Discrepancy of the intraocular pressure response between fellow eyes in one-eye trials versus bilateral treatment: verification with normal subjects

PURPOSE: To compare the correlation of the fellow-eye's intraocular pressure (IOP) response in one-eye trials performed separately for each eye with that of bilateral treatment in normal subjects. METHODS: A one-eye trial with topical latanoprost applied once daily for 7 days was carried out in the right eye and then in the left eye of 41 normal subjects. Bilateral treatment was performed in a different set of 41 normal subjects. IOPs were measured at 3 time points on day 0 and on day 7. RESULTS: Latanoprost significantly reduced IOP of treated eyes in one-eye trials (2.8+/-1.6 and 2.7+/-1.6 mm Hg in the first and second trial, respectively) and in bilateral treatments (2.8+/-1.3 and 2.6+/-1.4 mm Hg in the right and left eye, respectively). Correlation of mean diurnal IOP reduction between 2 one-eye trials was poor (r2=0.102), even after subtracting the nontreated eye IOP fluctuations from the treated eye IOPs (r2=0.097), but that between fellow eyes in bilateral treatment was excellent (r=0.849). Correlation of baseline IOP at each time point between fellow eyes in one-eye trials and bilateral treatment (r2=0.729 to 0.949) was better than that in the same eye between 2 one-eye trials (r2=0.319 to 0.631). CONCLUSIONS: Fellow eyes in normal subjects showed a symmetrical IOP response to short-term bilateral treatment with latanoprost, although they did not respond symmetrically to one-eye trials performed separately for each eye. Poor correlation of IOP changes between 2 one-eye trials may be caused by different IOP responsiveness to latanoprost at each trial, rather than asymmetrical IOP fluctuations.     

正常眼压性青光眼与高眼压性青光眼视神经图像分析的对比研究

目的 探讨正常眼压性青光眼 (normal-tension glaucoma, NTG)与高眼压性青光眼(high-tension glaucoma, HTG)视盘和视神经纤维层(retinal nerve fiber layer, RNFL)损害的差异。 方法 选择具有青光眼性视神经损害或RNFL缺损、相应的视野缺损的青光眼患者,NTG至少2次24 h眼压曲线和多次眼压测量均≤21 mm Hg(1 mm Hg =0.133 kPa)，HTG的眼压至少2次测量≥25 mm Hg。患者进行详细的眼科检查，同时用扫描激光偏振仪(scanning laser polarimetry, SLP)、光学相干断层扫描（optical coherence tomography, OCT）和海德堡视网膜成像仪(Heidelberg retinal tomography, HRT)定量测定视盘形态和RNFL厚度。比较两组视盘总体和相同象限测量参数。 结果 30例 NTG和 19例 HTG (共49只眼)患者的平均年龄分别为(59.6±8.6)岁(39～71岁)和(59.2±12.3)岁(36～75岁)。两组间视野缺损的平均偏差(mean deviation, MD)差异不显著(P＞0.05)。HRT测量的视盘 C/D面积比，除鼻侧象限外,NTG者视盘总体和上、下、颞侧3个象限均显著大于HTG者(P＜0.05 ),而盘缘面积小于HTG者(P＜0.05)；两组间其他视盘参数差异不显著。3种激光扫描技术所测定的总体和象限RNFL厚度，两组间差异不显著。 结论 NTG趋向大 C/D面积比和窄盘缘面积。RNFL缺损的形态分布须更精细和节段性分析。 (中华眼底病杂志, 2002, 18: 109-112)     

早期开角型青光眼的视网膜神经纤维层缺损及相关临床特点

目的观察早期原发性开角型青光眼（primary open-angle glaucoma,POAG）及正常眼压性青光眼（normal tension glaucoma,NTG）的弥漫性及局限性视网膜神经纤维层缺损（retinal never fiber layer defect,RNFLD）的分布及相关的临床特点。方法通过对立体眼底像的观察,明确81例POAG及70例NTG的RNFLD类型,分析弥漫性及局限性RNFLD在两型青光眼中的分布,比较两型RNFLD患者未治疗的最高眼压及视盘出血发生比例的不同。结果81例POAG中,78例出现RNFLD,其中弥漫性RNFLD50例,局限性RNFLD28例。70例NTG中,弥漫性RNFLD27例,局限性RNFLD43例,两型青光眼的RNFLD的分布相比较,差异有显著性（χ     

