Seasonal Fluctuation in Intraocular Pressure and Retinal Nerve Fiber Layer Thinning in Primary Open-Angle Glaucoma
Seasonal Fluctuation in Intraocular Pressure and Retinal Nerve Fiber Layer Thinning in Primary Open-Angle Glaucoma
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DOI：
10.1016/j.ogla.2020.11.005
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发表时间：
2021-07-22
影响因子：
2.9
通讯作者：
Nakano, Tadashi
中科院分区：
文献类型：
--
作者：
Terauchi, Ryo;Ogawa, Shumpei;Nakano, Tadashi
目的：检测健康眼睛和原发性开角型青光眼（POAG）眼睛眼内压（IOP）的季节性波动，并评估这些季节性波动是否影响 POAG 眼睛的视网膜神经纤维层（RNFL）变薄。设计：观察性、回顾性队列研究。参与者：接受全面健康检查的健康人群和仅使用局部药物的 POAG 患者纳入研究。方法：采用 Kaplan-Meier 生存分析来比较不同季节性 IOP 波动组之间 RNFL 变薄的累积发生概率。采用 Cox 比例风险模型，调整潜在混杂因素，评估 IOP 季节性波动与 RNFL 变薄之间的关联。主要指标：根据冬季和夏季 IOP 计算的眼压波动率以及通过高清 OCT 基于事件的分析确定的 RNFL 变薄。结果：共有 12 686 只健康眼和 179 名 POAG 患者的 179 只眼在冬季表现出明显较高的 IOP高于夏季（健康，13.2 +/- 3.0 mmHg vs. 12.5 +/- 2.9 mmHg [P < 0.001]；POAG，13.1 +/- 2.7 mmHg vs. 11.8 +/- 2.3 mmHg [P < 0.001]）。在 POAG 患者中，初始 OCT 和随访持续时间的平均年龄分别为 55.1 +/- 11.7 岁和 98.4 +/- 26.4 个月。首次就诊时的平均偏差 (MD)、MD 斜率和 RNFL 稀疏率分别为 -2.2 +/- 3.4 dB、-0.07 +/- 0.44 dB/年和 -0.44 +/- 0.88 gm/年。在研究期间，85 只眼睛 (47.5%) 显示 RNFL 变薄进展。 Kaplan-Meier 分析表明，高季节性 IOP 波动率显着抑制 RNFL 变薄（P < 0.05，对数秩检验）。调整 Cox 分析中的混杂因素后，季节性 IOP 波动率仍与 RNFL 变薄呈显着负相关（风险比，0.98；95% 置信区间，0.96-0.99；P = 0.005）。 结论：健康眼和 POAG 眼中，冬季 IOP 均高于夏季 IOP。夏季眼压暂时下降，而不是全年眼压保持恒定，可能会预防青光眼进展。 (C) 2020 年，美国眼科学会。
Purpose: To detect seasonal fluctuations in intraocular pressure (IOP) in healthy eyes and eyes with primary open-angle glaucoma (POAG) and to evaluate whether these seasonal fluctuations affect retinal nerve fiber layer (RNFL) thinning in eyes with POAG.Design: Observational, retrospective cohort study.Participants: Healthy population who underwent a comprehensive health check-up and patients with POAG using only topical medications were enrolled.Methods: Kaplan-Meier survival analysis was used to compare the cumulative incidence probabilities of RNFL thinning between different seasonal IOP fluctuation groups. A Cox proportional hazards model, with adjustments for potential confounding factors, was used to evaluate the association between seasonal fluctuations in IOP and RNFL thinning.Main Outcome Measures: Intraocular pressure fluctuation rate calculated from winter and summer IOPs and RNFL thinning as determined by event-based analysis with high-definition OCT.Results: A total of 12 686 healthy eyes and 179 eyes of 179 POAG patients showed a significantly higher IOP in winter than in summer (healthy, 13.2 +/- 3.0 mmHg vs. 12.5 +/- 2.9 mmHg [P < 0.001]; POAG, 13.1 +/- 2.7 mmHg vs. 11.8 +/- 2.3 mmHg [P < 0.001]). In POAG patients, the mean age at initial OCT and follow-up duration were 55.1 +/- 11.7 years and 98.4 +/- 26.4 months, respectively. The mean deviation (MD) at first visit, MD slope, and RNFL thinning rate were-2.2 +/- 3.4 dB, -0.07 +/- 0.44 dB/year, and -0.44 +/- 0.88 gm/year, respectively. During the study period, 85 eyes (47.5%) showed RNFL thinning progression. Kaplan-Meier analysis showed that a high seasonal IOP fluctuation rate significantly suppressed RNFL thinning (P < 0.05, log-rank test). After adjusting for confounders in the Cox analysis, the seasonal IOP fluctuation rate still showed a significantly negative association with RNFL thinning (hazard ratio, 0.98; 95% confidence interval, 0.96-0.99; P = 0.005).Conclusions: Winter IOP was higher than summer IOP in both healthy and POAG eyes. The temporary IOP decline in summer, rather than a constant IOP throughout the year, may prevent glaucoma progression. (C) 2020 by the American Academy of Ophthalmology.