视盘毛细血管瘤

目的探讨视盘毛细血管瘤的临床特征及其光凝治疗。方法回顾性分析我院确诊的13例14眼视盘毛细血管瘤的临床资料，其中5例6眼接受了激光光凝治疗。光凝方法是应用’YAG倍频、氩绿、氪黄绿激光直接密集光凝血管瘤体及其边缘，以出现灰色或灰白色反应为准，原则上采取长时间、低能量多次光凝。开始时每周一次，2～3次后，依据眼底及眼底荧光血管造影情况随时追加光凝，直至瘤体萎缩、渗漏停止。合并视网膜毛细血管瘤者，同时光凝。结果13例14眼中7例合并有视网膜毛细血管瘤，2例有家族史，1例属Von Hippel—Lindau病。在6～54个月的随访中，12眼瘤体周围视网膜出现了不同程度的水肿及渗出，4眼继发了视网膜脱离，5眼视力在0．02及以下。2眼失明。其中接受光凝治疗的5例6眼中，2例3眼因故中途终止治疗；3例3眼坚持治疗者，最终血管瘤萎缩，渗漏停止，但视力均显著下降，1眼瘤体位于视盘鼻侧者视力稳定在0．3，另2眼瘤体位于偏颞侧者，视力分别为0．02和CF／5cm，随访(48～54)个月没有变化。结论视盘毛细血管瘤是先天性疾病，其发病年龄多在10～40岁，属Von Hipple病一部分，呈慢性进展，预后极差，积极治疗很有必要。激光光凝疗效确切，但光凝时机及参数有待进一步探讨。     

视盘毛细血管瘤的临床表现及荧光素眼底血管造影特征

目的 观察视盘毛细血管瘤的临床表现及其荧光素眼底血管造影(FFA)的特征.方法 回顾性系列病例研究.分析9例(10眼)视盘毛细血管瘤的临床资料,包括眼底彩照及FFA.平均年龄(26.8±9.7)岁,4例(4眼)合并周边部视网膜毛细血管瘤,6例符合Von Hippel-Lindau病的临床诊断.结果 内生型8例(8眼),外生型1例(2眼).5眼瘤体位于视盘颢上、颢下或颢侧,3眼瘤体位于视盘中央并覆盖视盘表面.8例(9眼)行FFA检查者的FFA图像中,5眼呈现"冲刷"现象.结论 视盘毛细血管瘤多位于视盘颞侧或中央,瘤体周围伴有明显的视网膜水肿、渗出.内生型是常见的临床类型.FFA是重要的诊断和罄别诊断方法.     

视网膜血管瘤分期及治疗效果观察

目的观察不同临床分期的视网膜血管瘤采用激光光凝、冷冻、玻璃体视网膜手术以及瘤体切除等方法治疗的临床效果，探讨玻璃体视网膜手术治疗的适应证 。方法回顾分析22例视网膜血管瘤33只患眼治疗前后的临床资料。治疗前按照视网膜血管瘤有无明显扩张供养血管、周围渗出、局限性视网膜脱离、广泛视网膜脱离至晚期并发症的过程,将本病分为5期。其中13只患眼主要采用单纯激光光凝治疗；5只 患眼主要采用冷冻联合激光光凝治疗；11只眼患眼采用玻璃体视网膜手术治疗，其中3只眼同时进行了视网膜血管瘤瘤体切除治疗。治疗后平均随访时间46个月，对比分析患者治疗前 后视力、视网膜血管瘤以及视网膜等情况。结果单纯激光光凝治疗的1 3只眼视网膜血管瘤均退行萎缩，视网膜平伏，视力提高2只眼，不变11只眼；冷冻联合激光光凝治疗的5只眼中，4只眼视网膜血管瘤退行萎缩，未见血管瘤复发，1只眼出现玻璃体视 网膜增生及玻璃体积血需进一步采用玻璃体视网膜手术治疗，视力提高2只眼，不变2只眼，下降1只眼；玻璃体视网膜手术治疗的11只眼中，1只眼出现新的血管瘤，2只眼血管瘤引起 渗出性视网膜脱离，2只眼再次出现玻璃体视网膜增生，8只眼视网膜平伏，视力提高3只眼，不变3只眼，下降5只眼。同时进行视网膜血管瘤瘤体切除治疗的3只眼中均未见血管瘤复发，2只眼视网膜平伏，1只眼出现渗出性视网膜脱离，视力提高2只眼，下降1只眼。结论单纯激光光凝或联合冷冻治疗对早期视网膜血管瘤患者有效；对伴有玻璃体积血、视网膜前膜形成、增生明显、视网膜脱离范围大的晚期视网膜血管瘤病变宜采用玻璃体视网膜手术治疗，视网膜血管瘤瘤体切除可有选择性应用，其远期效果仍有待观察。  （中华眼底病杂志，2008，24：107-110）     