高眼压性和正常眼压性原发性开角型青光眼视神经损害特征的比较

目的探讨高眼压性原发性开角型青光眼(POAG)和正常眼压性青光眼(NTG)患者视神经损害的不同特点。方法应用德国Heidelberg公司生产的视网膜断层扫描仪对高眼压性POAG39例(47只眼)和NTG32例(38只眼)进行定量视盘参数和神经纤维层检查,并行眼底立体照相观察视网膜神经纤维层(RNFL)缺损类型,检测静态定量视野,并对检查结果进行比较。结果(1)NTG组视盘总体参数和分区(除颞侧外)盘沿面积、沿/盘面积小于高眼压性POAG组,而C/D大于高眼压性POAG组;平均RNFL厚度和RNFL面积在颞下和颞上小于高眼压性POAG组;总体盘沿容积小于高眼压性POAG组,总体平均视杯深度和颞下视杯面积大于高眼压性POAG组,两组差异均有统计学意义(P<005)。两组颞侧视盘各参数比较,差异无统计学意义(P>005)。(2)RNFL缺损类型高眼压性POAG组RNFL弥漫性缺损占5319%,局限性缺损占426%;NTG组弥漫性缺损占2105%,局限性缺损占5526%。两组RNFL缺损类型构成比比较,差异有统计学意义(P<001)。结论NTG较高眼压性POAG具有较大的C/D值、C/D面积比和窄盘沿面积,RNFL丢失严重。高眼压性POAG患者的RNFL以弥漫性缺损为主,NTG患者的RNFL以局限性缺损为主。两者视神经损害具有不同特点,其损害机制可能不同。(中华眼科杂志,2005,41136140)     

Comparisons of ganglion cell-inner plexiform layer loss patterns and its diagnostic performance between normal tension glaucoma and primary open angle glaucoma: a detailed, severity-based study

AIM: To evaluate the patterns of macular ganglion cell-inner plexiform layer (GCIPL) loss in normal tension glaucoma (NTG) and primary open angle glaucoma (POAG) in a detailed, disease severity-matched way; and to assess the diagnostic capabilities of GCIPL thickness parameters in discriminating NTG or POAG from normal subjects. METHODS: A total of 157 eyes of 157 subjects, including 57 normal eyes, 51 eyes with POAG and 49 eyes with NTG were enrolled and strictly matched in age, refraction, and disease severity between POAG and NTG groups. The average, minimum, superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal GCIPL thickness, and the average, superior, temporal, inferior, and nasal retinal nerve fiber layer (RNFL) thickness were obtained by Cirrus optical coherence tomography (OCT). The diagnostic capabilities of OCT parameters were assessed by area under receiver operating characteristic (AUROC) curves. RESULTS: Among all the OCT thickness parameters, no statistical significant difference between NTG group and POAG group was found (all P>0.05). In discriminating NTG or POAG from normal subjects, the average and inferior RNFL thickness, and the minimum GCIPL thickness had better diagnostic capabilities. There was no significant difference in AUROC curve between the best GCIPL thickness parameter (minimum GCIPL) and the best RNFL thickness parameter in discriminating NTG (inferior RNFL; P=0.076) and indiscriminating POAG (average RNFL; P=0.913) from normal eyes. CONCLUSION: Localized GCIPL loss, especially in the inferior and inferotemporal sectors, is more common in NTG than in POAG. Among all the GCIPL thickness parameters, the minimum GCIPL thickness has the best diagnostic performance in differentiating NTG or POAG from normal subjects, which is comparable to that of the average and inferior RNFL thickness.     

