不同类型青光眼和正常人视盘旁萎缩弧β区的比较研究

目的 比较正常人和原发性开角型青光眼(POAG)、闭角型青光眼(PACG)之间视盘旁萎缩弧β区发生率的差异以及其与视盘参数的关系.设计 病例对照研究.研究对象 年龄、屈光度数相匹配的正常人、POAG、PACG分别为143例(143眼)、59例(105眼)、50例(87眼).方法 利用Cannon眼底照相机采集受试者30°眼底彩色照片,并用计算机图像分析软件测量β区面积、视盘面积;青光眼患者测量盘沿面积、垂直杯盘比,对青光眼患者β区/视盘面积比和盘沿/视盘面积比、垂直杯盘比进行Spearman相关分析.主要指标 β区发生率、β区面积.结果 正常人、POAG及PACG者β区发生率分别为23.1%、69.5%、50.6%(P=0.000);POAG的β区发生率高于PACG(P=0.007).三组人群β区最多见于水平颞侧区,鼻侧区最少;POAG组β区/视盘面积比与盘沿/视盘面积比呈负相关(r=-0.370),与垂直杯盘比呈正相关(r=0.342).PACG组β区面积/视盘面积比与盘沿面积/视盘面积比和垂直杯盘比之间均无显著性相关.结论 POAG和PACG β区发生率高于正常人,POAG β区发生率高于PACG.PACG和POAG β区与视盘参数之间相关关系的差异可能和两者视神经损伤的机制不同有关.(眼科,2008,17:20-24)     

OCT3检测视盘参数与视野的相关性研究

目的:研究第三代光学相干断层扫描仪(stratus optical co-herence tomography3000,OCT3)检测原发性开角型青光眼(primary open angle glaucoma,POAG)视盘参数与视野平均缺损(mean defect,MD)的相关性,评估OCT3检测视盘参数在POAG早期诊断中的价值。方法:正常人43例(43眼)、48例原发性可疑型青光眼(SOAG)、55例(55眼)原发性开角型青光眼(POAG)。采用OCULUS Easyflied视野计和OCT3分别进行视野和视盘形态检测。比较OCT3检测三组间视盘参数的差异,分析青光眼组视野检测的视野平均缺损(MD)与OCT3视盘参数的关系。结果:OCT3检测三组间的视盘参数均存在显著性差异(P<0.01)。在原发性开角型青光眼组,RA与MD相关性最好(P<0.05)。结论:OCT3能够检测到青光眼的早期视盘结构的改变,且与MD有基本一致的较好相关性。OCT3检测视盘参数可用于POAG的早期诊断。     

青光眼视盘损伤可能性估测法与视野缺损相关性研究

目的　研究视盘损伤可能性估测法(diskdamagelikelihoodscale ,DDLS)与原发性开角型青光眼(primaryopen an gleglaucoma,POAG)视野损害的相关性。设计　回顾性研究。研究对象　6 0例(10 7只眼)POAG患者。方法　POAG患者经静态视野检查,在裂隙灯显微镜下经 6 0D非球面凸透镜测量其视盘垂直径,按DDLS分期。采用HPA视野分期系统及以视野平均缺损值(meandefect,MD)作为视野分期标准。经Pearson及Spearman相关系数分析。主要指标　视盘垂直径,盘沿最窄处宽度/视盘垂直径比值,MD ,视神经损伤分期与视野分期。结果　DDLS与MD的dB值之间存在着非常显著的正相关(Pearsonr =0 6 33,P <0 0 0 1) ;与两种不同视野分期标准间亦存在非常显著的正相关,Spearmanr值分别为0 5 93和0 6 4 3(P <0 0 0 1)。在中等大小视盘组(视盘直径1 5～2 0mm)和大视盘组(视盘直径>2 0mm) ,DDLS分期与MD(dB值)存在非常显著的正相关:Pearsonr值为0 779和0 6 0 5 (P <0 0 0 1)。结论　DDLS与青光眼性视野缺损程度有非常显著的相关性。     

