Objective: To investigate the relationship between the spontaneous focal lamina cribrosa (LC) defect and the progression of visual field defect (VFD) in primary open-angle glaucoma (POAG). Methods: Case-control study. The patients who were diagnosed as POAG with at least 5 visual field results had been collected from June 2018 to January 2019 at Beijing Tongren Hospital Affiliated to Capital Medical University. Serial imaging by swept source optical coherence tomography B-Scan of the optic discs were acquired at the end of the follow-up and LC defects status were reviewed. Intraocular pressure, mean defects of visual field, central corneal thickness and axis length were recorded in the follow-up duration. Eyes were classified as having either progressive or nonprogressive VFD, and associating factors were evaluated by χ(2) or Fisher's test, mixed-effect model analysis and multivariate Logistical regression analysis. Results: A total of 32 subjects (64 eyes) were enrolled in the study with mean age of (47±14) years, the group consisted of 17 males and 15 females. Fourty-five eyes showed nonprogressive VFD. LC defects were more common in eyes without (28/45) rather than with progressive VFD (5/19) (χ(2)=6.896, P=0.009). Eyes with nonprogressive VFD showed longer axis length[(26.82±1.34) mm vs. (25.79±1.44) mm; t=6.589, P=0.013] and wider LC defects diameter[211 (165-326) μm vs. 114 (106-156) μm; Z=4.797, P=0.042]. Multivariate Logistic regression analysis revealed that the presence of LC defect was significantly associated with nonprogressive VFD (odds ratio=0.217, P=0.012). There were 7 subjects with asymmetry VFD and the incedence of LC defects without progression (7/7) is higher than fellow eye with progression (1/7, P=0.002). There was only one patient with progressive VFD showed one LC defect with an smaller diameter (169 μm) than that in the contralateral eyes with stable VFD (269 μm). Conclusions: LC defects are more common in eyes with nonprogressive VFD. Spontaneous LC defects are associated with nonprogressive glaucomatous defects and could be a protective factor for POAG. (Chin J Ophthalmol, 2019, 55:338-346).
目的： 探讨原发性开角型青光眼（POAG）局限性筛板缺损与视神经损伤进展的关系。 方法： 病例对照研究。纳入2018年6月至2019年1月首都医科大学附属北京同仁医院北京同仁眼科中心就诊的具有5次以上Humphrey视野检查结果的POAG患者，进行视野缺损进展评估，并利用扫频光源相干光层析成像术观察筛板缺损情况。同时记录眼压、视野平均缺损、角膜厚度、眼轴长度等指标，比较视野缺损进展眼与不进展眼中筛板缺损发生情况，统计学分析采用χ(2)或Fisher检验、混合效应模型及Logistic回归法。 结果： 共纳入受试者32例（64只眼），年龄（47±14）岁，男性17例，女性15例；共45只眼视野缺损不进展。视野缺损不进展眼筛板缺损发生比例为28/45，高于视野缺损进展眼（5/19），差异有统计学意义（χ(2)=6.896，P=0.009），且视野缺损不进展眼眼轴长度[（26.82±1.34）mm]大于视野缺损进展眼[（25.79±1.44）mm]、视野缺损不进展眼单眼筛板缺损总直径[（211（165~326）μm]大于视野缺损进展眼[114（106~156）μm]，差异均有统计学意义（t=6.589，P=0.013；Z=4.797，P=0.042）。Logistic回归显示筛板缺损是POAG视野缺损的保护因素（OR=0.217，P=0.012）。32例患者中有7例双眼视野缺损进展不对称，其中视野缺损不进展眼中筛板缺损发生比例（7/7）大于对侧视野缺损进展眼（1/7），差异有统计学意义（P=0.002）；1只视野缺损进展眼仅发现1个筛板缺损，直径为169 μm，小于对侧7只视野缺损不进展眼单眼筛板缺损总直径的中位数269 μm。 结论： POAG视野缺损不进展眼局限性筛板缺损发生率高，筛板缺损直径足够大可延缓或终止青光眼视神经损伤进展，是POAG视野缺损的保护因素。（中华眼科杂志，2019，55：338-346）.
Keywords: Glaucoma, open-angle; Intraocular pressure; Lamina cribrosa defect; Tomography, optical coherence; Visual fields.