PDF(Pubmed)
Abstract：
UNASSIGNED: Identifying primary angle closure suspect (PACS) eyes at risk of angle closure is crucial for its management. However, the risk of progression and its prediction are still understudied in long-term longitudinal studies about PACS.
UNASSIGNED: To explore baseline predictors and develop prediction models for the 14-year risk of progression from PACS to primary angle closure (PAC).
UNASSIGNED: This cohort study involved participants from the Zhongshan Angle Closure Prevention trial who had untreated eyes with PACS. Baseline examinations included tonometry, ultrasound A-scan biometry, and anterior segment optical coherence tomography (AS-OCT) under both light and dark conditions. Primary angle closure was defined as peripheral anterior synechiae in 1 or more clock hours, intraocular pressure (IOP) greater than 24 mm Hg, or acute angle closure. Based on baseline covariates, logistic regression models were built to predict the risk of progression from PACS to PAC during 14 years of follow-up.
UNASSIGNED: The analysis included 377 eyes from 377 patients (mean [SD] patient age at baseline, 58.28 [4.71] years; 317 females [84%]). By the 14-year follow-up visit, 93 eyes (25%) had progressed from PACS to PAC. In multivariable models, higher IOP (odds ratio [OR], 1.14 [95% CI, 1.04-1.25] per 1-mm Hg increase), shallower central anterior chamber depth (ACD; OR, 0.81 [95% CI, 0.67-0.97] per 0.1-mm increase), and shallower limbal ACD (OR, 0.96 [95% CI, 0.93-0.99] per 0.01 increase in peripheral corneal thickness) at baseline were associated with an increased 14-year risk of progression from PACS to PAC. As for AS-OCT measurements, smaller light-room trabecular-iris space area (TISA) at 500 μm from the scleral spur (OR, 0.86 [95% CI, 0.77-0.96] per 0.01-mm2 increase), smaller light-room angle recess area (ARA) at 750 μm from the scleral spur (OR, 0.93 [95% CI, 0.88-0.98] per 0.01-mm2 increase), and smaller dark-room TISA at 500 μm (OR, 0.89 [95% CI, 0.80-0.98] per 0.01-mm2 increase) at baseline were identified as predictors for the 14-year risk of progression. The prediction models based on IOP and central and limbal ACDs showed moderate performance (area under the receiver operating characteristic curve, 0.69; 95% CI, 0.63-0.75) in predicting progression from PACS to PAC, and inclusion of AS-OCT metrics did not improve the model\'s performance.
UNASSIGNED: This cohort study suggests that higher IOP, shallower central and limbal ACDs, and smaller TISA at 500 μm and light-room ARA at 750 μm may serve as baseline predictors for progression to PAC in PACS eyes. Evaluating these factors can aid in customizing PACS management.
UNASSIGNED: To explore baseline predictors and develop prediction models for the 14-year risk of progression from PACS to primary angle closure (PAC).
UNASSIGNED: This cohort study involved participants from the Zhongshan Angle Closure Prevention trial who had untreated eyes with PACS. Baseline examinations included tonometry, ultrasound A-scan biometry, and anterior segment optical coherence tomography (AS-OCT) under both light and dark conditions. Primary angle closure was defined as peripheral anterior synechiae in 1 or more clock hours, intraocular pressure (IOP) greater than 24 mm Hg, or acute angle closure. Based on baseline covariates, logistic regression models were built to predict the risk of progression from PACS to PAC during 14 years of follow-up.
UNASSIGNED: The analysis included 377 eyes from 377 patients (mean [SD] patient age at baseline, 58.28 [4.71] years; 317 females [84%]). By the 14-year follow-up visit, 93 eyes (25%) had progressed from PACS to PAC. In multivariable models, higher IOP (odds ratio [OR], 1.14 [95% CI, 1.04-1.25] per 1-mm Hg increase), shallower central anterior chamber depth (ACD; OR, 0.81 [95% CI, 0.67-0.97] per 0.1-mm increase), and shallower limbal ACD (OR, 0.96 [95% CI, 0.93-0.99] per 0.01 increase in peripheral corneal thickness) at baseline were associated with an increased 14-year risk of progression from PACS to PAC. As for AS-OCT measurements, smaller light-room trabecular-iris space area (TISA) at 500 μm from the scleral spur (OR, 0.86 [95% CI, 0.77-0.96] per 0.01-mm2 increase), smaller light-room angle recess area (ARA) at 750 μm from the scleral spur (OR, 0.93 [95% CI, 0.88-0.98] per 0.01-mm2 increase), and smaller dark-room TISA at 500 μm (OR, 0.89 [95% CI, 0.80-0.98] per 0.01-mm2 increase) at baseline were identified as predictors for the 14-year risk of progression. The prediction models based on IOP and central and limbal ACDs showed moderate performance (area under the receiver operating characteristic curve, 0.69; 95% CI, 0.63-0.75) in predicting progression from PACS to PAC, and inclusion of AS-OCT metrics did not improve the model\'s performance.
