Classifying juvenile onset primary open angle glaucoma using cluster analysis
Classifying juvenile onset primary open angle glaucoma using cluster analysis
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DOI：
10.1136/bjophthalmol-2019-314660
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发表时间：
2020-06-01
影响因子：
4.1
通讯作者：
Gupta, Viney
中科院分区：
文献类型：
--
作者：
Birla, Shweta;Gupta, Dinesh;Gupta, Viney
目的采用聚类分析方法，将青少年发病原发性开角型青光眼（JOAG）患者分为不同的临床表型。方法在527例不相关的JOAG患者中，研究纳入了414例具有研究所需的所有表型特征的患者。采用聚类分析，根据患者的虹膜形态、眼角形态、发病年龄、最高未治疗眼压、最差眼最大平均偏差和最大垂直杯盘比对患者进行分类。将虹膜特征大致分为正常虹膜隐窝组（NIC）、突出虹膜隐窝组（PIC）和无虹膜隐窝组。阴膜照片分为正常角度、无特征角度、高虹膜插入角和虹膜突突出角。采用层次聚类模型和双向聚类分析方法，对JOAG的聚类分布进行分析，得到JOAG亚型的分类。结果4个主要聚类为：聚类1具有NIC和正常角度，未治疗时IOP最低，发病年龄较高；具有NIC和无特征角度的簇2被发现与最早发病年龄有关。集群3有NIC和高虹膜插入或突出的虹膜突起。集群4是一个异质性集群，由PIC和高虹膜插入组成的组中患者人数最多。结论聚类分析提取了JOAG表型的四个亚组，这些亚组具有临床和预后意义，可能有助于临床对这些患者进行评估。
AimTo classify unrelated patients with juvenile onset primary open angle glaucoma (JOAG) into clinically useful phenotypes using cluster analysis.MethodsOut of the 527 unrelated patients with JOAG, the study included 414 patients who had all the phenotypic characteristics required for the study. A cluster analysis was performed to classify the patients based on their iris and angle morphology, age of onset, highest untreated intraocular pressure (IOP), worst mean deviation and greatest vertical cup disc ratio of the worst eye. The iris features were broadly classified into three groups: those with normal iris crypts (NIC), those with prominent iris crypts (PIC) and those with absence of iris crypts. The gonio photographs were graded as normal appearing angle or those with angle dysgenesis in the form of a featureless angle, one with a high iris insertion and an angle with prominent iris processes. Using a hierarchical clustering model and a two-way cluster analysis, the distribution of clusters of JOAG was analysed to obtain a classification of JOAG subtypes.ResultsThe four major clusters identified were: Cluster 1 with NIC and normal angles had the lowest untreated IOP and higher age of onset among all clusters. Cluster 2 with NIC and featureless angle was found to be associated with earliest age of onset. Cluster 3 had NIC and either a high iris insertion or prominent iris processes. Cluster 4 was a heterogeneous cluster with maximum number of patients in a group comprising of those with PIC and high iris insertion.ConclusionsCluster analysis extracted four subgroups of the JOAG phenotype that have clinical and prognostic significance and can potentially be helpful while evaluating these patients in the clinics.