开角型青光眼与正常大陷凹眼中视乳头旁萎缩区的比较研究

目的研究原发性开角型青光眼(POAG)、正常眼压性青光眼(NTG)与正常大陷凹眼的视乳头旁脉络膜萎缩区(PPA)的差异及其与视野的关系。方法利用计算机图像分析系统对拍摄的视乳头立体图像进行测量,比较42例(42只眼)POAG、40例(40只眼)NTG与45例(45只眼)正常大陷凹眼之间PPA的发生率及大小差异,分析PPA的有关参数与视乳头结构指标、视野分级之间的相关性。所有入选患者的屈光度(等效球镜度数)均在+3.00~-3.00D之间。结果正常大陷凹组、POAG组及NTG组α区的出现率分别为85.4%、100.0%、95.0%,β区的出现率分别为19.1%、48.9%、37.5%,POAG组和NTG组的α区和β区的出现率均大于正常大陷凹组,差异均有统计学意义(P<0.05)。正常大陷凹组、POAG组及NTG组β区面积分别为(0.08±0.25)、(0.24±0.36)、(0.14±0.21)mm2,POAG组的β区面积大于正常大陷凹组,差异有统计学意义(P<0.05)。三组的α区面积差异无统计学意义(Chi-Square=4.534,P=0.104)。而POAG组与NTG组间上述各指标及α区和β区出现率的差异均无统计学意义(P>0.05)。青光眼患者视乳头结构指标与视野相关分析结果表明,杯/盘比值与视野受损分级之间有较强相关性(r=0.5624,P<0.01)。而α区面积、β区面积与视野受损分级之间均为低相关性(α区:r=0.246,P<0.01;β区:r=0.2302,P<0.01)。有无青光眼性视野缺损相关因素的Logistic回归分析结果显示,在包括年龄、性别、屈光度、杯/盘比值分级指标及α区面积和β区有无的多个因素中,仅年龄和杯/盘比值分级指标被证实为两个可能的影响因素。结论排除了-3.00D以上的中高度近视人群后,POAG和NTG患者的α区和β区出现率及β区面积虽与正常大陷凹者有所不同,但其与视野缺损程度的相关性较传统的视乳头结构指标低,在两组青光眼患者间也未见明显差异。由此认为PPA不能作为诊断POAG的独立指标,也不能作为POAG与NTG的鉴别诊断指标。     

OCT3和HRT-Ⅱ检测视盘参数在青光眼早期诊断中的应用价值

目的应用OCT3和HRT-Ⅱ检测正常眼、可疑性开角型青光眼(suspected open-angle glaucoma,SOAG)和原发性开角型青光眼(primary open-angle glaucoma,POAG)患者的视盘结构参数,探讨OCT3和HRT-Ⅱ检测视盘参数的相关性及OCT3视盘分析在青光眼早期诊断中的价值。方法用OCT3和HRT-Ⅱ检测48例SOAG、55例POAG和年龄相匹配的43例正常人的视盘参数。从视盘参数中选择视盘面积、视杯面积、盘沿面积、视杯容积、盘沿容积、杯盘面积比进行分析。对两种仪器检测视盘参数的一致性及与视野平均缺损值的相关性做对比分析;建立青光眼ROC曲线图,根据ROC曲线下面积比较两种仪器诊断青光眼的能力。结果OCT3与HRT-Ⅱ检测正常人、SOAG和POAG三组间各视盘参数差异均有极显著性(P<0.01)。三组中任意两组间比较,两种仪器所测大部分视盘参数差异有显著性(P<0.05)。OCT3与HRT-Ⅱ检测视盘参数有较好的一致性(r=0.358～0.798),且与视野平均缺损值有较好的相关性。两种仪器诊断青光眼的最优参数均为盘沿面积和盘沿容积,且具有基本相等的ROC曲线下面积值。结论OCT3和HRT-Ⅱ检测视盘有较好的一致性,且与视神经损害状态密切相关,两种仪器均能检测到青光眼视盘参数改变。在青光眼组,OCT3和HRT-Ⅱ所测视盘参数与视野缺损都有一定程度的相关。OCT3与HRT-Ⅱ检测视盘参数在青光眼早期诊断中具有同等重要的价值。     