UNASSIGNED: This cohort study suggests that higher IOP, shallower central and limbal ACDs, and smaller TISA at 500 μm and light-room ARA at 750 μm may serve as baseline predictors for progression to PAC in PACS eyes. Evaluating these factors can aid in customizing PACS management.
摘要：
■确定处于闭角风险的主要闭角可疑（PACS）眼睛对于其管理至关重要。然而,在PACS的长期纵向研究中,进展风险及其预测仍未得到充分研究.
■探索基线预测因子并开发从PACS进展到原发性闭角（PAC）的14年风险的预测模型。
这项队列研究涉及中山角封闭预防试验的参与者，他们的眼睛未经治疗PACS。基线检查包括眼压测量，超声A扫描生物测量，和眼前节光学相干断层扫描（AS-OCT）在明暗条件下。原发性房角闭合定义为1小时或更长时间的外周前粘连，眼内压（IOP）大于24mmHg，或锐角闭合。基于基线协变量，建立logistic回归模型来预测14年随访期间从PACS到PAC的进展风险.
■该分析包括377例患者的377只眼（基线时患者年龄的平均值[SD]，58.28[4.71]岁；317名女性[84%]）。通过14年的后续访问，93只眼（25％）从PACS发展到PAC。在多变量模型中，较高的IOP(比值比[OR]，每1-mmHg增加1.14[95%CI，1.04-1.25])，中央前房深度较浅（ACD；或，每0.1毫米增加0.81[95%CI，0.67-0.97])，和较浅的角膜缘ACD(或，基线时角膜厚度每增加0.010.96[95%CI,0.93-0.99])与从PACS进展到PAC的14年风险增加相关。至于AS-OCT测量，距巩膜骨刺500μm处的光室小梁-虹膜空间面积(TISA)较小(或，每0.01-mm2增加0.86[95%CI，0.77-0.96])，距巩膜骨刺750μm处的较小光室角度凹陷区域(ARA)(或，每0.01-mm2增加0.93[95%CI，0.88-0.98])，和500μm的较小暗室TISA(或，基线时每0.01-mm2增加0.89[95%CI,0.80-0.98])被确定为14年进展风险的预测因子。基于IOP以及中央和角膜缘ACD的预测模型表现出中等性能（接收器工作特性曲线下的面积，0.69；95%CI，0.63-0.75）在预测从PACS到PAC的进展中，纳入AS-OCT指标并不能改善模型的性能。
■这项队列研究表明，较高的IOP，较浅的中央和角膜缘ACD，500μm的较小TISA和750μm的光室ARA可作为PACS眼中进展为PAC的基线预测因子。评估这些因素有助于定制PACS管理。
■探索基线预测因子并开发从PACS进展到原发性闭角（PAC）的14年风险的预测模型。
这项队列研究涉及中山角封闭预防试验的参与者，他们的眼睛未经治疗PACS。基线检查包括眼压测量，超声A扫描生物测量，和眼前节光学相干断层扫描（AS-OCT）在明暗条件下。原发性房角闭合定义为1小时或更长时间的外周前粘连，眼内压（IOP）大于24mmHg，或锐角闭合。基于基线协变量，建立logistic回归模型来预测14年随访期间从PACS到PAC的进展风险.
■该分析包括377例患者的377只眼（基线时患者年龄的平均值[SD]，58.28[4.71]岁；317名女性[84%]）。通过14年的后续访问，93只眼（25％）从PACS发展到PAC。在多变量模型中，较高的IOP(比值比[OR]，每1-mmHg增加1.14[95%CI，1.04-1.25])，中央前房深度较浅（ACD；或，每0.1毫米增加0.81[95%CI，0.67-0.97])，和较浅的角膜缘ACD(或，基线时角膜厚度每增加0.010.96[95%CI,0.93-0.99])与从PACS进展到PAC的14年风险增加相关。至于AS-OCT测量，距巩膜骨刺500μm处的光室小梁-虹膜空间面积(TISA)较小(或，每0.01-mm2增加0.86[95%CI，0.77-0.96])，距巩膜骨刺750μm处的较小光室角度凹陷区域(ARA)(或，每0.01-mm2增加0.93[95%CI，0.88-0.98])，和500μm的较小暗室TISA(或，基线时每0.01-mm2增加0.89[95%CI,0.80-0.98])被确定为14年进展风险的预测因子。基于IOP以及中央和角膜缘ACD的预测模型表现出中等性能（接收器工作特性曲线下的面积，0.69；95%CI，0.63-0.75）在预测从PACS到PAC的进展中，纳入AS-OCT指标并不能改善模型的性能。
■这项队列研究表明，较高的IOP，较浅的中央和角膜缘ACD，500μm的较小TISA和750μm的光室ARA可作为PACS眼中进展为PAC的基线预测因子。评估这些因素有助于定制PACS管理。
