蓝黄视野与自动视野检查法联合光学相干断层成像在原发性开角型青光眼诊断中的应用

目的 探讨蓝黄视野检查法(Blue on Yellow Perimetry,BYP)、自动视野检查法(stmdard Automatic Perimetry,SAP)和光学相干断层成像(Optical Coherence Tonometry,OCT)在原发性开角型青光眼诊断中的应用.方法 POAG患者42例66只眼,24例双眼、18例单眼,男性30例48只眼,女性12例18只眼,左32只眼、右36只眼,年龄为19～69岁,平均(38.06±14.86)岁.应用HUMPHERY750Ⅱ-i电脑自动视野计的Sita-Standard检测程序进行SAP检查和蓝黄视野检测程序来进行BYP检查,应用STRATUSOCTTM型OCT检查视网膜神经纤维层(RNFL)平均厚度.结果 SAP、BYP和OCT三种检测方法的阳性率分别为75.00%、93.75%和84.37%,三者总体的差异比较无统计学意义(P=0.118).POAG早期SAP和BYP的平均缺损(MD)值与OCT检测的RNFL平均厚度均存在相关关系.进展期和晚期,SAP和BYP的MD值与RNFL平均厚度则均存在相关关系和线性回归关系.进展期和晚期,BYP的MD值与RNFL平均厚度的决定系数均高于SAP.早期、进展期和晚期SAP和BYP的PSD与RNFL平均厚度均不存在相关.结论 BYP比SAP更能进一步反映POAG视野和视功能的损害程度.BYP、SAP和OCT联合应用可提高POAG早期诊断的敏感性.     

蓝黄视野与标准静态视野在原发性开角型青光眼诊断中的应用观察

目的探讨蓝黄视野和标准静态视野检测在原发性开角型青光眼诊断中的应用价值。方法分别采用OCTOPUS101全自动电脑视野分析仪中蓝黄视野和标准静态视野的G2测试程序对正常组25例(36只眼)、早期23例(35只眼)、中期13例(24只眼)和晚期14例(23只眼)青光眼患者进行蓝/黄及白/白光视野检测,将中心30°视野内视网膜光敏感度均值(MS)和缺损(MD)进行比较和分析,并对两种视野检测正常组和早期青光眼组的敏感性和特异性进行分析。结果每组青光眼蓝/黄光视野平均光敏感度明显低于白/白光视野,平均缺损高于白/白光视野,有显著性差异(P<0.001);各组与正常组相比有显著性差异(P<0.05)。早期开角型青光眼组35只眼蓝/黄光视野检测阳性者30只眼,敏感性为85.7%,白/白光视野检测阳性者17只眼,敏感性为48.6%。结论在各期原发性开角型青光眼视野检测中,蓝/黄光比白/白光敏感,蓝/黄光检测出的缺损面积大而且深。在早期青光眼诊断中蓝/黄光敏感性高于白/白光。     

原发性开角型青光眼早期诊断中视网膜电图和蓝黄视野检查联合应用研究

目的:研究图形视网膜电图(pattern electroretinogram,PERG)和蓝黄视野(blue-on-yellow perimetry,B/YP)在原发性开角型青光眼(primary open angle glaucoma,POAG)早期诊断方面的临床应用价值。方法:通过对25例42眼标准自动视野检查正常的可疑开角型青光眼(SOAG)患者和25例50眼正常人PERG的P50,N95波的振幅、峰时值和B/YP的视野结果进行对比分析。结果:在SOAG患者中,PERG检查19例34眼的P50,N95波振幅下降,峰时延长,B/YP检查18例32眼视野出现异常,与正常人比较,有显著性差异(P<0.01)。结论:SOAG患者PERG和B/YP的异常结果表明其视网膜神经节细胞已经受损,两者联合应用是POAG早期诊断的有效途径。     

高通分辨视野检查法对原发性开角型青光眼的早期诊断价值

目的探讨高通分辨视野检查法对青光眼的早期诊断价值。方法参照Ｆｒｉｓéｎ所介绍的方法，利用微型计算机设计适合检测青光眼早期视野缺损的高通分辨视野检查仪。并对２２例（４４只眼）正常人、２７例（４１只眼）自动视野检查异常的原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎａｎｇｌｅｇｌａｕｃｏｍａ，ＰＯＡＧ）及１０例（１３只眼）自动视野检查正常的早期或可疑ＰＯＡＧ进行高通分辨视野测量。结果正常人的平均分辨阈值为右眼３．９６±０．５５ｄＢ，左眼３．９８±０．５５ｄＢ。高通分辨视野检查对检测青光眼视野损害的敏感性高于常规的自动视野计检查，敏感性为９３．７５％，特异性为９７．７％，青光眼早期视野损害可表现为分辨阈值升高。结论高通分辨视野检查法是检测ＰＯＡＧ早期视野损害的敏感方法之一，值得推广应用。     