原发性开角型青光眼视盘旁萎缩弧β区5年变化研究

目的：探讨原发性开角型青光眼(primary open angle glaucoma,POAG)视盘旁萎缩弧β区的变化和POAG进展之间的关系。

方法：本研究为回顾性病例研究。对POAG 44例66眼进行5a的随访,其基线和5a随访时的所拍摄的眼底照片用于视盘形态学的评估。本研究对前后视盘旁萎缩弧β(β区)的变化和青光眼进展进行判断,并且用计算机软件测量了POAG患者基线和随访时盘沿/视盘面积比、β区/视盘面积比、垂直杯盘比。

结果：基线时66眼POAG眼有48眼存在β区,其中β区扩大20眼(42%)。β区扩大组和无变化组之间基线的年龄,屈光,性别,垂直杯盘比,盘沿/视盘面积比,β区/视盘面积比之间无统计学差异。排除屈光度数大于-3.00D的眼后,19例无进展青光眼中β区扩大4例(21%),25例进展青光眼中β区扩大15例(60%),两者之间有显著统计学差异(χ²=6.67,P=0.011)。

结论：POAG中有β区扩大组青光眼进展率大于无扩大组,β区的变化可能对POAG病情的进展有预测作用。     

视盘损伤可能度与原发性开角型青光眼视盘结构和功能的关系

目的:探讨利用海德堡视网膜断层扫描仪-Ⅲ(HRT-Ⅲ)对原发性开角型青光眼(primary open angle glaucoma,POAG)进行视盘损伤可能度(disc damage likelihood scale,DDLS)评分,DDLS值能否反映POAG视盘结构和功能的变化。方法:共有60例POAG纳入本研究。对受检者进行HRT-Ⅲ和OCTOPUS-900视野检查,记录盘沿面积(rim area,RA)和视野平均缺损(mean defect,MD)值。根据HRT-Ⅲ的地形图、反射图和DDLS评分表,对受检者的视盘进行DDLS评分。对结果选用Persons相关系数分析各数值之间的相关性。结果:患者60眼中视盘面积3.09～3.43mm2有11眼,2.41～2.67mm2有36眼,1.64～1.81mm2有13眼。研究结果显示DDLS值与RA和MD相关;随视盘面积变化,DDLS值与MD相关性无明显变化。结论:应用HRT对POAG视盘进行DDLS分期,能够很好的对视神经结构和功能的损害程度进行分级。     

原发性开角型青光眼与慢性原发性闭角型青光眼视网膜神经纤维层厚度与视野缺损的关系

目的 探讨原发性开角型青光眼(primary open-angle glaucoma,POAG)和慢性原发性闭角型青光眼(chronic primary angle-closure glaucoma,CPACG)患者频域光学相干断层扫描(optical coherence tomography,OCT)检测的视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度与视野平均缺损(mean defect,MD)的相关性.方法 采用RTVue100-2频域OCT和OCTO-PUS101视野计对POAG患者22例(22眼)及CPACG患者22例(22眼)进行检测,将两组患者RNFL厚度及视野MD值进行比较,应用Pearson积矩相关分析法确定RNFL厚度与视野MD值、上方和下方RNFL厚度与相对应半侧视野MD值的相关性.结果 POAG患者RNFL厚度、上方RNFL厚度及下方RNFL厚度分别为(91.19±15.85)μm、(94.93±18.76) μm、(87.82±15.65) μm,CPACG患者相应的RNFL厚度分别为(88.22±13.01) μm、(90.41±14.16)μm、(86.49±16.63) μm,两组患者各RNFL参数的比较差异均无统计学意义(均为P＞0.05).POAG组总MD值、上方半侧视野MD值、下方半侧视野MD值分别为(8.41±6.07)dB、(8.46±5.39)dB、(6.79±6.67) dB,CPACG组相应的MD值分别为(10.69±3.76) dB、(11.17±3.52) dB、(9.71±5.86)dB,两组患者各MD参数比较,差异均无统计学意义(均为P＞0.05).POAG组总RNFL厚度、上方RNFL厚度及下方RNFL厚度与视野相对应区域MD值呈中度负相关(r分别为:-0.574、-0.464、-0.600,均为P＜0.05),CPACG组总RNFL厚度、上方RNFL厚度及下方RNFL厚度与视野相应区域MD值呈高度负相关(r分别为-0.819、-0.884、-0.812,均为P =0.000);两组患者RNFL厚度与MD的相关系数和下方RNFL厚度与上方半侧视野MD的相关系数的差异均无统计学意义(P＞0.05),两组患者上方RNFL厚度与下方半侧视野MD的相关系数的差异有统计学意义(P＜0.05).结论 POAG患者RNFL厚度与视野MD呈中度负相关,CPACG患者RNFL厚度与视野MD呈高度负相关;相对于POAG患者,CPACG患者上方RNFL厚度与下方半侧视野MD具有更好的相关性.     