应用激光扫描眼底镜检查视网膜神经纤维层

目的评价激光扫描眼底镜检查视网膜神经纤维层缺损的敏感性和特异性,以及其在临床上的应用价值。方法选择原发性开角型青光眼４９例（９５只眼）,高眼压症１９例（３７只眼）,疑似青光眼患者４３例（８３只眼）,正常志愿者１８例（３４只眼）作为研究对象。所有研究对象均散瞳后应用４８８ｎｍ的蓝色氩激光为光源,１～３ｍｍ的共焦点光圈,获得４０°和２０°视角的视网膜神经纤维层图像,记录在录像带上。由具有相当经验的研究者判断有无视网膜神经纤维层缺损以及缺损类型。在回避了第一次结果的条件下,对６８只眼视网膜神经纤维层的情况进行不同观察者及两次观察的重复性研究。结果两次观察和不同观察者判断有无视网膜神经纤维层缺损以及缺损类型的一致性分别为高度和中到高度。激光扫描眼底镜检查视网膜神经纤维层缺损的敏感性为８０．０％,特异性为９４．１％。结论激光扫描眼底镜检查视网膜神经纤维层是一种方便、快捷、准确和安全地发现视网膜神经纤维层缺损的有效方法,对于提高青光眼的早期诊断率有一定的临床实用价值。     

Specificity and sensitivity of glaucoma detection in the Japanese population using scanning laser polarimetry.

AIMS: To investigate the usefulness of the scanning laser polarimeter (GDx; GDx Nerve Fiber Analyzer) for glaucoma detection in the Japanese population, and to investigate the difference in the thickness of retinal nerve fibre layer (RNFL) between normal tension glaucoma (NTG) and primary open angle glaucoma (POAG). METHODS: 69 eyes of 69 normal subjects and 115 eyes of 115 chronic open angle glaucoma patients (60 NTG and 55 POAG patients) were studied. The thickness of RNFL was measured with GDx. An eye was diagnosed as glaucomatous, if at least one original GDx variable showed p <5%. The difference in thickness of RNFL between the NTG and POAG groups was then investigated. RESULTS: 46 normal eyes (66.7%) were diagnosed as not glaucomatous (no variables showing p <5%), and 93 glaucomatous eyes (46 NTG and 47 POAG eyes) (80.9%) were diagnosed as glaucomatous. Actual values of average thickness, ellipse average, superior average, and superior integral were significantly lower in the POAG group than those in the NTG group. CONCLUSIONS: New variables which elucidate focal RNFL defects or early changes are needed to improve the moderate detection ability found in this present study. The pattern of the change in RNFL may differ in NTG and POAG groups.     

Effect of concomitant use of latanoprost and brinzolamide on 24-hour variation of IOP in normal-tension glaucoma

PURPOSE: To study the effect of the concomitant use of latanoprost and brinzolamide on the 24-hour variation in the intraocular pressure (IOP) in patients with normal-tension glaucoma (NTG). METHODS: We studied a total of 44 eyes from 22 NTG patients. Mean 24-hour IOP variation was determined after a washout period of > or =4 weeks. Latanoprost monotherapy was continued in both eyes for 8 weeks. Thereafter, patients were randomized to continue latanoprost monotherapy in 1 eye whereas brinzolamide was added as an adjunct to latanoprost therapy in the other eye. Eight weeks after the initiation of brinzolamide treatment, the 24-hour IOP variation was remeasured. IOP was measured in the sitting position 8 times daily using a Goldmann applanation tonometer before and after treatment. RESULTS: The eyes treated with latanoprost monotherapy and those treated with latanoprost and brinzolamide showed a significant decrease in IOP at all time points. Percent reductions in the diurnal mean IOP (mean IOP at 10 AM, 1 PM, and 4 PM) and in nocturnal mean IOP (mean IOP at 10 PM, 1 AM, and 3 AM) were significantly greater in the eyes treated with the combination of latanoprost and brinzolamide than those with latanoprost alone (diurnal mean IOP: latanoprost and brinzolamide=19.8%, latanoprost=14.1%, P<0.001; nocturnal mean IOP: latanoprost and brinzolamide=13.4%, latanoprost=10.0%, P<0.05). CONCLUSIONS: For the treatment of NTG, the combination of latanoprost and brinzolamide demonstrated additive effects in lowering IOP, not only during the day, but also at night.     

