Long-term Development of Significant Visual Field Defects in Highly Myopic Eyes
Long-term Development of Significant Visual Field Defects in Highly Myopic Eyes
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DOI：
10.1016/j.ajo.2011.01.052
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发表时间：
2011-08-01
影响因子：
4.2
通讯作者：
Tokoro, Takashi
中科院分区：
文献类型：
--
作者：
Ohno-Matsui, Kyoko;Shimada, Noriaki;Tokoro, Takashi
目的：探讨与高度近视眼视野(VF)缺陷显著相关的特征。设计：回顾、观察系列。方法：对308例(492眼)高度近视(近视屈光度<8或眼轴长度<26.5 mm)患者的临床资料进行回顾分析，并随访5年以上。用Goldmann动态视野测量仪测定VF，并对V4等视线内100个扇区的VF进行量化。失去10%或更多扇区的眼被归类为有显著的VF缺陷，在随访期内进一步丢失10%或更多的眼被归类为显著进展。为了避免高度近视引起的后部眼底改变的影响，排除了任何类型的近视黄斑或周边病变可能导致视野缺陷的眼睛。结果：在平均11.6+/-5.5年的随访标准差中，13.2%的高度近视眼睛新出现了明显的VF缺陷。椭圆形视盘近视眼的VF明显高于圆形视盘近视眼。在有室颤缺陷的近视眼中，椭圆形视盘的出现频率明显更高。同一只眼存在颞部和鼻部室颤缺陷。VF明显缺损者中，圆形视盘占61.5%，垂直椭圆形视盘占75.0%，斜视椭圆形视盘占68.2%。平均随访+/-标准差10.2+/-3.4年，73.8%的眼显示室颤明显进展。巩膜曲率的突然改变(Curtin的VII型和IX型葡萄肿)是与VF缺陷进展显著相关的唯一因素。结论：由于VF缺陷是进行性的，我们建议高度近视是VF缺陷的高危因素，每年至少检查一次。高度近视眼视神经纤维的损伤可能是由于巩膜曲率突变引起的视神经纤维的拉伸和变形共同作用的结果。《眼科杂志》2011；152：256-265。(C)2011年由Elsevier Inc.保留所有权利。)
PURPOSE: To identify the characteristics that are associated significantly with visual field (VF) defects in highly myopic eyes.DESIGN: Retrospective, observational series.METHODS: The medical records of 492 eyes of 308 patients with high myopia (myopic refractive error > 8 diopters or axial length >= 26.5 mm) with a follow-up of 5 years or more were reviewed. The VFs were determined by Goldmann kinetic perimetry, and the VFs were quantified in 100 sectors within the V4 isopter. Eyes with loss of 10% or more of the sectors were classified as having significant VF defects, and a further loss of 10% or more during the follow-up period was classified as a significant progression. To avoid the influence of the posterior fundus changes resulting from the high myopia, eyes with any type of myopic macular or peripheral lesions that could cause visual field defects were excluded.RESULTS: Significant VF defects were newly developed in 13.2% of these selected highly myopic eyes during a mean follow-up standard deviation of 11.6 +/- 5.5 years. The incidence of significant VF defects in myopic eyes was significantly higher in eyes with an oval optic disc than that in eyes with a round optic disc. An oval optic disc was present significantly more frequently in the myopic eyes with VF defects. Temporal and nasal VF defects were present in the same eye. Among the eyes with significant VF defect, the temporal VF defects were observed in 61.5% of the eyes with round discs, in 75.0% of the eyes with vertically oval discs, and in 68.2% of the eyes with obliquely oval discs. During a mean follow-up +/- standard deviation of 10.2 +/- 3.4 years, 73.8% of the eyes showed a significant progression of the VF defects. An abrupt change of the scleral curvature (types VII and IX staphyloma by Curtin) was the only factor significantly associated with a progression of the VF defects.CONCLUSIONS: Because the VF defects are progressive, we suggest that high myopia is a high risk factor for VF defects and that these eyes be examined at least once yearly. The combination of stretching and distortion of the optic nerve fibers resulting from an abrupt change of scleral curvature may be the factors that lead to the damage of the optic nerve fibers in highly myopic eyes. (Am J Ophthalmol 2011;152:256-265. (C) 2011 by Elsevier Inc. All rights reserved.)