蓝黄视野及黄斑阈值检测对早期青光眼诊断的研究

目的：探讨蓝黄视野及黄斑阈值检测在青光眼早期诊断中的应用价值。方法：采用HumphreyⅡ—750型自动视野计(Zeiss公司产)，对正常人60眼，早期原发性青光眼63眼进行标准视野(white—on—white Perimetry,W／W)，蓝黄视野(Blue—on—yellow Perimetry,B/Y)及黄斑阈值视野(Macular threshold Perimetry,MTP)检查，并对三种视野检查结果进行比较分析。结果：正常组与早期青光眼组两组W／W，B／Y，MTP的平均光敏感度(Mean Sensibility,MS)之间差别均具有统计学意义(P＜0．05)。在诊断早期青光眼中，MTP的敏感性最高，为83％；B／Y的敏感性次之，为65％；W／W的敏感性最低，为48％。如将B／Y与MTP联合运用时，并联试验可使敏感性提高到94％；串联试验可使特异性提高到87％。结论：在检测早期青光眼中，蓝黄视野与黄斑阈值的敏感性均高于标准视野，以黄斑阈值更为敏感；蓝黄视野及黄斑阈值检测联合应用，可提高青光眼早期诊断的敏感性与特异性，在青光眼早期诊断有应用价值。     

蓝/黄视野检查法对原发性开角型青光眼正常半侧视野的检测

目的　探讨蓝/黄视野检查法( blue-on-yellowperimetry,BYP)检测早期青光眼视野异常的能力。方法　对普通白/白视野检查法(white on-white-perimetry,WWP)检查结果仅为半侧视野异常的23例23眼原发性开角型青光眼患者进行BYP检查。结果　BYP检查的平均光敏感度、平均缺损及偏离缺失值与WWP检查的平均光敏感度、平均缺损及偏离缺失分别呈明显正相关(r 分别为0.597 0,0.787 9和0.850 7,P<0.000)。WWP检查异常的半侧视野中,BYP检查的视野缺损点数明显多于WWP检查的缺损点数(t=2.1535,P=0.018 4);WWP检查正常的半侧视野中,有52.17%(12/23)的患者出现BYP检查结果异常。结论　BYP检查法能发现WWP检查法尚不能检出的视野缺损。     

倍频视野与蓝黄视野的研究及应用新进展

视野检查是原发性开角型青光眼诊断的主要依据。传统的自动视野检查,或称白对白视野检查法,存在着检测早期青光眼视野敏感性差,检测时间长,光阈值波动大以及仅检测光敏感度等缺陷。倍频视野检查法,尤其是第二代的MatrixFDT,在不降低第一代倍频视野高敏感度的基础上改善了其检测点数少、无法检测中心30°视野的缺陷。蓝黄视野检查法,或称短波长视野检查法,通过对短波色觉通道的分离检测提高了早期诊断的敏感性,近年来通过检测程序和检测策略的改进使其更适用于检测青光眼视野损害。本文对MatrixFDT和蓝黄视野的原理、检查程序、检测策略及其在青光眼早期诊断中的应用进行综述。     

蓝/黄视野检查法对原发性开角型 青光眼的早期诊断价值

目的探讨蓝/黄视野检查法(blue-on-yellow perimetry,B/Y PM)对青光眼的早期诊断价值。 方法利用OCTOPUS 101全自动视野计G2程序分别对16例(32只眼)正常人,25例(35只眼)白/白视野检查(white-on-white perimetry,W/W PM)异常的原发性开角型青光眼(primary open-angle glaucoma,POAG),15例(15只眼)W/W视野检查正常的早期POAG及11例 (22只眼)可疑POAG进行B/Y视野检查。结果正常人、 可疑POAG、早期、中期及晚期POAG B/Y视野检查视网膜平均敏感度分别为(23．24±1．22 )dB、(20．97±3．42)dB、(18．44±3．570dB、(11．04±1．85)dB及(8 ．55±2．29)dB。B/Y 视野检查法对检测青光眼视野损害的敏感性高于常规W/W视野检查法,敏感性为92％,特异性为 90．62％。早期和中期POAG中,B/Y视野检测出视野缺损点数明显多于W/W视野检测出的缺损点数。结论B/Y视野检查 法是检测POAG早期视野损害的敏感方法之一。(中华眼底病杂志,2001,17:125-127)     