PNT治疗开角型青光眼及高眼压症的临床观察

目的:对比研究真空小梁成形术（pneumatic trabeculoplasty, PNT）与0.05g/L拉坦前列腺素滴眼液治疗开角型青光眼及高眼压症患者的临床效果。方法:选取我院就诊的开角型青光眼及高眼压症患者30例48眼,随机分为A,B两组,A组12例24眼行PNT治疗,B组18例24眼给予0.05g/L拉坦前列腺素滴眼液点眼,频次1次/睡前。记录两组治疗前后的视力、眼压、视野及视盘周围神经纤维层厚度变化,进行统计分析。结果:眼压:A组治疗后1~3mo平均眼压值较治疗前明显降低（P＜0.01）。B组整个治疗过程平均眼压均较治疗前明显降低（P＜0.01）。治疗后1~6mo眼压降低≥20%的眼数,A组分别占79%,62%,50%,25%,12%,0;B组分别为92%,83%,83%,79%,71%,62%,两组第3mo开始差异有统计学意义（P=0.014）。在治疗随访过程中,两组患者的视力、视野及视盘周围神经纤维层厚度均无明显变化（P＞0.05）。不良反应:A组多为一过性结膜充血及结膜下出血,且均在1wk内吸收消失;B组有8眼治疗后持续结膜充血较明显,有5例8眼患者诉不同程度刺激症状。结论:真空小梁成形术和0.05g/L拉坦前列腺素滴眼液均能有效降低开角型青光眼及高眼压症患者眼压,但前者副作用更小,而后者降眼压效果持久。     

Effects of the combination of bimatoprost and latanoprost on intraocular pressure in primary open angle glaucoma: a randomised clinical trial

AIMS: To evaluate the effect of the combination of bimatoprost and latanoprost on intraocular pressure (IOP) in primary open angle glaucoma (POAG). METHODS: An open label randomised clinical trial was conducted, which included 18 glaucomatous patients (36 eyes). In the first 4 weeks, latanoprost 0.005% was prescribed for both eyes of the patients and any other antiglaucoma medication was discontinued. In the next 4 weeks (phase 1), bimatoprost 0.03% was combined with latanoprost in one randomly assigned eye (case eye) of each patient. In the next 4 weeks (phase 2), bimatoprost was discontinued in the case eyes, while bimatoprost was substituted for latanoprost in the fellow eye (control eye). The IOP was measured at the end of the first 4 weeks (baseline measurement) and weekly during phases 1 and 2. RESULTS: In the case eyes, the mean IOP increased along the first phase (1.8 mm Hg; p = 0.006) when compared to baseline measurements. The IOP returned to previous values after discontinuation of bimatoprost in phase 2. In the control eyes, the mean IOP did not change throughout the study. CONCLUSION: The combination of bimatoprost and latanoprost in POAG increases the IOP and should not be considered as a therapeutic option.     

原发性开角型青光眼患者及正常人的眼压日内波动趋势

目的研究原发性开角型青光眼（POAG）、正常眼压性青光眼（NTG）患者及正常人双眼眼压昼夜波动趋势及其眼压峰值出现的规律，比较双眼眼压波动趋势是否一致。设计前瞻性病例系列。研究对象POAG、NTG患者及正常对照各30例。方法用Goldmann压平眼压计测量眼压日曲线，比较双眼的日眼压波动模式及眼压峰值分布。主要指标眼压测量值。结果眼压峰值出现于非办公时段的正常人为右眼6．7％、左眼10．0％；NTG患者为右眼20．0％、左眼23．3％；POAG患者为右眼23．3％、左眼20.0％。结论POAG、NTG患者和正常人有着不同的眼压昼夜波动模式，且双眼的波动趋势不尽相同，不能完全将双眼等同看待；部分观察对象的峰值眼压分布于非办公时段，办公时段多次眼压测量不能完全代替一日眼压监测。（眼科，2007,16：33．36）     

Retinal nerve fiber loss in high- and normal-tension glaucoma by optical coherence tomography.

