【发现】糖尿病患者罹患青光眼风险增加

这项meta分析共纳入47项研究，调查糖尿病与青光眼、高眼压症、以及眼内压（IOP）增加发生风险之间的关系。研究发现，随着糖尿病病程延长，以及空腹血糖水平升高，患者青光眼发生风险显著增加。但是，糖尿病和空腹血糖与IOP增加之间的相关性较弱。

作者指出，高血糖和血管病变可能在青光眼发病中发挥重要作用，但是，其确切机制仍不清楚。考虑到这些相关性，需要在这个人群中加强青光眼筛查。

专家评述

宾夕法尼亚州赫尔希眼科中心Joseph W Sassani教授

为了确证普通人群中糖尿病及血糖水平与青光眼、眼内压、以及高眼压症之间的关系，Zhao教授及其同事进行了一项系统性回顾和meta分析研究，纳入47项研究，涉及来及16个国家的2981342例受试者。

结果让人沮丧。Zhao教授等发现，糖尿病、糖尿病病程和空腹血糖水平与青光眼风险显著增加有关。Zhao教授等概述了一个可能的病理生理机制：在糖尿病相关青光眼患者中，血糖水平升高可能会产生一个渗透梯度，吸引大量房水进入前房，并导致自主神经功能紊乱。而在其他理论中，高血糖引起小梁网功能紊乱也被认为是糖尿病患者青光眼风险增加的一个机制。但是，由于糖尿病与眼内压之间特定相关性较弱，眼内压升高可能并不是糖尿病患者青光眼风险增加的唯一病因，并得出眼内压以外的其他因素可能参与了青光眼发病这一个结论。例如，血管机制也要被考虑在内。

Zhao教授等对糖尿病与青光眼之间相关性的各种可能病理生理机制进行了极好的综述，并借助文献突出了其他流行病学研究结果。这是一项有趣、且有价值的分析。

TAKE-HOME MESSAGE

This meta-analysis of 47 studies showed an association between diabetes and the risk for developing glaucoma, ocular hypertension, and increased intraocular pressure (IOP). There was an increased risk of glaucoma with longer duration of diabetes, as well as with elevated fasting blood glucose levels. The association between diabetes and fasting blood sugar and diabetes and increased IOP was weaker.

The authors report that hyperglycemia and vascular alterations may play a role, but the exact mechanism is unclear. Given these associations, the need for glaucoma screening in this population is stressed.

Expert Comment

Zhao and associates performed a systematic review and meta-analysis of 47 studies involving 2,981,342 individuals from 16 countries to summarize the association of diabetes and blood glucose levels with glaucoma, intraocular pressure (IOP), and ocular hypertension in the general population.

The news is not good. They found that diabetes, diabetes duration, and fasting glucose levels were associated with a significantly increased risk for glaucoma. The authors reviewed a possible pathophysiologic mechanism: In glaucoma associated with diabetes, elevated blood glucose might produce an osmotic gradient that draws excess aqueous humor into the anterior chamber and leads to autonomic dysfunction. Dysfunction of the trabecular meshwork from hyperglycemia also was considered, among other theories. Nevertheless, elevated IOP probably is not the only reason, as the specific association between diabetes and IOP was weak, leading to the conclusion that other factors independent of IOP may be involved. For example, vascular mechanisms may be a consideration.

The authors presented an excellent review of these and other possible pathophysiologic mechanisms for the association between diabetes and glaucoma and highlight other epidemiologic findings from the literature. It is an interesting and worthwhile analysis.

Ophthalmology

Diabetes, Fasting Glucose and the Risk of Glaucoma: A Meta-Analysis

Ophthalmology 2014 Oct 02;[EPub Ahead of Print], D Zhao, J Cho, MH Kim, DS Friedman, E Guallar

This abstract is available on the publisher's site.

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