Гиперметропия как фактор риска возрастной макулярной дегенерации. Обзор

Авторы представили полный комплексный анализ совокупных данных 11 поперечных (статичных) и 11 когортных продольных исследований с продолжительностью наблюдения от 5 до 14 лет, 16 исследований по типу «случай-контроль», а также 3 системных метаанализов и 1 «зонтичного» исследования с оценкой научной гипотезы, согласно которой гиперметропия является фактором риска развития возрастной макулярной дегенерации (ВМД). В этих исследованиях ВМД верифицировали по диагностическим критериям трех разных классификационных систем: критериям Национального института глаза, Международной системы по изучению возрастной макулопатии и Висконсинской классификации WARMGS. В общей сложности были охвачены 82 308 пациентов с ВМД. Анализировали 3 исходных показателя в популяции: исходную гиперметропию, сферический коэффициент (SE) и осевую длину глаза (AL), с одной стороны, и распространенность ВМД — с другой. Рассчитывали традиционные статистические показатели: отношение риска (OР) ВМД среди гиперметропов по сравнению с эметропами и 95 % доверительный интервал (ДИ). Объединенные данные метаанализов показали значимые ассоциации между дальнозоркостью, SE, AL и распространенностью ранней ВМД. Объединенные ОР и 95 % ДИ составили: 1,13 (1,06–1,20), 1,10 (1,07–1,14), и 0,79 (0,73–0,85) соответственно. Увеличение SE на одну диоптрию коррелировало с ранней ВМД (ОР 1,06; 95 % ДИ 1,02–1,10). При поздней ВМД не подтвердилась связь с аномалией рефракции. Данные зонтичного метаанализа понизили статистическую значимость этой связи для ранней ВМД (ОР = 1,08, 95 % ДИ 1,01–1,18); для поздней ВМД (ОР = 0,84, 95 % ДИ 0,77–0,91). В целом эксперты пришли к выводу, что вероятность развития ВМД зависит от рефракционного статуса пациента. 

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