蓝黄视野在糖尿病视网膜病变早期诊断中的初步研究

目的 探讨蓝黄视野(B/YP)在糖尿病视网膜病变早期诊断中的应用价值.方法 采用瑞士Octopus101型全自动视野计分别对无糖尿病视网膜病变(NDR组)患者30例(60只眼)、糖尿病视网膜病变(DR组)患者20例(40只眼)和非糖尿病人(对照组)20例(40只眼)进行白色视野(W/WP)和B/YP检查.对各组的W/WP和B/YP检查结果分别进行两两比较.结果 白色视野中,NDR组和对照组之间MS差异有统计学意义(P＜0.05).DR组和对照组之间MS、MD、LV差异有统计学意义(P＜0.05).蓝黄视野中,NDR组和对照组之间及DR组和对照组之间MS、MD、LV差异有统计学意义(P＜0.05),NDR组和DR组之间MS、MD差异有统计学意义(P＜0.05).结论 B/YP可以提示糖尿病患者早期视功能改变,在DR早期诊断中具有一定的临床应用价值.     

正常人和青光眼计算机视野检查的可靠性研究

目的探讨计算机自动视野检查仪的可靠性指标在正常人和青光眼患者中的变化。方法采用Humphety—630型计算机视野检查仪对两组被检查者在受检过程中的三项可靠性指标（固视丢失率、假阳性率、假阴性率）进行监测比较。结果固视丢失率及假阴性率青光眼较正常人发生率有显著增高。结论固视丢失率及假阴性率的升高可在一定程度上反映青光眼视功能损害的情况。     

开角型青光眼视盘周围脉络膜萎缩与视野缺损的相关性研究

目的:探讨原发性开角型青光眼(primaryopenangleglaucoma,POAG)和可疑开角型青光眼(suspectedopenangleglaucoma,SOAG)视盘周围脉络膜萎缩(peripapillarychoroidalatrophy,PPCA)的发生率及不同分区的面积大小与视野指数平均缺损(Meandefect,MD)之间的相关性。方法:对128只POAG和78只SOAG行静态视野检查及眼底视盘彩色照相,对有PPCA改变的视盘确定其α区和(或)β区,并测出不同分区的面积。结果:POAG组中,PPCA的α和β区的发生率分别为57.03%和39.84%,面积均数分别为(0.54±0.37)mm2和(1.68±1.06)mm2,MD为(8.31±3.66)dB;SOAG组中,α和β区的发生率分别为43.59%和26.92%,面积均数分别为(0.42±0.29)mm2和(1.15±0.67)mm2,MD则为(4.16±2.07)dB。在2组病例中,α区和β区面积值与MD之间均具有显著意义的正性相关(P<0.001)。结论:PPCA不同分区的面积值与MD之间具有显著相关性;β区的发展是辨认青光眼或青光眼性视神经损害是否进展的重要参数,有助于发现及预测青光眼病情的发展。     

Differences between Non-arteritic Anterior Ischemic Optic Neuropathy and Open Angle Glaucoma with Altitudinal Visual Field Defect

PurposeTo investigate the differences in retinal nerve fiber layer (RNFL) change and optic nerve head parameters between non-arteritic anterior ischemic optic neuropathy (NAION) and open angle glaucoma (OAG) with altitudinal visual field defect.MethodsSeventeen NAION patients and 26 OAG patients were enrolled prospectively. The standard visual field indices (mean deviation, pattern standard deviation) were obtained from the Humphrey visual field test and differences between the two groups were analyzed. Cirrus HD-OCT parameters were used, including optic disc head analysis, average RNFL thickness, and RNFL thickness of each quadrant.ResultsThe mean deviation and pattern standard deviation were not significantly different between the groups. In the affected eye, although the disc area was similar between the two groups (2.00 ± 0.32 and 1.99 ± 0.33 mm², p = 0.586), the rim area of the OAG group was smaller than that of the NAION group (1.26 ± 0.56 and 0.61 ± 0.15 mm², respectively, p < 0.001). RNFL asymmetry was not different between the two groups (p = 0.265), but the inferior RNFL thickness of both the affected and unaffected eyes were less in the OAG group than in the NAION group. In the analysis of optic disc morphology, both affected and unaffected eyes showed significant differences between two groups.ConclusionsTo differentiate NAION from OAG in eyes with altitudinal visual field defects, optic disc head analysis of not only the affected eye, but also the unaffected eye, by using spectral domain optical coherence tomography may be helpful.     