放射状视神经切开术治疗视网膜中央静脉阻塞

目的观察放射状视神经切开术（RON）治疗视网膜中央静脉阻塞（CRVO）的临床疗效。方法回顾分析12例CRVO患者RON治疗的临床资料。所有患者均进行常规视力和眼底检查、眼底照相和荧光素眼底血管造影（FFA）、光相干断层扫描（OCT）检查。12只患眼视力均在0.1以下，伴有严重出血、视网膜水肿。手术时用显微玻璃体视网膜刀（MVR）或CRVO切开刀（CRVO knife）刺入视盘鼻侧，切口深达筛板及筛板后且于筛板区鼻侧切开。手术后随访观察2~15个月，平均随访时间为6.5个月。对比观察手术眼视力、视野及眼底改变情况。结果12只患眼的RON手术均获成功。9只眼视力有不同程度提高，占75%，6只眼手术后视力大于或等于0.1，占50%。眼底检查、眼底照相和FFA、OCT检查显示视网膜水肿、出血逐渐消失，静脉怒张、纡曲明显好转；视网膜浆液性脱离减轻或消失；黄斑囊样水肿消退，3只眼黄斑中心凹恢复。3只眼手术中视神经出血，晚期4只眼视神经切开部位萎缩。结论视盘鼻侧边缘的RON安全可行，可以改善CRVO患眼的视力，缓解视网膜出血和水肿。(中华眼底病杂志,2005,21:10-12)     

经瞳孔温热疗法治疗眼内肿瘤疗效观察

目的 观察经瞳孔温热疗法(transpupillary thermotherapy, TTT)治疗眼内肿瘤的临床效果。 方法 对50例临床诊断为眼内肿瘤的患者(脉络膜血管瘤37例，视网膜血管瘤2例，脉络膜骨瘤5例，脉络膜黑色素瘤4例，视网膜母细胞瘤2例)行TTT治疗及1～20个月随访观察。 结果 脉络膜血管瘤30例复诊，平均随访5.1个月。其中29例瘤体萎缩，色素沉着，视网膜脱离及视网膜下液部分或全部复位、吸收，占复诊患者的96.7%；1例无效，占3.3%。视力不变者24例，占80.0%；增进者4例，占13.3%；下降者2例，占6.7%。视网膜血管瘤2例均无效。脉络膜 骨瘤4例5只眼复诊，平均随访6个月。1只眼瘤体无变化，其余4只眼瘤体均萎缩，视力不变者3只眼；增进及下降各1只眼。脉络膜黑色素瘤4例复诊，平均随访8个月。瘤体缩小1例，不变2例，增大1例。视力不变及下降各2例。视网膜母细胞瘤2例瘤体均有不同程度萎缩，1例小儿随访20个月，无法行视力检查，另1例随访3个月视力不变。所有患者治疗及随访期间未发现严重并发症。 结论 除视网膜血管瘤外，TTT对部分眼内肿瘤临床疗效肯定，副作用少，是一种很有潜力的眼内肿瘤治疗方法。 （中华眼底病杂志，2003，19：144-148）     