正常人与原发性开角型青光眼和闭角型青光眼视盘萎缩弧β区发生率的比较

目的:比较正常人和青光眼(原发性开角型青光眼(primary open angle glaucoma,POAG)、闭角型青光眼(primary angle-closure glaucoma,PACG))间视盘萎缩弧β区发生率的差异。方法:选择年龄、屈光度数相匹配的正常人135例135眼、POAG58例101眼、PACG50例81眼。利用海德堡眼底照相机采集受试者30°眼底彩色照片,并用计算机图像处理软件测量青光眼患者垂直杯盘比,利用卡方检验分析不同程度青光眼损伤的患者眼底β区发生率与垂直杯盘比的关系。结果:正常人、POAG和PACGβ区发生率分别为23.0%,69.3%和49.4%(χ2=51.3,P=0.000);POAG的β区发生率高于PACG(χ2=7.5,P=0.005)。三组人群β区最多见于水平颞侧象限,鼻侧象限最少(χ2=19.4,P=0.000;χ2=50.3,P=0.000;χ2=11.7,P=0.009);POAG组中,视神经损伤较重组的β区发生率明显高于较轻组(χ2=14.0,P=0.000);PACG组中,视神经损伤较重组β区发生率与较轻组无明显差异(χ2=0.6,P=0.287)。结论:POAG和PACGβ区发生率高于正常人,POAGβ区发生率高于PACG。视神经损伤较重组POAG眼相对于较轻组更易发生β区。     

限定地区人群为基础的视盘旁萎缩弧形态学研究

目的评估限定地区人群为基础的视盘旁萎缩弧情况。设计限定地区人群为基础的横断面研究。人群5324个参与者中4439个人入选到本研究中,应答率为83.4%。最低年龄在40岁以上。其中农村人群为1973人(44.4%),城市人群为2466人(55.6%)。方法应用佳能彩色眼底照相机对眼底视盘拍照后,进行视盘形态学的评估。眼底照相机的放大倍数通过计算视盘的面积得到矫正。结果4163张清晰的眼底照片入选到本研究中,其中2955人(70.98%)有α区,平均面积为(0.729±0.629)mm2(0.053～13.719mm2)。α区的大小和年龄相关(r=0.194,p=0.000<0.001)。同时和近视的程度相关(r=-0.094,p=0.000<0.001)。男性和女性之间萎缩弧α区大小无明显统计学差异(p=0.045,95%CI:0.706,0.752)。而872人有β区(20.95%),平均值为(1.985±2.223)mm2(0.102～14.999)mm2。β区的大小和年龄相关(r=0.144,p=0.000<0.001)。和近视的程度相关(r=-0.556,p=0.000<0.001)。男性和女性之间的β区大小无明显差异(p=0.096,95%CI:-0.548,0.045)。α区和β区面积大小与人群的裸眼视力,最佳矫正视力有关。两种萎缩弧均易发于视盘的颞侧,其次为颞下、颞上,最少发生在视盘鼻侧。结论α区和β区各自在人群中的发生率为70.98%和20.95%。由于β区多发于青光眼人群,β区的正常人群研究资料可能对青光眼的早期发现有重要意义。     