Diagnostic Consistency and Relation Between Optical Coherence Tomography and Standard Automated Perimetry in Primary Open-Angle Glaucoma

Purpose: To assess diagnostic consistency and relation between spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP) in patients with primary open-angle glaucoma (POAG). Methods: This retrospective study comprised 51 eyes of 51 patients with a confirmed diagnosis of POAG. The qualitative and quantitative SD-OCT parameters (retinal nerve fiber layer thicknesses [RNFL; average, superior, inferior, nasal and temporal], RNFL symmetry, rim area, disc area, average and vertical cup/disc [C/D] ratio and cup volume) were compared with parameters of SAP (mean deviation, pattern standard deviation, visual field index, and glaucoma hemifield test reports). Results: Fifty-one eyes of 51 patients with POAG were recruited. Twenty-nine eyes (56.9%) had consistent RNFL and visual field (VF) damage. However, nine patients (17.6%) showed isolated RNFL damage on SD-OCT and 13 patients (25.5%) had abnormal VF test with normal RNFL. In patients with VF defect, age, average C/D ratio, vertical C/D ratio, and cup volume were significantly higher and rim area was lower when compared to those of the patients with normal VF. In addition to these parameters, worsening in average, superior, inferior, and temporal RNFL thicknesses and RNFL symmetry was significantly associated with consistent SD-OCT and SAP outcomes. Conclusions: In routine practice, patients with POAG can be manifested with inconsistent reports between SD-OCT and SAP. An older age, higher C/D ratio, larger cup volume, and lower rim area on SD-OCT appears to be associated with detectable VF damage. Moreover, additional worsening in RNFL parameters might reinforce diagnostic consistency between SD-OCT and SAP.     

剥脱性开角型青光眼与原发性开角型青光眼眼前节结构参数的比较

目的：比较剥脱性开角型青光眼（PXOAG）与原发性开角型青光眼（POAG）眼前节结构参数的差异。方法：病例对照研究。选取2012 年12 月至2016 年12 月住院治疗的连续PXOAG病例54 例（54 眼）作为PXOAG组,平均眼压为（28.8±7.9）mmHg（1 mmHg=0.133 kPa）。选取性别、年龄及眼压相匹配的POAG病例53 例（53 眼）作为POAG组,平均眼压为（26.3±7.4）mmHg。测定2 组患者角膜厚度、角膜内皮细胞密度、六角型细胞比例、前房深度及晶状体厚度等眼前节参数,并采用独立样本t 检验进行数据分析。结果：POAG组角膜厚度、角膜内皮细胞密度、六角型细胞比例、前房深度及晶状体厚度分别为（535±36）μm、 （2 538±356）/mm2、 （52±12）%、 （2.89±0.36）mm和（4.96±0.41）mm;PXOAG组相应参数分别为（523±41）μm、 （2 323±451）/mm2、 （52±14）%、 （2.79±0.60）mm和（4.98±0.42）mm。2 组患者角膜厚度、六角型细胞比例、前房深度及晶状体厚度比较差异无统计学意义（t =1.57、0.18、1.11、0.26,P ＞0.05）,而角膜内皮细胞密度比较差异有统计学意义（t =2.78,P =0.01）。结论：PXOAG与POAG相比,角膜内皮细胞密度较低,提示在临床治疗过程中应更加注意对角膜内皮的保护。     