经瞳孔温热疗法治疗三种眼底良性肿瘤

目的 观察经瞳孔温热疗法（TTT）治疗三种眼内良性肿瘤的疗效。 方法 通过最佳矫正视力、眼压、视野、眼前节和眼底检查以及彩色眼底照相、荧光素钠和吲哚青绿血管造影、B型超声、光相干断层扫描（OCT）、CT等检查确诊的眼内良性肿瘤患者17例20只眼。男12例，女5例，右眼8只，左眼12只。其中，视盘血管瘤3例3只眼，平均视力为0.17，2只眼曾行手术放液;脉络膜血管瘤9例9只眼，平均视力为0.39，其中4例为首诊病例，5只眼曾做过激光光凝治疗，肿瘤未全平复，尚有浆液性视网膜脱离;脉络膜骨瘤5例8只眼，平均视力为0.20，其中3只眼合并黄斑出血。TTT用810 nm半导体红外激光，光斑3.0 mm，按肿物大小连接照射1～5个光斑。功率360～1200 mW，时间60～80 s。1～3次为1疗程，2次治疗之间间隔时间1个月;需要时再作1疗程治疗。治疗后定期随访观察，时间为3～36个月，平均随访时间14.5个月。 结果 随访结束时平均视力，视盘血管瘤患者为0.27，脉络膜血管瘤患者为0.46，脉络膜骨瘤患者为0.31。视盘血管瘤3只眼瘤体的红色部位缩小，表面纡曲扩张的血管变平直，视盘周围出现脉络膜萎缩弧，视网膜下浆液性渗出消失。脉络膜血管瘤9只眼瘤体透红光区消失，视网膜下积液消退，治疗区色素增生。脉络膜骨瘤8只眼中视网膜下积液吸收，肿瘤颜色由黄红变为黄白，并出现色素和薄的瘢痕，合并黄斑出血者出血消失。所有患眼治疗后未出现严重并发征。 结论 TTT治疗视盘血管瘤、脉络膜血管瘤和脉络膜骨瘤，无论首次接受治疗或补充以前治疗均获一定效果。 (中华眼底病杂志, 2006, 22:181-184)     

鼻咽癌放疗后放射性视网膜病变的临床分析

为探讨放射性视网膜病变 ( Radiation Retinopathy,RR)的临床表现及光凝治疗的效果 ,对鼻咽癌外照射后发生的 13例 ( 2 6只眼 ) RR患者的临床表现、彩色眼底照相、眼底萤光血管造影 ( Fundus Fluorescein Angiography,FFA)和氩激光光凝治疗黄斑水肿 3眼进行回顾性分析。结果 :13例 RR患者 2 6只眼 ( 10 0 % )眼底改变为黄斑部毛细血管扩张和 /或微血管瘤 ,另外单独或同时伴视盘颜色变淡 11只眼 ,水肿、出血 6只眼 ;视网膜出血 2 2只眼 ,广泛性视网膜小血管闭塞 7只眼 ;黄斑水肿 11只眼 ,深层出血 1只眼。81% ( 2 1/ 2 6) RR患眼视力下降。光凝治疗后 6个月 10 0 % ( 3 / 3 )患眼视力提高及黄斑水肿消退。结论 :RR最早期和最常见表现为黄斑部毛细血管扩张和 /或微血管瘤。RR患者视力下降是由于黄斑部水肿、黄斑部毛细血管闭塞、视盘缺血等原因所致。氩激光光凝可有助于放射性黄斑水肿消退 ,视力提高而获得满意的疗效     

近视盘视网膜毛细血管瘤的临床特点及随访观察

目的:观察近视盘视网膜毛细血管瘤（RCH）的临床特征及治疗随访效果。方法:回顾性病例系列研究。2007年1月至2019年12月于北京协和医院眼科检查确诊且随访时间>12个月的近视盘RCH(JRCH）患者14例15只眼纳入研究。患者中,男性7例7只眼,女性7例8只眼;平均年龄（29.8±12.7）岁。孤立型JRCH 6例...     

