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개방각녹내장에서 맥락막분수계역, 야간 혈압하강 및 녹내장성 시야결손의 상관관계

Relationship among Water-Shed Zone, Nocturnal Dip and Visual Field Progression in Open Angle Glaucoma

김남영|노세현|서홍융
대한안과학회 (The Korean Ophthalmological Society)|2014.07|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제55권 제7호|pp. 1030-1038

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참고문헌

키워드

Nocturnal dipVascular dysregulationTwenty-four-hour blood pressure monitoringWater-shed zone
주제분류안과학

초록

목적: 맥락막분수계역(water-shed zone, WSZ)과 야간 혈압하강(nocturnal dip, ND)이 녹내장성 시야결손 진행에 미치는 영향에 대해알아보고자 하였다. 대상과 방법: 목표안압 이하로 안압이 유지되는 OAG환자를 대상으로 형광안저촬영, 24시간활동혈압검사 및 시야검사를 시행하여 WSZ,10% 이상의 ND (dip) 및 녹내장성 시야결손 진행과의 관계를 분석하였다. 결과: WSZ과 dip의 상관관계는 OAG군(p=0.024) 및 NTG군(p=0.029)에서 유의하였다. dip와 시야결손 진행과의 상관관계는 OAG군(p=0.003)과 NTG군(p=0.005)에서 의미를 보였다. WSZ과 시야결손 진행의 관계는 모든 군에서 유의하였다(OAG: p=0.002, NTG:p=0.023, POAG: p=0.021). WSZ의 시신경유두 침범과 시야결손의 진행 사시에는 OAG군(p=0.004)과 NTG군(p=0.009)에서 유의했다. 시야결손의 진행에 대한 이항로지스틱회귀분석에선 OAG군에서 dip (p=0.010, OR=6.227)만이 통계적으로 유의한 위험요인으로나타났다. 결론: OAG군 및 NTG군에서 WSZ는 dip와 상관관계를 보였고 dip는 녹내장성 시야결손의 진행에 영향을 주었다. WSZ는 모든 군에서시야결손 진행에 영향을 주었고 시신경유두 침범여부가 중요하였다. 목표안압 이하로 안압이 유지됨에도 불구하고 녹내장성 시야결손 진행을 보이는 OAG환자에서 WSZ와 시신경유두의 침범여부, dip를 확인하는 것이 도움이 될 것으로 생각한다.

Abstract

Purpose: To investigate the influence of water-shed zone (WSZ) and nocturnal dip (ND) on the progression of the glaucomatousvisual field (V/F) defects in open-angle glaucoma (OAG) patients when the intraocular pressure (IOP) was maintained underthe target pressure. Methods: We performed fluorescence angiography (FAG), 24-hour ambulatory blood pressure monitoring (24-hr ABPM), andV/F tests. We examined the relationships among WSZ in early-FAG, ND over 10% (dip), and the progression of the glaucomatousV/F defects using chi-square, Fisher’s exact, and multivariate logistic regression tests. A p-value < 0.05 was consideredstatistically significant. Results: When considering the correlation between WSZ and dip, statistical significance was found in OAG (p = 0.024, odds ratio(OR) = 3.308) and normal tension glaucoma (NTG) (p = 0.029, OR = 4.364) patients. In patients with dip, glaucomatous V/Fdefects significantly progressed (OAG: p = 0.003, OR = 5.938, NTG: p = 0.005, OR = 13.929). In patients with WSZ, the glaucomatousV/F defects progressed in all groups (OAG: p = 0.002, OR = 5.156, NTG: p = 0.024, OR = 4.750, primary open angleglaucoma (POAG): p = 0.021, OR = 8.750). In the patients with WSZ involving optic nerve head, the glaucomatous V/F defectshad progressed in OAG (p = 0.004, OR = 5.958) and NTG (p = 0.009, OR = 8.333) groups. Based on binary logistic regressionanalysis, dip (p = 0.010, OR = 6.227) significantly affected V/F progression only in OAG patients. Conclusions: In the OAG and NTG groups, ND over 10% influenced the progression of the glaucomatous V/F defects. The patientswith WSZ tended to have ND over 10% in OAG and NTG groups and glaucomatous V/F defects progressed in all patients. Therefore, performing early FAG and 24-hr ambulatory blood pressure monitoring may be helpful for glaucoma patients withprogressing glaucomatous V/F defects even when the IOP was maintained under the target pressure.

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