PURPOSE: To compare the pattern of retinal nerve fiber layer (RNFL) damages in high-tension and normal-tension primary chronic open-angle glaucoma using optical coherence tomography (OCT). METHODS: Age- and refractive error-matched patients with normal-tension glaucoma (NTG) (n = 38) and high-tension glaucoma (HTG) (n = 48) and normal subjects (n = 48) were recruited. All subjects underwent complete eye examinations and OCT RNFL assessments. RESULTS: No statistically significant difference was found between eyes with HTG and NTG for any OCT RNFL thickness parameters (p > 0.05). Inferotemporal thickness values were significantly lower than the superotemporal thickness values in both glaucoma groups (p < 0.001), but no difference was observed in the normal group. Compared with the results from normal subjects, several OCT parameters, including average, superior, inferior, inferotemporal, and superotemporal values, were significantly lower in patients with HTG and NTG (p < 0.01). CONCLUSIONS: A mixture of diffuse RNFL damage (superotemporal and inferotemporal regions) and local damage in inferotemporal region was observed in patients with HTG and NTG, suggesting that HTG and NTG may undergo same pathological process.     

Localized wedge-shaped defects of retinal nerve fiber layer and disc hemorrhage in glaucoma.

OBJECTIVE: To evaluate frequencies of localized wedge-shaped defects of the retinal nerve fiber layer (RNFL) in eyes with and without disc hemorrhage in normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG). This study also aims to define a topographic correlation between disc hemorrhage and localized RNFL defects in POAG. DESIGN: Cross-sectional study. PARTICIPANTS AND CONTROLS: The authors studied 83 eyes of 83 patients with NTG (male/female = 23/60; age, 58.8+/-12.9 years) and 20 eyes of 20 patients with POAG (male/female = 9/11; age, 61.6+/-11.4 years); subjects in both groups had developed new disc hemorrhage at the time of enrollment. The authors randomly selected 45 eyes of 45 patients with NTG (male/female = 20/25; age, 62.0+/-9.3 years) and 24 eyes of 24 patients with POAG (male/female = 13/11; age, 56.3+/-14.5 years) with no history of disc hemorrhage during the follow-up period of more than 2 years. METHODS: Visual field in the patients with POAG was matched to that of the patients with NTG regarding global indices for both the hemorrhage and the nonhemorrhage groups. Localized wedge-shaped defects of RNFL were identified by scanning laser ophthalmoscopy using an argon-blue laser. MAIN OUTCOME MEASURES: The frequency of localized RNFL defects and the relationship between the locations of disc hemorrhages and localized RNFL defects were determined. RESULTS: Localized wedge-shaped defects of RNFL occurred significantly more often in the hemorrhage group than in the nonhemorrhage group in both NTG (Fisher's exact probability test, P < 0.0001) and POAG (P < 0.05) patients. Regardless of the presence of disc hemorrhage, there was no significant difference in the frequency of localized RNFL defects between patients with NTG and those with POAG. Most disc hemorrhages were present in the vicinity of the border between localized RNFL defects and relatively healthy-looking RNFL in both patients with POAG and those with NTG. CONCLUSION: Disc hemorrhage is associated with localized damage of RNFL in both NTG and POAG.     

The damage patterns of retinal nerve fiber layer in acute and chronic intraocular pressure elevation in primary angle closure glaucoma

 Purpose: To observe the differences of damage patterns of retinal nerve fiber layer (RNFL) between acute and chronic intraocular pressure (IOP) elevation in primary angle closure glaucoma (PACG) using optical coherence tomography (OCT). Methods: Twenty four patients (48 eyes) with unilateral acute PACG (APACG) attack in the 6 months after remission and 36 patients (64 eyes) with chronic PACG (CPACG) were included in this prospective study. For all cases, IOP has been controlled less than 21 mm Hg after treatment. Using stratus OCT, the RNFL thickness was assessed in eyes with PACG within 3 days, 2 weeks, 1, 3 and 6 month after IOP controlled. Repeated measures ANOVA was used to examine the time course of changes after IOP controlled in RNFL thickness in both acute attack and unaffected fellow eyes of APACG and eyes with CPACG. Results: The mean RNFL thickness (μm) for the APACG-attacked eyes increased significantly within 3 days (121.49±23.84) after acute strike and then became thinner along with time (107.22±24.72 at 2 week, 93.58±18.37 at 1 month, 84.10±19.89 at 3 month and 78.98±19.17 at 6 month). In APACG-attacked eyes, there were significant differences of average RNFL thickness among 5 different times after IOP was controlled (P ＜ 0.001). In the APACG unaffected fellow eyes and CPACG eyes, there were no significant differences in mean RNFL thickness among 5 different times (F = 0.450, P = 0.104 in APACG unaffected fellow eyes and F = 1.558, P = 0.200 in CPACG eyes). There was significant difference for interaction between time periods and groups (F = 1.912,P = 0.003). Conclusion:  RNFL damage patterns are different under different IOP elevated courses. In APACG, RNFL was found to be swollen and thickening right after acute attack and then becomes thinning and atrophy along with the time, while RNFL was found to be diffused thinness in CPACG.     

