정상안압녹내장에서 경사상판압력차와 시신경유두의 구조적 지표와의 관련성
Correlation between Trans-lamina Cribrosa Pressure Difference and Morphologic Parameters of Optic Disc in Normal Tension Glaucoma Patients
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 정상안압녹내장 환자에서 경사상판압력차(trans-lamina cribrosa pressure difference, TLCPD)와 시신경유두의 구조적 지표와의 관계를 알아보고자 하였다. 대상과 방법: 정상안압녹내장 환자 31명(31안), 대조군 29명(29안)의 의무기록을 검토하여 혈압, 체질량지수, 나이를 통해 뇌척수액압을 추정(estimated cerebrospinal fluid pressure, ECSFP)했고, 안압과의 차를 TLCPD로 정의하여 이것과 빛간섭단층촬영기로 도출한 시신경유두의 구조적 지표들과의 상관관계를 분석했다. 결과: 대조군과 환자군의 연령, 혈압, 안압, 구면렌즈대응치, 체질량지수는 유의한 차이가 없었다. ECSFP는 대조군, TLCPD는 환자군에서 유의하게 높았다. TLCPD와 시신경유두테면적(rim area)은 환자군에서 유의한 음의 상관관계를(r=-0.595), TLCPD와 평균 시신경유두함몰비(cup/disc ratio [CDR], r=0.504), 수직 CDR (r=0.434), 시신경유두함몰부피(cup volume [CV], r=0.420)는 유의한 양의상관관계를 보였다. 환자군에서 TLCPD와 평균 RNFLT 역시 유의한 음의 상관성이 있었고(r=-0.500) 비측을 제외한 사분면의 평균 RNFLT도 모두 유의한 음의 상관관계를 보였다. Rim area와 ECSFP도 유의한 상관관계가 있었으나(r=0.511), rim area와 안압 사이의 상관관계는 보이지 않았다. 결론: 정상안압녹내장 환자에서 TLCPD가 대조군에 비해 높았으며, TLCPD가 높은 것은 좁은 rim area, 큰 평균 및 수직 CDR, 얇은 RNFLT와 관련이 있었다.
Abstract
Purpose: To investigate the relationship between trans-lamina cribrosa pressure difference (TLCPD) and morphologic parameters of optic disc (OD) in normal tension glaucoma (NTG) patients. Methods: Data from 31 NTG patients (31 eyes) and 29 controls (29 eyes) were analyzed retrospectively. Their cerebrospinal fluid pressure was estimated using diastolic pressure (DBP), body mass index (BMI) and age. TLCPD was defined as the difference of intraocular pressure (IOP) and the estimated cerebrospinal fluid pressure (ECSFP). Measurements of the rim area (RA), disc area (DA), average and vertical cup/disc (C/D) ratio, retinal nerve fiber layer thickness (RNFLT) and cup volume (CV) were taken for all patients using optical coherence tomography. The correlation between TLCPD and morphologic parameters of OD were assessed. Results: There were no significant differences between the two groups in terms of age, DBP, IOP and spherical equivalent (SE) and BMI. The mean ECSFP was significantly higher in the controls (10.7 ± 2.8 vs. 12.2 ± 2.2 mm Hg, p = 0.031) and TLCPD was significantly higher in patients (2.4 ± 2.1 vs. 4.9 ± 3.7 mm Hg, p = 0.002). In the NTG group, there was a negative correlation between TLCPD and RA (r = -0.595) and positive correlations between TLCPD and the average C/D ratio (r = 0.504), vertical C/D ratio (r = 0.434) and CV (r = 0.420). Average RNLFT was also significantly correlated with TLCPD (r = -0.500) and RNFLT for four quadrants, except the nasal quadrant, in NTG patients. Conclusions: NTG patients had higher TLCPD. A higher TLCPD was associated with a narrower RA, larger C/D ratio, and thinner RNFLT.
참고문헌 (15)
- Berdahl JP., "Cerebrospinal fluid pressure is decreased in primary open-angle glaucoma", Ophthalmology, 115, pp.763~768 (2008)
- Jonas JB., "Anatomic relationship between lamina cribrosa, intraocular space, and cerebrospinal fluid space", Invest Ophthalmol Vis Sci, 44, pp.5189~5195 (2003)
- Xie X., "Noninvasive intracranial pressure estimation by orbital subarachnoid space measurement: the Beijing Intracranial and Intraocular Pressure (iCOP) study", Crit Care, 17, pp.R162~ (2013)
- Jonas JB., "Body height, estimated cerebrospinal fluid pressure and open-angle glaucoma. The Beijing Eye Study 2011", PLoS One, 9, pp.e86678~ (2014)
- Garvin MK., "Automated 3-D intraretinal layer segmentation of macular spectral-domain optical coherence tomography images", IEEE Trans Med Imaging, 28, pp.1436~1447 (2009)
- Shpak AA., "Comparison of measurement error of Cirrus HD-OCT and Heidelberg Retina Tomograph 3 in patients with early glaucomatous visual field defect", Graefes Arch Clin Exp Ophthalmol, 250, pp.271~277 (2012)
- Sommer A., "Clinically detectable nerve fiber atrophy precedes the onset of glaucomatous field loss", Arch Ophthalmol, 109, pp.77~83 (1991)
- Kim CS., "Prevalence of primary open-angle glaucoma in central South Korea the Namil study", Ophthalmology, 118, pp.1024~1030 (2011)
- Leske MC., "Risk factors for incident open-angle glaucoma : the Barbados Eye Studies", Ophthalmology, 115, pp.85~93 (2008)
- Ren R., "Trans-lamina cribrosa pressure difference correlated with neuroretinal rim area in glaucoma", Graefes Arch Clin Exp Ophthalmol, 249, pp.1057~1063 (2011)
- Jonas JB., "Pressure-dependent neuroretinal rim loss in normal-pressure glaucoma", Am J Ophthalmol, 125, pp.137~144 (1998)
- Morgan WH., "The influence of cerebrospinal fluid pressure on the lamina cribrosa tissue pressure gradient", Invest Ophthalmol Vis Sci, 36, pp.1163~1172 (1995)
- Berdahl JP., "Intracranial pressure in primary open angle glaucoma, normal tension glaucoma, and ocular hypertension : a case-control study", Invest Ophthalmol Vis Sci, 49, pp.5412~5418 (2008)
- Ren R., "Cerebrospinal fluid pressure in glaucoma : a prospective study", Ophthalmology, 117, pp.259~266 (2010)
- Jonas JB., "Trans-lamina cribrosa pressure difference and open-angle glaucoma. The central India eye and medical study", PLoS One, 8, pp.e82284~ (2013)