倍频532激光治疗视盘新生血管型糖尿病视网膜病变观察

目的探讨倍频532激光治疗视盘新生血管型糖尿病视网膜病变（DR）的疗效。方法对67例（109只眼）视盘新生血管型DR患者行超全视网膜光凝。激光治疗后1、3、6、12个月行荧光素眼底血管造影（FFA）检查,新生血管未消退者追加光凝。随访24～36个月（平均32.8个月）。结果光凝术后视力提高者19只眼（17.43%）,视力不变者63只眼（57.80%）,视力下降者27只眼（24.77%）。经一次或多次追加光凝,最终71只眼（65.14%）新生血管消退,14只眼（12.84%）新生血管变细变少,24只眼（22.02%）新生血管无变化或加重。激光治疗量为2650（1600～5450）点。结论倍频532激光治疗视盘新生血管型DR安全有效。     

光动力疗法与经瞳孔温热疗法治疗孤立型脉络膜血管瘤的疗效观察

目的 观察经瞳孔温热疗法(TTT)和光动力疗法(PDT)治疗孤立型脉络膜血管瘤(CCH)的疗效.方法 回顾性分析经眼底检查、荧光素眼底血管造影(FFA)、吲噪青绿血管造影(ICGA)、光相干断层扫描(OCT)、眼部B型超声检查确诊为CCH的患者32例33只眼的临床资料.所选病例治疗前最佳矫正视力为指数/眼前～0.2,瘤体大小2～10个视盘直径(DD),均有浆液性视网膜脱离.其中21例22只眼CCH位于除乳斑柬及黄斑拱环内区域外的后极部采用经瞳孔温热疗法(TTT)治疗.使用Iris 810 nm半导体红外激光,能量700～1200 mw,时间60 S,光斑1～3个不等;11例11只眼CCH位于乳斑束及黄斑拱环以内区域的PDT治疗.经静脉注射维速达尔15 min后采用689 nm波长半导体激光对病灶进行照射83～123 s.随访时间12～48个月,平均随访时间为25.6个月.治疗后复查视力、间接检眼镜、彩色眼底照像、FFA、ICGA、OCT和B型超声波检查,观察其疗效.结果 TTT治疗22只眼中,15只眼视力提高,7只眼视力稳定,眼底检查见视网膜平复,瘤体呈灰白色机化瘢痕,造影显示病灶无荧光渗漏,晚期机化瘢痕处呈荧光染色.OCT检查显示22只眼视网膜神经上皮脱离消失,视网膜下积液完全吸收,其瘤体部脉络膜光带反射增强,瘢痕形成;B型超声检查显示22只眼无视网膜脱离,瘤体萎缩.PDT治疗11只跟中9只眼视力提高,2只眼视力稳定,眼底检查见瘤体萎缩,色素沉着,造影显示荧光渗漏消失;OCT显示视网膜下液完全吸收,B型超声检查11只眼瘤体萎缩.结论 TTT与PDT治疗CCH有效但适用部位有所不同.两种方法均可使瘤体萎缩,稳定或提高患者的视力.     

Transpupillary thermotherapy in the management of juxtapapillary and parafoveal circumscribed choroidal hemangioma

BACKGROUND: Circumscribed choroidal hemangioma (CCH) is a rare, vascular tumor that may be associated with formation of subretinal fluid, cystic retinal de-generation, and serous retinal detachment. Studies have suggested that proximity of this tumor to the fovea or optic nerve precludes the use of trans-pupillary thermotherapy (TTT) for treatment. We report our experience using TTT in managing patients with juxtapapillary and parafoveal CCH. METHODS: We reviewed the records of consecutive patients with CCH treated by TTT at Princess Margaret Hospital, Toronto, between November 1999 and March 2003. This resulted in 11 eyes of 11 patients with juxtapapillary or parafoveal tumors. Treatment was delivered via slit lamp using an 810 nm diode laser with 350 to 800 mW, a 3.0 mm spot, and duration range from 5 s to 90 s. Outcome measures were reduction in tumor thickness, resolution of serous fluid, tumor control, visual acuity, and complications of treatment. RESULTS: Mean age of patients was 47.6 years. Symptoms included blurred vision, metamorphopsia, light flashes, and floaters. Macular and optic disk edema, field defect, presence of subretinal fluid, and retinal detachment were noted. At presentation, Snellen visual acuity ranged from 20/70 to hand motions. Mean tumor base diameter was 6.0 mm and tumor thickness at baseline was 3.0 mm. Mean follow-up was 18.0 months. Post-TTT, mean tumor thickness was 2.8 mm. Macular and optic disk edema resolved in the majority of patients. Partial regression of the tumor was noted in 4 cases (36%) and good tumor control in 9 cases (82%). Visual acuity improved in 6 patients (55%). INTERPRETATION: TTT can be effective for treating juxtapapillary and para-foveal CCH. Proximity to the fovea and optic nerve may not be predictive of poor post-treatment visual acuity, although statistical analysis with a larger sample size would more clearly demonstrate a clear advantage.     