原发性急性闭角型青光眼视网膜神经纤维层厚度变化研究

目的 观察原发性急性闭角型青光眼(APACG)首次发作后6个月内视网膜神经纤维层厚度(RNFLT)变化规律.方法 用光学相干断层扫描仪(OCT)测量首次单侧发作的APACG患者(24例)在眼压控制后3 d内、2周、1月、3月和6月时的双眼RNFLT,比较双眼各时间点RNFLT.对侧眼在发作眼眼压控制后3d内及6月时的RNFLT与正常人(55名55只眼)比较.结果 发作眼平均RNFLT在眼压控制后3 d内(121.49±23.84)μm,较对侧眼明显增加(P＜0.01);2周(107.22±24.72)μm和1月(93.58±18.37)μm与对侧眼的差异无统计学意义(P=0.31和0.08);3月(84.10±19.89)μm和6月(78.98±19.17)μm较对侧眼明显减少(P＜0.01).发作眼不同时间点的RNFLT变化均有统计学意义(P＜0.01～0.048).对侧眼在发作眼眼压控制后3 d内及6月的RNFLT和正常人比较差异无统计学意义(P=0.13～0.98).结论 APACG发作后RNFL厚度即有明显增加,发作后2周至1个月RNFL厚度趋向正常,1个月后RNFL厚度逐渐变薄,至术后6个月RNFL厚度较对侧眼和正常人明显减少.     

Early detection of thinning of retinal nerve fiber layer in glaucomatous eyes by optical coherence tomography 3000: analysis of retinal nerve fiber layer corresponding to the preserved hemivisual field

The retinal nerve fiber layer (RNFL) thickness was measured with the optical coherence tomography using version 3.0 software (OCT3000) in 153 eyes of 153 normal subjects. The mean of the average RNFL thickness over the entire 360 degrees in the control group was 92.5 +/- 12.9 microm which was significantly thinner than the normative data of 95.9 +/- 11.4 microm included with the OCT3000 (p < 0.01). The RNFL thickness decreased with increasing age (p < 0.01, r = -0.395). The RNFL thickness was also measured in 53 eyes of 53 patients with glaucoma whose superior (13 eyes) or inferior (40 eyes) perimetric hemifields were normal. Only the RNFL thickness corresponding to the preserved perimetric hemifields were measured by OCT3000 and scanning laser ophthalmoscopy (SLO). The RNFL thickness in the superior and inferior 30 degrees sectors, the maximum and average RNFL thickness in the superior (S(max) and S(avg)), and inferior quadrants (I(max) and I(avg)) were analyzed.The S(max), S(avg), I(max), I(avg), and the RNFL thickness in the superior (p < 0.05), superotemporal and inferotemporal sectors (p < 0.01) in the glaucoma patients without a nerve fiber layer defect (SLO) were significantly thinner than in the control subjects in same age. OCT3000 measurements showed that the RNFL thickness in glaucomatous eyes with normal perimetric visual fields and SLO was significantly thinner than the RNFL thickness in normal eyes.     

Retinal nerve fiber layer thickness in the fellow eyes of normal-tension glaucoma patients with unilateral visual field defect

PURPOSE: To quantitatively evaluate retinal nerve fiber layer (RNFL) thickness in the fellow eyes of normal-tension glaucoma (NTG) patients with unilateral visual field defect. DESIGN: Observational case-control study. METHODS: Twenty-nine NTG patients with unilateral visual field defect were enrolled in this study. All 29 fellow eyes showed normal visual field. Thirty-one normal eyes of 31 subjects served as controls. The RNFL thickness around the optic disk was determined using Fast RNFL thickness (3.4) of optical coherence tomography. Average and segmental (4 quadrants and 12 clock- hours) RNFL thickness measurements were compared among the three groups. RESULTS: RNFL thicknesses were significantly different among the three groups in the average, superior quadrant (11 and 12 clock-hour segments), and inferior quadrant (6 clock-hour segment) (P = .00, one-way ANOVA and Tukey's tests). CONCLUSIONS: RNFL thickness reductions are already present in the fellow eyes of NTG patients with unilateral visual field defect.     