Intravascular oxygen saturation in retinal vessels in normal subjects and open-angle glaucoma subjects

PURPOSE: To measure the oxygen saturation (SO(2)) in retinal arterioles and venules in patients with glaucomatous optic neuropathy. METHODS: We examined SO(2) in retinal arterioles and venules simultaneously by imaging spectrometry. Oxygen saturation was evaluated according to the difference of the extinction spectra of haemoglobin and oxyhaemoglobin. The arterio-venous difference (avD) was calculated by (SO(2art) - SO(2ven)). The optic nerve head topography was estimated by Heidelberg retinal tomography and the visual field using the Octopus G1. We examined one eye in each of 58 healthy persons (mean age 58.6 +/- 10.7 years; mean rim area 1.52 +/- 0.33 mm(2); mean defect 0.65 +/- 1.31 dB; mean intraocular pressure [IOP] 18.5 +/- 2.7 mmHg), 49 patients with normal-tension primary open-angle glaucoma (NTG) (mean age 63.0 +/- 8.5 years; mean rim area 0.89 +/- 0.34 mm(2); mean defect 5.4 +/- 4.1 dB; mean IOP 19.2 +/- 2.9 mmHg), and 45 patients with high-tension primary open-angle glaucoma (POAG) (mean age 62.6 +/- 10.3 years; mean rim area 0.97 +/- 0.47 mm(2); mean defect 7.1 +/- 6.4 dB; mean IOP 31.6 +/- 10.8 mmHg). RESULTS: The intraclass correlation coefficients of the SO(2) measurement were 0.82 (arteriole) and 0.59 (venule). In normal eyes, the SO(2art), SO(2ven) and avD were 92.3 +/- 3.4%, 55.7 +/- 6.8% and 36.6 +/- 7.0%, respectively. Equivalent data were 89.7 +/- 5.4%, 56.0 +/- 8.3% and 33.7 +/- 10.6%, respectively, in NTG eyes and 91.4 +/- 4.0%, 58.3 +/- 10.5% and 33.1 +/- 11.5%, respectively, in POAG eyes. Over all examined eyes, the arteriolar SO(2) and the retinal arterio-venous difference correlated significantly with the rim area. CONCLUSION: Eyes with NTG showed significantly decreased arteriolar SO(2). These changes were not seen in POAG patients.     

Corneal thickness and visual field damage in glaucoma patients

PURPOSE: To verify whether there was a significant correlation between central corneal thickness (CCT) and visual field damage in patients with primary open angle glaucoma (POAG). METHODS: A total of 99 eyes with POAG were consecutively recruited. Patients were classified as glaucomatous based on visual field and optic nerve head damage. All underwent applanation tonometry, Humphrey perimetry, and measurement of CCT with ultrasonic pachymetry. Based on CCT value, the sample was split at the mode in two groups (group 1<535 microm, n=49; group 2>or=535 microm, n=50). RESULTS: Entire cohort: mean CCT 554 microm+/-45.03; mean deviation (MD) -6.68 dB+/-7.32; pattern standard deviation (PSD) 5.33+/-3.75; intraocular pressure (IOP) 17.91+/-4.16 mmHg with treatment. Group 1: CCT was 504.8 microm+/-30.8; MD -9.01 dB+/-8.72; PSD 6.38+/-3.99; IOP 18.02 mmHg+/-4.66. Group 2: mean CCT 574.6 microm+/-35.03; MD -4.39 dB+/-4.70; PSD 4.25+/-3.19; IOP 17.79 mmHg+/-3.57. A significant difference was found between the two groups for both MD and PSD. Linear regression analysis showed a significant correlation between CCT and PSD (P<0.001). CONCLUSIONS: Our data show that patients with a thinner cornea had a worse MD and PSD. As a thinner CCT causes an underestimation of the true IOP, there may be a delay in the diagnosis of POAG or an inadequate estimate of the clinical course despite apparently desirable IOP applanation readings.     

