原发性闭角型青光眼视野损害的特点

目的 探讨原发性闭角型青光眼(PACG)与原发性开角型青光眼(POAG)及慢性PACG与急性PACG的视野损害特点.方法 系列病例研究.应用Humphrey Ⅱ型(750)视野分析仪的中心30-2程序进行静态阈值视野检查,采用国际地域性和流行病学眼科学组(ISGEO)的分类系统,选取早期青光眼干预性研究(AGIS)评分在1～11分之间的早中期青光眼患者纳入本研究对象.其中慢性PACG组患者53例,急性PACG组患者42例,POAG组患者42例.根据患者视野检查结果,分析各类青光眼患者的视野损害特点.采用SAS 9.1统计学软件进行数据分析.其中组间视野平均缺损值、模式标准差值、鼻侧视野和全视野AGIS计分比较采用2×3析因设计定量资料的方差分析,上、下半侧视野AGIS计分比较采用具有一个重复测量的三因素设计定量资料的方差分析,各组间中央视野受累率、早期鼻侧视野受累率及视野受累最重象限之间的差异采用X2检验.以P<0.05作为差异有统计学意义.结果 (1)与POAG组比较,慢性PACG组(t=4.24,P=0.0000)和急性PACG组(t=3.28,P=0.0013)患者下半侧视野AGIS分值均较高;慢性PACG组(t=1.35,P=0.1808)和急性PACG组(t=0.55,P=0.5824)患者各组内上、下半侧视野计分比较,差异均无统计学意义;POAG组上半侧视野AGIS计分大于下半侧视野AGIS计分,差异有统计学意义(t=6.52,P=0.0000);慢性PACG组模式标准差值明显高于急性PACG组,差异有统计学意义(P<0.05).(2)组间青光眼患者中央10°视野的受累率差异有统计学意义(X2=10.385,P=0.006),POAG组患者中央视野最易受累,而慢性PACG组患者最不易受累.(3)各组青光眼患者早期鼻侧视野普遍受累(X2=2.518,P=0.641),受累最重象限比较,差异无统计学意义(X2=1.573,P=0.954).结论 PACG与POAG组患者比较,其上、下方半侧视野损害无明显差别;急性PACG组与慢性PACG组患者相比,急性PACG组患者上、下方半侧视野损害更弥散,中心视野受累更明显.(中华眼科杂志,2009,45:14-20)

Charactistics of visual field defects in primary angle-closure glaucoma

Objective To determine the difference of visual field defects between acute angle-closure glaucoma (AACG) and chronic angle-closure glaucoma (CACG) and to analyze the difference in the changes of visual field between primary angle-closure glaucoma (PACG) and primary open angle glaucoma (POAG). Methods This retrospective case series study consisted of 53 patients with CACG,42 with AACG, and 42 with POAG. Visual field tests were examined using the 30-2 threshold program of the Humphrey Visual Field Analyzer. All cases with eligible visual fields were scored from 1 to 11 with the modified criterion used by Advanced Glaneoma Intervention Study (AGIS seures, mild groups: 1-5 and moderate groups: 6-11). An upper hemifields, lower hemifields, nasal area and overall field, mean defect (MD) and pattern standard deviation (PSD) were calculated and compared among the three glaucoma groups. The differenee in central 10°(12 points) of visual field damage, the nasal area, and the most defect quadrant of static visual field in each groups were evaluated. All analyses were performed with SAS 9.1 software. The factor analysis was used to analyze significant differences in mean defect (MD), pattern standard deviation (PSD), VF scores of nasal area and overal field among the three glaucoma groups. Analysis of variance were assessed differences between VF scores of the superior hemifield and the inferior hemifield. The differences in central 10° of visual field damage,the nasal area and the most defect quadrant of static visual field in each groups were examined using a chi-square test. P<0.05 were considered to be statistically significant. Results (1) VF scores with inferior hemifieid in POAG were lower than in CACG (t=4.24, P=0.0000) and in AACC(t=3.28, P=0.0013); There were no significant differences of VF seores between the superior hemifieid and the inferior hemifield in CACG (t=1.35, P=0.1808) and AACG (t=0.55, P=0.5824). There was found a significant differences of VF scores between the superior hemifield and the inferior hemifield in POAG(t=6.52, P=0.0000). The CACG cases had a significantly greater amount of PSD than acute angle-closure glaucoma (P<0.05 ). (2) There was found a significant differences in the number of patients with central visual field damage among the three glaucoma groups(X2=10.385,P=0.006). The POAG cases had the greatest rate of central visual field damage (52.38%), followed by acute angle-closure glaucoma (47.62%), the central visual field of CACG is the least suffered (22.64%). (3)The nasal area was the most commonly involved area in the early stage of glaucoma. There were no significant differences among three groups (X2=2.518,P=0.641). There were no different distribution in the most defect quadraut of static visual field in different types of glaucoma(X2=1.573,P= 0.954). Conclusions Using AGIS scores, AACG had more diffused visual field damage than CACG and had more severe defect of the central visual field, while the damage of superior and the inferior hemifield in PACG are similar to POAG. (Chin J Ophthalmol, 2009,45:14-20)