光学相干断层成像术测量视网膜神经纤维层厚度对开角型青光眼早期诊断的意义

目的 评价光学相干断层成像术（ＯＣＴ）测量视网膜神经纤维层（ＲＮＦＬ）厚度在原发性开角型青光眼（ＰＯＡＧ）早期诊断中的意义。方法 正常对照组共１２０例（１６９眼）,青光眼患者９６例（１３２眼）并分为早期、进展期及晚期３组。采用ＯＣＴ进行盘周ＲＮＦＬ厚度的测量。结果 青光眼各期ＲＮＦＬ厚度均显著薄于正常对照组,其中早期ＲＮＦＬ厚度异常率为５０％。ＲＮＦＬ在青光眼诊断中的敏感性和特异性分别为７９．５４％与８０．４７％。结论 青光眼早期ＲＮＦＬ厚度已异常变薄,ＯＣＴ对ＲＮＦＬ厚度的测量为青光眼诊断提供了一项新的指标。     

频域OCT视盘形态及神经纤维层厚度参数在青光眼诊断中的作用μ

背景青光眼是一种可引起视神经结构改变,继而导致不可逆视功能损害的一类疾病。光学相干断层扫描（OCT）通过对视盘形态以及神经纤维层的检测,有助于青光眼的早期诊断。目的探讨频域OCT视盘形态及神经纤维层厚度各参数在青光眼诊断中的作用。方法非干预性、横断面研究。应用频域RTVue OCT测量62例正常人和67例青光眼患者的视盘参数,以及视网膜各区域的神经纤维层厚度。用受试者工作特性曲线下面积（ROC）评价OCT每个检测参数区分正常眼与青光眼的能力大小。结果各型青光眼组患者的年龄明显大于正常组,各型青光眼组视野平均缺损（MD）和视野模式标准化差（PSD）值均明显大于正常组,差异均有统计学意义（P〈0．01）。正常组、青光眼组、开角型青光眼组和闭角型青光眼组间视盘面积的总体差异均无统计学意义（P=0．101、0．741、0．652）;正常人平均视网膜神经纤维层厚度为（109．758±9．095）μm,青光眼患者为（79．539±18．986）μm,明显低于正常人（P〈0．01）。在视盘周围8个神经纤维层区域中,正常人最厚的区域在颞下方和颞上方,分别为（150．109±18．007）μm和（146．105±15．529）μm,而青光眼患者最厚处在颞上方和颞下方,分别为（104．354±27．641）μm和（102．436±32．243）μm,但均较正常参数减小。正常人和青光眼患者鼻侧和颞侧视网膜神经纤维层厚度均较薄。视盘参数中,各型青光眼诊断效能最高的是盘沿容积和垂直杯盘比,二者的ROC值在总青光眼患者中分别为0．850和0．840,其特异性在80％时的敏感性分别为73．1％和76．1％,在开角型青光眼患者中分别为0．841和0．849,其特异性在80％时的敏感性分别为73．0％和81．1％,在闭角型青光眼患者中分别为0．862和0．830,其特异性在80％时的敏感性分别为73．3％和70．O％。视网膜神经纤维层厚度各参数中,诊断效能最高的是平均神经纤维层厚度,其ROC值在总青光眼、开角型青光眼、闭角型青光眼中分别为0．925、0．910和0．942,其特异性在80％时的敏感性分别为89．6％、89．2％和90．0％。视盘周围8个神经纤维层区域中,诊断效能最高的是IT区域,诊断效能最低的是TU和TL区域。结论RTVueOCT具有很好地区别正常人和青光眼患者的能力,在青光眼诊断方面是一个较实用的工具。