视盘损伤可能度和杯盘比与POAG视野缺损的关系

目的:利用海德堡视网膜断层扫描仪-Ⅲ(HRT-Ⅲ)对原发性开角型青光眼(primary open angle glaucoma,POAG)进行视盘损伤可能度(disc damage likelihood scale,DDLS)评分,比较DDLS评分是否比杯盘比(cup/disc ratio,C/D)值更能反映POAG视野缺损的程度。方法:共有56例56眼POAG患者纳入本研究。在双盲情况下确定C/D值。完成对受检者的OCTOPUS-900视野计(G2-TOP)和HRT-Ⅲ检查后,记录视野平均缺损值(meandefect,MD),再根据HRT-Ⅲ的地形图对受检者的视盘进行DDLS评分。结果选用Pearson相关系数进行评价。结果:大视盘(视盘面积3.09~3.43mm2)9眼、中等大小的视盘(2.41~2.67mm2)34眼和小视盘(1.64~1.81mm2)13眼纳入分析。DDLS与MD强相关(总:Pearsonr=0.916,P<0.01;大视盘:Pearsonr=0.850,P=0.0037,中视盘:Pearsonr=0.934,P<0.01;小视盘:Pearsonr=0.912,P<0.01)。C/D与MD有中等程度相关(总:Pearsonr=0.676,P<0.01;大视盘:Pearsonr=0.472,P=0.199,中视盘:Pearsonr=0.682,P<0.01;小视盘:Pearsonr=0.788,P=0.0014)。结论:利用HRT-Ⅲ对POAG的视盘进行DDLS分期,是比C/D更好地对POAG视神经损害程度进行分级的方法。     

Comparing glaucomatous optic neuropathy in primary open angle and chronic primary angle closure glaucoma eyes by optical coherence tomography

PURPOSE: To comparatively evaluate the optic nerve head (ONH) using Optical Coherence Tomography (OCT) in normal subjects, primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) patients. METHODS: A total of 138 normal eyes (138 subjects) and 139 glaucomatous eyes (139 patients), were evaluated in this cross-sectional observational study. The ONH was imaged on OCT using the optic disc scan. Disc area, cup area, rim area, vertical integrated rim area (VIRA), rim volume (horizontal integrated rim volume), average cup/disc ratio, horizontal and vertical cup/disc ratios, and cup volume were evaluated. Additionally, cup depth and slope of the temporal ONH were also measured. These ONH parameters were compared between normal subjects and eyes with early POAG and CPACG. Correlation of mean deviation and corrected pattern standard deviation on full threshold 30-2 perimetry, with measured ONH parameters was carried out amongst the two groups. RESULTS: There was a significant difference in disc area (2.38 +/- 0.5, 2.77 +/- 0.4, 2.62 +/- 0.4 mm(2), p < 0.01), cup area (0.88 +/- 0.6, 1.99 +/- 0.7, 1.60 +/- 0.7 mm(2), p < 0.01), rim area (1.48 +/- 0.4, 0.86 +/- 0.4, 0.96 +/- 0.4 mm(2), p < 0.01), VIRA (1.64 +/- 0.3, 1.23 +/- 0.3, 1.22 +/- 0.4 mm(2), p < 0.01), rim volume (0.34 +/- 0.2, 0.1 +/- 0.1, 0.15 +/- 0.1 mm(3), p < 0.01) and cup/disc ratio (0.36 +/- 0.2, 0.69 +/- 0.1, 0.63 +/- 0.2, p < 0.01) in normal vs POAG vs CPACG eyes respectively. A comparison of ONH parameters between early POAG and early CPACG showed a significant difference in the disc area (2.85 +/- 0.3, 2.57 +/- 0.4 mm(2), p = 0.03), cup area (2 +/- 0.5, 1.34 +/- 0.5 mm(2), p < 0.01), rim area (0.96 +/- 0.4, 1.21 +/- 0.5 mm(2), p = 0.009), rim volume (0.12 +/- 0.1, 0.18 +/- 0.1 mm(3), p < 0.01) and cup/disc ratio (0.67 +/- 0.1, 0.53 +/- 0.2, p < 0.01). The parameters with the highest area under the receiver operator characteristic (AROC) curves for differentiating normal and early POAG eyes were rim volume, 0.89, VIRA, 0.84, and rim area, 0.76. The AROC values (normal vs early CPACG eyes) were 0.75 for rim volume, 0.72 for VIRA, and 0.66 for rim area. CONCLUSION: OCT may serve as a useful diagnostic modality in distinguishing a normal optic disc from a glaucomatous one, even in the early stages of glaucoma. Rim volume, VIRA and rim area can be used to differentiate normal from early glaucoma (both early POAG and CPACG), and most efficiently early POAG eyes. CPACG eyes have smaller discs, a smaller cup, smaller cup/disc ratio, and a larger rim area when compared with eyes with POAG.     