Evolution of a juxtapapillary von Hippel-Lindau tumour examined by optical coherence tomography

Purpose: The aim was to report the evolution of a case of von Hippel–Lindau (VHL) juxtapapillary retinal capillary haemangioblastoma (RCH) by optical coherence tomography (OCT3). Case report: The progress of a 24‐year‐old man suffering from VHL disease with a juxtapapillary haemangioblastoma and a small peripheral lesion was followed for 26.4 months with fundus photographs and OCT of the optic nerve head using the optic nerve head rim volume, ranging from 1.106 to 1.895 mm³. Visual acuity remained 6/6 throughout. Conclusions: OCT can be a useful tool in the follow up and decision‐making of patients with small retinal capillary haemangioblastoma of the optic nerve.     

脉络膜血管瘤误诊病例的临床病理学分析

目的探讨因临床误诊而行眼球摘除的脉络膜血管瘤的临床和病理特征。方法对本院病理科从1978年至1997年间收检的7例病理检查证实为脉络膜血管瘤但临床误诊的眼球标本及其临床资料进行分析。结果手术前7例中1例被误诊为继发性青光眼绝对期，6例被误诊为脉络膜黑色素瘤。这些病例的临床表现大部分为视力进行性减退，眼底视盘旁扁平隆起的肿物，伴广泛渗出性视网膜脱离。病理证实均为脉络膜海绵状血管瘤，一般呈扁平圆盘状，表面有小灶状或条块状色素沉着斑。结论后极部脉络膜扁平形肿物是本组脉络 膜血管瘤患者的临床病理学特征，应注意与脉络膜黑色素瘤鉴别。(中华眼底病杂志,1999,15:91-93)     

应用共焦扫描激光多普勒视网膜血流分析仪检测视网膜脱离术后患者眼底血流参数

目的 探讨视网膜脱离（retinal detachment,RD）手术对患者视网膜和视乳头血流的影响。方法 应用共焦扫描激光多普勒视网膜血流分析仪（heidelberg retina flowmeter,HRF)检测62例（62只眼)单眼孔源性RD术后患者的视网膜和视乳头血流参数。其中34只眼采用玻璃体视网膜（vitreoretinal,VR)手术,28只眼采用常规巩膜扣带（scleral bucking,SB)术,手术方式包括巩膜环扎术、巩膜外冷冻术、晶状体或玻璃体切除术、眼内激光光凝术,术中应用全氟萘烷液体、长效气体及硅油填充等。结果 RD组与对照组比较,眼底血流量、血流速及红细胞移动速率均降低,颞侧视乳头盘沿及鼻侧视乳头盘沿的红细胞移动速率差异均有显著意义（P＜0．05）;视乳头大血管血流量、血流速及红细胞移动速率,颞侧、鼻侧视乳头盘沿的血流量及血流速,颞侧、鼻侧视乳头旁视网膜血流量相比较,差异均有非常显著意义（P＜0．01）。VR术组与SB术组比较,其血流量、血流速及红细胞移动速率均明显降低;颞侧、鼻侧视乳头盘沿,鼻侧视乳头旁视网膜的红细胞移动速率,颞侧视乳头旁视网膜的血流速比较,差异均有显著意义（P＜0．05）。硅油填充组与未填充组比较,其眼底血流量、血流速及红细胞移动速率均降低;其中鼻侧视乳头盘沿及鼻侧视乳头旁视网膜血流量比较,差异均有显著意义（P＜0．05）;颞侧视乳头盘沿血流量及红细胞移动速率、摄侧视乳头旁视网膜的血流量比较,差异均有非常显著意义（P＜0．01）。结论 VR术组与SB术组患者的视网膜和视乳头血流量、血流速、红细胞移动速率均受RD手术的影响,VR术组较SB术组明显,术中硅油填充亦影响患者的眼底血流量及红细胞移动速率。     

