摘要
高眼压症是指眼压升高但未引起青光眼性视神经改变或视野损伤的一种状态,在40岁以上人群中的患病率高达4%~10%。美国高眼压症治疗研究(OHTS)指出,高眼压症患者的原发性开角型青光眼(POAG)发病率逐年上升,因此有必要对其进行长期随访。本文详述了高眼压症进展为POAG的五大基本危险因素,包括年龄、眼压、垂直杯盘比、视野模式标准差和中央角膜厚度,并介绍了其他潜在危险因素,如眼压的长期波动、双眼眼压及视野的不对称性、视盘的结构内表型及视盘出血。根据危险因素可预测高眼压症进展为POAG的风险,不同风险的患者开始治疗的时机和随访时间间隔不同,风险大者应更早开始预防性治疗,且随访间隔时间较短。药物治疗和选择性激光小梁成形术(SLT)均可作为高眼压症的初始治疗方式。结合循证医学研究证据和个体化评估治疗,可更有效地提高高眼压症的临床诊疗水平。
Ocular hypertension(OHT)refers to a condition in which the intraocular pressure increases without causing glaucomatous optic nerve changes or visual field damage.The incidence rate of OHT in people over 40 years old is as high as 4%to 10%.According to the OHT Treatment Study(OHTS),the incidence of primary open angle glaucoma(POAG)among OHT patients is increasing year by year,so it is necessary to conduct long-term follow-up.This article elaborates on five major risk factors for the progression of OHT to POAG:age,intraocular pressure,vertical cup-disc ratio,pattern standard deviation of visual field,and central corneal thickness.It also summarizes other potential risk factors,such as long-term fluctuations in intraocular pressure,asymmetry of intraocular pressure and visual field between the two eyes,structural phenotypes of the optic disk,and optic disk hemorrhage.Predicting the risk of OHT progression to POAG based on risk factors,patients with different risk levels require different timing for treatment initiation and follow-up intervals.Those with higher risks should start preventive treatment earlier and have shorter follow-up intervals.Both drug therapy and selective laser trabeculoplasty can serve as initial treatment options for OHT.Combining evidence-based medicine research and individualized evaluation of treatment can enhance the clinical diagnosis and treatment level of OHT.
作者
乔春艳
王思宇
Qiao Chunyan;Wang Siyu(Beijing Institute of Ophthalmology,Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology&Visual Sciences,Beijing 100730,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2024年第24期2195-2199,共5页
National Medical Journal of China
关键词
高眼压
青光眼
开角型
循证医学
Ocular hypertension
Glaucoma,open-angle
Evidence-based medicine