蓝/黄视野检查法和白/白视野检查法阈值变异的对比研究

目的:比较蓝/黄视野检查法[Blue-on-yellow（B/Y）perimetry]和白/白视野检查法[White-on-white（W/W）perimetry]阈值变异的情况,评价B/Y视野检查法的可重复性。方法:应用Octopus 101全自动视野计分别对12例（24眼）正常人、16例（32眼）原发性开角型青光眼（Primary open angle glaucoma,POAG）和 7例（14眼）可疑POAG患者分别进行B/Y视野检查和W/W视野检查。所有受检者在2周内再次分别进行上述两种视野检查。将两种视野检查的阈值进行点对点阈值变异分析和比较。结果:在所有受检者中,B/Y视野检查的全视野总的平均阈值变异（2.61±0.94）decibels（dB）大于 W/W视野检查的阈值变异（2.11±0.90）dB,但差异无显著性意义（P=0.6244）。正常人 B/Y视野检查的全视野总的平均阈值变异（2.07±0.54）dB明显大于W/W视野检查的阈值变异（1.50±0.34）dB（P=0.0006）,而可疑POAG和POAG组,两种视野检查的全视野总的平均阈值变异差异无显著性意义（P=0.0523和 0.9371）。正常人和可疑POAG组中,有部分离心度处的阈值变异,两种视野检查法之间差异有显著性意义,而在POAG组中,两种视野检查法各相应离心度之间差异均无显著性意义。结论:正常人B/Y视野检查的阈值变异大于W/W视野检查的阈值变异,而可疑POAG和POAG患者B/Y     

Parapapillary autofluorescence as indicator for glaucoma

BACKGROUND: A pronounced fundus autofluorescence (lipofuscin) occurs in eyes with AMD. Parapapillary lipofuscin accumulation in the retinal pigment epithelial cells was observed in eyes with advanced glaucoma histologically. The aim of this study was to evaluate the parapapillary autofluorescence (PAF) in vivo in healthy eyes (controls), and in eyes with primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PSXG) or normal tension glaucoma (NTG). PATIENTS AND METHODS: Controlled cross-sectional analysis was performed on 281 consecutive eyes (98 controls, 95 POAG, 32 PSXG, 56 NTG). Eyes with fundus pathologies were excluded. The confocal scanning laser ophthalmoscope HRA II (Heidelberg Retina Angiograph II) was used after lipofuscin-excitation with an argon blue laser (488 nm) to detect PAF in the spectrum above 500 nm. PAF area and PAF distance to the optic nerve head were analyzed using the HRA standard software. Two experienced ophthalmologists classified independently the stage of glaucomatous optic nerve head atrophy (GONHA) using 15 degrees fundus photographs. RESULTS: Vital optic nerve heads had smaller PAF areas (stage 0: 0.07 +/- 0.09 mm (2)) in contrast to advanced stages of GONHA (stages 1 to 4: 0.27 +/- 0.46 mm (2); p < 0.001; logistic regression Cox and Snell: r = 0.7; p = 0.015). The PAF distance to the optic nerve head was lower in controls (0.12 +/- 0.08 mm) than in eyes with POAG, PSXG, or NTG (0.25 +/- 0.21 mm, Bonferroni: p < 0,004). The PAF area correlated significantly with the stage of GONHA (stage 1: 0.23 +/- 0.23 mm (2), stage 2: 0.24 +/- 0.19 mm (2), stages 3 and 4: 0.34 +/- 0.73 mm (2), p < 0.01). No significant difference of PAF area was found between the glaucoma types. However, the distance between PAF and optic nerve head was higher in POAG (0.28 +/- 0.26 mm) than in NTG (0.24 +/- 0.07 mm) or in PSXG (0.18 +/- 0.07 mm, Bonferroni: p < 0.03). CONCLUSIONS: A pronounced fundus autofluorescence was detected as a sign of increased lipofuscin accumulation in the parapapillary atrophic zone of eyes with POAG, PSXG, and NTG in contrast to controls. The PAF analysis may provide an indicator for glaucomas in the future.     