Clinical Characteristics of Juvenile-onset Open Angle Glaucoma

PurposeTo demonstrate the clinical characteristics of juvenile-onset open angle glaucoma (JOAG) and to evaluate the prognostic factors for visual field (VF) progression in eyes with JOAG.MethodsThe medical records of 125 eyes of 72 patients with JOAG were analyzed retrospectively. At least four reliable VF tests were required to determine the VF progression, and the progression was defined using the modified Anderson criteria. Comparisons in clinical manifestations among groups were performed using independent t-test, and generalized estimating equations were also conducted.ResultsThe mean follow-up duration was 94.4 ± 50.5 months. Patients with JOAG showed a male preponderance (64 %), myopia (−4.99 ± 4.01 diopters) and a severe elevation of intraocular pressure (35.6 ± 10.8 mmHg). Forty-two JOAG patients (58 %) had complained of symptoms associated with vision and pain; however, one-third presented with no definite symptoms. Fifty-seven patients were diagnosed with JOAG in both eyes, and they were significantly older (p = 0.039) and had a greater family history (p = 0.035) than patients with unilateral JOAG. The progression group exhibited a significantly higher intraocular pressure at the last visit (p = 0.023) than the non-progression group.ConclusionsBecause patients with considerable JOAG had no definite symptoms, periodic eye examinations are needed. To prevent the VF''s progression, JOAG patients may require more careful management of intraocular pressure.     

HRT-Ⅱ对可疑青光眼和原发性开角型青光眼患者的诊断分析

目的 评价海德堡激光眼底扫描仪(HRT-Ⅱ)对临床可疑青光眼和原发性开角型青光眼(POAG)患者的诊断能力.方法 入选临床医生诊断为可疑青光眼患者119人和POAG患者56人,以眼底立体像为诊断的金标准,重新分组为正常眼组和青光眼组.利用HRT-Ⅱ检测各象限盘沿形态,对比两组之间的关系.并且分别评价临床医师诊断、HRT-Ⅱ的Moorfield判别函数、刘杏等建立的判别函数、结合动态反射图的综合分析对于青光眼的诊断价值.结果 共有162人入选,其中正常人109人211只眼,POAG53人62只眼.正常眼和POAG患眼的参数视杯面积、盘沿面积、视杯容积、盘沿容积、平均视杯深度、平均RNFL厚度、视杯形态测量、视杯高度变异轮廓、垂直杯/盘比等的差异有统计学意义(P<0.05),并且HRT-Ⅱ可以有效地发现RNFL缺损,与眼底立体像对RNFL缺损的检出一致率为71%.临床医师的青光眼诊断的敏感性是62.9%,Kappa值为0.414.HRT-Ⅱ的Moorfield判定诊断青光眼敏感性、特异性分别是74.2%、53.6%,Kappa值为0.466,与眼底立体像的一致程度一般.HRT-Ⅱ对青光眼的综合诊断的敏感性、特异性分别是87.1%和92.4%,Kappa值为0.796,与眼底立体像的一致程度较好.刘杏等建立判别函数的受试者工作特征(receiver operator characteristic,ROC)曲线下面积为0.834,敏感性和特异性分别为90.3%、61.1%.结论 HRT-Ⅱ可以有效区分临床诊断为可疑青光眼的正常眼组和POAG患眼,结合HRT动态反射图进行的综合分析对于青光眼的诊断的敏感性、特异性较好,与眼底立体像的一致性较高,而普通门诊医师对青光眼诊断的准确性较差.     

慢性闭角型青光眼视野损害的特点

目的　为了了解早中期慢性闭角型青光眼 (chronicangleclosureglaucoma ,CACG)的静态视野损害特点。对象与方法　对象为MD≤ 15dB的慢性青光眼患者 81例 81只眼 ,其中CACG 2 7例 2 7只眼 ,正常眼压性青光眼 19例 19只眼 ,和原发性开角型青光眼 3 5例 3 5只眼。采用Octopus10 1视野计G2程序 ,将视野内 5 9个静点划分为 9个区和中央 1个点 ,通过图中各点的值 ,分别计算每只眼的每个点、区的MD ;再将视野以 0°～ 180°为界 ,分成上下两个半侧视野 ,分别计算和比较上方和下方半侧视野的MD和LV ;最后对中央 9个点 (6°范围 )进行受累情况的判断 ,并进行CACG、POAG和NTG三组组内和组间的比较。结果　CACG组的中央区MD比POAG NTG组要小 (Z =-2 0 69,P =0 0 3 9) ,其余各区和中心点差异无显著性 (Z =-0 0 6～ 1 72 1,P =0 0 9～ 0 95 2 ) ;CACG和POAG上方半侧视野的MD明显比下方的MD要大 (P =0 0 2 4和 0 0 10 ) ,而NTG的上下方视野MD差异无显著性 (P =0 0 77)。CACG、NTG和POAG中央 6°视野的受累率分别是 2 5 9%、5 7 9%和 5 1 9% (P =0 0 40 )。结论　CACG上方半侧视野比下方受损明显 ,与POAG/NTG视野改变模式有所不同的是 ,中央视野比较不易受损。