用跨筛板压力差评价高眼压症的临床转归的研究

Ocular hypertension is a group of disease with high intraocular pressure but without glaucomatous damage. The prevalence of ocular hypertension in over 40s is about 3-10% . Only 9.5-15% ocular hypertension patients progress to glaucoma without any treatment for 5 years. Because of the lack of effective method to predict the clinical outcome, and the irreversibility of glaucomatous damage, ophthalmologists usually offer the ocular hypertension patients long term intraocular pressure lowering treatment, leading to serious excessive treatment..Our team found that it is the elevation of trans-lamina cribrosa pressure gradient not the intraocular pressure itself causing the glaucomatous damage. We also formed a non-invasive method of measuring trans-lamina cribrosa pressure gradient using MRI. Based on the above work, we put forward our hypothesis that the ocular hypertension patients progressing to glaucoma have a higher trans-lamina cribrosa pressure gradient than the non-progressing patients. .To test our hypotheses, we plan to 1. Optimize the method of trans-lamina cribrosa pressure gradient; 2.Randomly select 50 ocular hypertension patients without glaucomatous damage after 5 years’ follow-up and 50 progressing to glaucoma, evaluate the role of trans-lamina cribrosa pressure gradient in clinical outcome prediction of ocular hypertension. By doing this, we want to investigate the mechanism of non-progressing for ocular hypertension patients, and provide a potential noninvasive method for the clinical outcome prediction for ocular hypertension to reduce the excessive treatment in the clinical practice and reduce the economic burden...

高眼压症是眼压高而未检测到青光眼性损害的疾病，国外40岁以上人群患病率为3-10%，其中约9.5%五年内进展为青光眼。由于缺乏预测高眼压症临床转归的手段，临床存在严重的过度治疗。申请者团队前期国内外首次证实了跨筛板压力差高（眼压和颅压的差值）而非眼压高是青光眼发生的病因，进而提出假说：高眼压症患者中进展为青光眼的是由于跨筛板压力差高，不进展的是由于跨筛板压力差低。项目组前期建立了利用MRI的无创跨筛板压力差检测方法，已临床应用，实践中发现尚有不足。本项目拟通过：1.针对不足建立更准确的无创跨筛板压力差测算方法；2.收集五年以上随访资料齐全首诊为高眼压症的患者，选取进展为青光眼的50例，年龄性别匹配的未进展组50例，进行眼科和跨筛板压力差检查，分析组间差异，评价诊断准确性指标，以验证假说。项目的完成将为临床提供一项准确的无创测量跨筛板压力差的新技术，提供一种可能的预测高眼压症临床转归的方法。

高眼压症是眼压高而未检测到青光眼性损害的疾病，国外40岁以上人群患病率为3-10%，其中约9.5%五年内进展为青光眼。由于缺乏预测高眼压症临床转归的手段，临床存在严重的过度治疗。项目组针对现有方法的不足建立了新的基于MRI的球后视神经蛛网膜下腔间隙的测量方法，新方法的时间重复性、不同测量者间、同一测量者内的ICC均高于0.85，优于旧方法；通过收集符合纳入排除标准的需做腰穿检查的患者，拟合出了新的无创跨筛板压力差测算公式（R2=0.79）;收集五年以上随访资料齐全首诊为高眼压症的患者，选取进展为青光眼的50例，年龄性别匹配的未进展组50例，发现高眼压症进展组较不进展组跨筛板压力差明显大（9.0 ± 4.2 mm Hgmm Hg VS 3.6 ± 3.2），利用跨筛板压力差可将高眼压症进展组和不进展组进行分类，具有良好的灵敏度和特异度（最佳决策界值跨筛板压力差7.42mmHg，敏感性63%，特异性71%）。项目的完成为临床提供了一项准确的无创测量跨筛板压力差的新技术，提供了一种预测高眼压症临床转归的方法，有望降低高眼压症的过度治疗。