The Role of Intraocular Pressure and Systemic Hypertension in the Progression of Glaucomatous Damage to the Macula.
The Role of Intraocular Pressure and Systemic Hypertension in the Progression of Glaucomatous Damage to the Macula.
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DOI：
10.1097/ijg.0000000000002018
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发表时间：
2022-05-01
影响因子：
2
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采用光学相干断层扫描（OCT）结构测试和视野（VF）功能测试，检查眼内压（IOP）、全身性高血压和青光眼进展之间的关系。分析了一项前瞻性纵向研究（青光眼性黄斑损伤的结构和功能进展研究）中入选的119例诊断为青光眼的患者的191只眼。患者接受了10-2和24-2 VF测试，并以4-6个月的时间间隔获得了频域OCT。收集每次访视的IOP。在纳入的患者中，72只眼（37%）报告了自我报告的HTN诊断。使用线性混合效应回归检验VF和OCT的汇总统计量与HTN诊断之间的关系。用贝叶斯信息准则评价拟合优度。平均随访IOP与以下OCT参数最相关：全局黄斑GCL、下黄斑GCL、平均MaVZ GCL和平均LVZ黄斑GCL，以及与以下VF参数最相关：10-2 PSD和10-2 MD。对于任何OCT或VF参数，HTN和非HTN患者之间的进展率无显著差异。HTN与进展之间关系的最佳拟合优度模型与针对IOP观察到的模型相同。与更常规的参数相比，黄斑结构和功能参数在青光眼进展方面对IOP更敏感。虽然HTN与使用任何参数的进展没有显著相关性，但黄斑结构和功能参数对模型进展具有更好的拟合优度，并且可能用作终点。与常规参数相比，黄斑结构和功能参数与压力依赖性青光眼损害的相关性更好。在该队列中，自我报告的全身性高血压与结构或功能进展无关。
To examine the relationships between intraocular pressure (IOP), systemic hypertension, and glaucoma progression using structural testing with optical coherence tomography (OCT) and functional testing with visual field (VF). 191 eyes of 119 patients enrolled in a prospective, longitudinal study (Structural and Functional Progression of Glaucomatous Damage to the Macula study) with a diagnosis of glaucoma were analyzed. Patients were tested with 10-2 and 24-2 VF and spectral-domain OCT obtained at 4–6 month intervals. IOP from each visit was collected. Self-reported diagnoses of HTN were reported in 72 eyes (37%) in the patients included. Linear mixed effects regression was used to test the relationship between summary statistics from VF and OCT and HTN diagnosis. The goodness-of-fit of relationships was assessed with Bayesian Information Criterion. Mean follow-up IOP was most associated with the following OCT parameters: global macula GCL, inferior macula GCL, mean MaVZ GCL, and mean LVZ macula GCL, and with the following VF parameters: 10-2 PSD and 10-2 MD. There was no significant difference in rates of progression between HTN and non-HTN patients for any OCT or VF parameter. Models with the best goodness-of-fit for the relationship between HTN and progression were the same as those observed for IOP. Macular structural and functional parameters are more sensitive to IOP in terms of glaucomatous progression when compared to more conventional parameters. While HTN was not significantly associated with progression using any parameter, macular structural and functional parameters had a better goodness-of-fit to model progression and may be useful as endpoints. Macular structural and functional parameters were better correlated with pressure-dependent glaucomatous damage than conventional parameters. Self-reported systemic hypertension was not associated with structural or functional progression in this cohort.