Photodynamic therapy for retinal capillary hemangioma

Purpose

To describe the results of photodynamic therapy (PDT) for juxtapapillary and peripheral retinal capillary hemangioma (RCH).

Patients and methods

Interventional case series of four eyes (four patients) with juxtapapillary RCH and one eye (one patient) with peripheral RCH. Two eyes with juxtapapillary RCH had received two sessions of full-fluence, double-duration PDT; whereas other two eyes had received single session of half-fluence, single-duration PDT. The peripheral RCH was treated with a single session of full-fluence, single-duration PDT.

Results

Two patients had von Hippel–Lindau disease. Follow-up duration ranged from 4 months to 1 year. Pre-PDT visual acuity (VA) ranged from 20/200 to HM (juxtapapillary RCH) and 20/100 (peripheral RCH). Among the eyes with juxtapapillary RCH, tumor regression with partial resolution of macular edema was noted in two eyes (one eye each with half-fluence and full-fluence PDT), whereas two eyes had no change in tumor size with persistent macular edema. VA remained stable in three eyes and declined in one eye. In an eye with peripheral RCH, regression of tumor and macular edema with VA improvement was noted. Post-PDT complications included epiretinal membrane (one eye) and transient exudative retinal detachment (one eye).

Conclusion

PDT can be effective in reducing macular edema associated with RCH but this does not always correspond with an improvement in VA especially for juxtapapillary tumors.     

Juxtapapillary hemangioma: a case report and review of clinical features and management of von Hippel-Lindau disease.

BACKGROUND: The phakomatose von Hipple-Lindau (VHL) disease is a multisystem disorder characterized by hemangioblastomas of the central nervous system (CNS), retinal angiomas, and multiple cysts and tumors of the viscera. Retinal capillary hemangiomas are the most common manifestation of VHL disease, which can occur in the optic nerve, where it may simulate disc edema, or in the retinal periphery, which is characterized by massive retinal exudation. Both locations can result in progressive accumulation of exudates leading to a decrease in visual acuity and potentially to a serous retinal detachment. CASE REPORT: A juxtapapillary hemangioma was observed in a 72-year-old man who presented for a routine examination. The patient was asymptomatic, despite the presence of a trace afferent papillary defect. This finding had to be carefully differentiated from sectoral disc edema. Blood tests, computed tomography (CT), and magnetic resonance imaging (MRI) all had normal results. Fluorescein angiography was a valuable secondary test showing early filling of the vascular network overlying the nerve head and characteristic late hyperfluorescence. CONCLUSIONS: There are 2 distinct forms of capillary hemangiomas--the juxtapapillary tumor or the peripheral capillary hemangioma. Although both types are similar histologically, they do vary in their appearance, differential diagnosis, and treatment. In both types, fluorescein angiography is an extremely helpful ancillary test in making the initial diagnosis. This case report reviews the ocular manifestations and systemic findings associated with VHL disease.     

Benefits and complications of photodynamic therapy of papillary capillary hemangiomas