原发性开角型青光眼HRT视盘参数和视野缺损的关系

目的 :探讨原发性开角型青光眼视盘参数和视野平均缺损之间的关系。方法 :用海德堡视网膜断层扫描仪和自动视野计测定 5 5名原发性开角型青光眼患者的视盘参数 (杯盘面积比、盘沿面积、盘沿容积、视杯容积、视杯形态测量、视杯高度变异轮廓和平均神经纤维层厚度 )和静态光阈值。视盘参数与视野平均缺损作相关分析和多元线性回归分析。结果 :盘沿面积与平均缺损显著相关 (r =0 3 5 0 ,P <0 0 5 )。盘沿面积每减少 1mm2 ,视野缺损绝对值增加 8 0 81dB。本研究没有发现其它 6个参数与平均缺损相关关系的显著性。结论 :盘沿面积在HRT众多参数中最能反映青光眼的视野平均缺损程度。     

Morphology of the optic papilla in glaucoma. II. Secondary chronic open angle glaucoma

Previous studies have shown that the chronic open-angle glaucomas form a heterogeneous spectrum of diseases which have in common an open anterior chamber angle and glaucomatous optic nerve damage. Purpose of this study was to evaluate whether the appearance of the optic disc shows specific features among various types of secondary chronic open-angle glaucoma. METHODS: Clinical data and color-stereo optic disc photographs of 126 patients with pseudoexfoliative glaucoma and 47 patients with pigmentary glaucoma were compared with those of 501 patients with primary open-angle glaucoma (POAG) and of 481 normal subjects. The glaucoma groups did not differ in neuroretinal rim nor in perimetric mean defect. RESULTS: Mean optic disc area was significantly smaller in the pseudoexfoliative glaucoma eyes (2.54 +/- 0.51 mm2 vs. 2.71 +/- 0.63 mm2, p = 0.03) than in the primary open-angle glaucoma eyes. The pigmentary glaucoma group did not vary significantly from the primary open-angle glaucoma group in size of the optic disc. No significant differences were found for neuroretinal rim area, configuration of neuroretinal rim, depth of optic cup and diameters of the retinal arterioles and venules at the disc border between the secondary glaucoma groups and the POAG group respectively. Size of zone beta of the parapapillary atrophy was slightly, but not significantly smaller in the secondary glaucoma groups than in POAG. In the secondary glaucoma groups, the maximal intraocular pressure measurements were significantly (p < 0.001) higher than in the group with POAG. All glaucoma groups had a significantly smaller neuroretinal rim, significantly smaller retinal arterioles, and significantly larger parapapillary atrophy compared to the normal group. CONCLUSIONS: Except of a slightly smaller optic disc in eyes with pseudoexfoliative glaucoma, eyes with secondary glaucoma due to pseudoexfoliation or due to pigmentary dispersion do not vary significantly in their optic disc morphology compared to POAG and do not show pathognomonic features of the optic disc despite marked changes in the anterior segment of the eye.