of retinal artery as the significant risk factors for the development of PMBD. Regarding PMBD progression, low BMI, concomitant retinal nerve fiber layer defect (RNFLD) at non-PMB sites, optic disc hemorrhage, and higher vertical cup/disc ratio were individual significant risk factors. Conclusion PMBD is associated with ischemic effects. Although the majority of PMBD do not progress, some of cases are associated with glaucomatous damage in a long-term way. PMBD might be a personalized indicator representing ischemia-associated diseases and a predictive factor for diagnosis and preventive management of glaucoma.