OBJECTIVE: To evaluate the potential benefit and risks of photodynamic therapy (PDT) in the treatment of papillary capillary hemangioma. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Five patients with solitary capillary hemangioma on the temporal portion of the optic nerve presenting with exudative decompensation and decrease in visual acuity (VA). METHODS: All eyes received a standardized PDT treatment with 6 mg/kg body surface area verteporfin and application of 100 J/cm(2) light at 692 nm. One to three PDT courses were performed until resolution of exudation was achieved. A continuous follow-up was provided with documentation 1 week before and at 4 to 6 weeks, 3 months, and 12 months after the last treatment application. MAIN OUTCOME MEASURES: Functional parameters included best-refracted VA (Early Treatment Diabetic Retinopathy Study), and central scanning laser ophthalmoscope (SLO) scotometry and peripheral (automated perimetry) visual fields; anatomic parameters were presence of retinal edema or serous detachment (ophthalmoscopy) and tumor size (ultrasonography). RESULTS: Pretreatment VA levels ranged from 20/40 to 20/800; posttreatment levels ranged from 20/64 to 20/2000. Tumor regression with resolution of macular exudate and serous retinal detachment was obtained in all eyes. A decline in VA of 1, 3, and 10 lines, respectively, was documented in three patients. Complications included transient decompensation of vascular permeability, occlusion of retinal vessels, and ischemia of the optic nerve. CONCLUSIONS: PDT is successful in reducing tumor size and exudative activity. Vaso-occlusive effects at the level of the retina and optic nerve compromise the functional benefit. Parameters proven safe in choroidal neovascularization may be inappropriate in retinal capillary lesions of the optic nerve.     

原发性开角型青光眼视盘及视网膜血流的研究

目的探讨原发性开角型青光眼患者和正常人视盘及其周边视网膜血液供应是否存在差异.方法本研究采用了一种新型共焦扫描激光多普勒血流仪--海德堡视网膜血流仪(heidelberg retina     

Visual field defect and perfusion of the juxtapapillary retina and the neuroretinal rim area in primary open-angle glaucoma

• Background: At this time little information is available about the relationship between glaucomatous visual field defects and impaired blood flow in the optic nerve head. The purpose of this study was to examine blood flow of the juxtapapillary retina and the rim area of the optic nerve head in primary open-angle glaucoma with a borderline visual defect. • Methods: Juxtapapillary retinal and neuroretinal rim area blood flow was measured by scanning laser Doppler flowmetry (SLDF). The visual field was evaluated by static perimetry (Octopus-G1). The optic nerve head was assessed on 15° color stereo photographs. We examined 116 eyes of 91 patients with POAG with controlled IOP and 66 eyes of 44 healthy individuals. The POAG group was divided into eyes with a mean defect lower than 2 dB (POAG group I) and in eyes with a mean defect equal to or greater than 2 dB (POAG group II). The mean age of POAG group I and POAG group II was 55±11 years and 57±10 years, respectively. The mean age of the control group was 45±15 years. The eyes of POAG group I had an average C/D ratio of 0.71±0.18 with an average mean defect of the visual field of 0.97±0.68 dB; the eyes of POAG group II had an average C/D ratio of 0.80±0.17 with an average mean defect of the visual field of 8.2±6.0 dB. The intraocular pressure on the day of measurement in POAG group I was 18.2±3.7 mmHg, in POAG group II 17.6±4.0 mmHg, and in the control group 15.1±2.5 mmHg. For statistical analysis, age-matched groups of 32 normal eyes of 32 subjects (mean age 52±10 years) were compared to 18 glaucomatous eyes of 18 patients (POAG group I, mean age 55±11 years) and 59 glaucomatous eyes of 59 patients (POAG group II, mean age 55±10 years). • Results: In the eyes of POAG group I and POAG group II, both juxtapapillary retinal blood flow and neuroretinal rim area blood flow were significantly decreased compared to an age-matched control group: neuroretinal rim area “flow” POAG group I −65%, POAG group II −66%; juxtapapillary retina “flow” POAG group I −52%, POAG group II −44%. All eyes of the POAG group I (MD<2 dB) and 56 of 61 eyes of the POAG group II (MD>=2 dB) showed a retinal perfusion lower than the 90% percentile of normal blood flow. We found no correlation between reduction of juxtapapillary or papillary blood flow and mean defect in POAG eyes. • Conclusion: Glaucomatous eyes with no defects or borderline visual field defects as well as glaucomatous eyes in an advanced disease stage show significantly decreased optic nerve head and juxtapapillary retinal capillary blood flow. Received: 2 December 1996 Revised version received: 7 February 1997 Accepted: 27 March 1997