垂体瘤患者神经眼科学检查分析72例

目的 分析垂体瘤患者静态中心视野、视觉诱发电位及头磁共振成像(magnctic resonance imaging,MRI)检查结果的关系,探讨静态中心视野检查及视觉诱发电位检查在垂体瘤早期诊断及病情评估中的临床意义.方法 选择2010年7月至2011年12月由我院神经外科确诊为垂体瘤的30～50岁患者72例(144眼),经头MRI强化检查显示瘤体均位于蝶鞍内或突破鞍隔向上生长.应用全自动视野分析仪24-2阈值程序进行静态中心视野检查,记录平均缺损(mean defect,MD)值,应用诱发电位仪进行图形翻转视觉诱发电位检查(pattern reserval visual evoked potential,PRVEP).根据视野检查结果将患者分为4组:正常视野组9例;轻度缺损组13例(-5 dB≤MD ＜0 dB);中度缺损组38例(-15dB＜MD＜-5dB);重度缺损组12例(MD≤-15dB),采用单因素方差分析及q检验分析比较各组患者MRI正中矢状位、冠状位肿瘤的相对高度及PRVEP P100波潜伏期.结果 患者视野异常以颞侧偏盲最多,此外可见不典型视野缺损.随着视野缺损程度的增加,MRI正中矢状位及冠状位肿瘤相对高度均增大(F=125.1,P＜0.05;F=109.8,P＜0.05),正常视野组为(0.9±0.3)cm/(0.7-0.2) cm,轻度缺损组为(1.1 ±0.4)cm/(0.8±0.2)cm,中度缺损组为(2.6 ±0.5)cm/(2.4±0.6)cm,重度缺损组为(3.9±0.4) cm/(3.8±0.4)cm.其中正常视野组与轻度缺损组比较,差异无统计学意义(q=1.49,P＞0.05).随着视野缺损程度的增加,PRVEP P100波潜伏期也呈逐渐延长趋势(F=23.5,P＜0.05),正常视野组为(102.2±4.3)ms,轻度缺损组为(109.4 ±5.4)ms,中度缺损组为(114.5±4.8),至重度缺损组达(118.1±3.9)ms.根据MRI结果,垂体微腺瘤共11例,其中行静态中心视野检查异常率为27.3％,行PRVEP检查异常率达72.7％,差异具有统计学意义(x2=4.55,P＜0.05).结论 静态中心视野检查结果有助于垂体瘤的定性、定位诊断.视野缺损程度与垂体瘤所致视神经功能受损程度一致,且与头MRI所示瘤体大小相对应.对于垂体微腺瘤引起的视功能亚临床损害,PRVEP检查更为敏感,对垂体瘤的早期诊断具有重要价值.     

垂体瘤术后视野改善的时程特征及改善程度的影响因素

目的：通过对垂体瘤患者进行术前及术后不同时间点中心静态视野的定量分析,来探讨经鼻蝶垂体瘤切除术后患者视野改善时程的特征,以及术后视野改善程度的影响因素。方法：回顾性系列病例研究。收集2013 年1 月至2016 年2 月在复旦大学附属上海市第五人民医院行经鼻蝶垂体瘤切除术且术前有视野缺损的垂体瘤患者110 例（212 眼）,对其中在术后1 周复查视野有改善且术后3、6、12 个月时随访资料完整的30 例患者（45 眼）视野改善的时程特征进行分析。采用平均缺损（MD）定量分析视野。对各影响因素先进行单因素分析,再进行多因素Logistic回归分析。结果：随访资料完整的30例患者视野在术后1周时改善最为明显,而后随时间推移视野改善程度逐渐趋于平缓,其中有1例患者在术后12个月时出现垂体瘤复发。110例患者手术后1周视野正常、改善、无改善者最佳矫正视力（BCVA）、视野MD绝对值、全颞上象限视野缺损、视交叉压迫以及肿瘤最大径的差异有统计学意义（F=17.025,P <0.001;F=37.580,P < 0.001;χ2=17.459,P < 0.001;χ2=11.296,P=0.004;F=13.197,P < 0.001）;多因素Logistic回归分析显示术前BCVA（β=2.241,P=0.011,OR=9.406）、术前视野MD绝对值（β=0.195,P < 0.001,OR=1.215）、术前全颞上象限视野缺损（β=1.614,P=0.002,OR=5.024）、肿瘤最大径（β=0.512,P=0.023,OR=1.668）为影响术后视野改善程度的相对独立的影响因素。结论：经鼻蝶垂体瘤切除术后患者视野在术后1 周时改善最为迅速。术前BCVA、术前视野MD绝对值、术前全颞上象限视野缺损和肿瘤最大径为影响垂体瘤患者术后视野改善程度的相对独立影响因素。     

视路疾病患者脑功能性磁共振成像初步观察

目的 观察视路疾病患者视网膜拓扑投射的分布及脑功能性磁共振成像(fMRI)与视野检查结果的关系.方法 3例经病理检查确诊为垂体瘤和颅咽管瘤的鞍区占位患者(患者组)6只眼以及年龄24～30岁的3名健康志愿者纳入研究.患者组6只眼最佳矫正视力无光感～1.0;健康志愿者矫正视力1.0,除近视外无其他眼疾.受检者均无fMRI检查禁忌.常规行最佳矫正视力、直接和(或)间接检眼镜眼底检查,Octopus101电脑全自动视野计32程序策略趋势导向检查法行中心静态视野检查.fMRI检查采用GE signa VH/I 3.0T扫描机.视觉刺激占据12°视角,采用对比度接近100%的黑白棋盘格,背景为棋盘格的平均亮度,包括周期性扩张或收缩的环形刺激和顺时针或逆时针旋转的楔形刺激两种模式.功能图像采用梯度回波的平面同波序列的血氧水平依赖扫描序列,垂直于距状裂冠状位扫描,三维采集方式的扰相梯度回波序列矢状位采集高分辨率解剖结构数据.数据分析采用AFNI软件,并且应用Freesurfer进行皮层的分割、膨胀处理.结果 6只患眼中,视野颢侧缺损3只眼,颞上方缺损2只眼,不能完成检查1只眼.环形刺激的功能图像显示,枕叶视觉皮层产生了时相对应的激活图像,枕叶后极沿距状裂向前迁移对应黄斑中心区向周边视野的迁移.楔形刺激的功能图像显示,初级视觉皮层的极角拓扑投射的空间序列与视野相反.距状裂下方的视皮层主要对应对侧上方视野,距状裂上方主要对应对侧下方视野.刺激患眼不能诱导出与相应视野缺损相关的初级视觉皮层的激活,存在相应视觉皮层反应的减少.结论 fMRI检查结果与常规视野计检查的结果有很好的对应关系,可以反映视路疾病患者的视野缺损对应的皮层反应.     

非动脉炎性前部缺血性视神经病变视野表现分析

目的 观察分析非动脉炎性前部缺血性视神经病变(NAION)视野损伤特征及其影响因素.方法 确诊为NAION并有完整视野检查记录的139例患者纳入研究.其中,男性65例,占46.7%;女性74例,占53.3%.平均发病年龄(56.2±10.8)岁.所有患者均行视力、屈光状态、屈光间质检查,裂隙灯显微镜加前置镜眼底检查、眼底彩色照相、视野检查,其中125例患者进行了荧光素眼底血管造影(FFA)检查,同时行血压、实验室血常规及血生物化学检查.对所有患者的视野表现及其影响因素进行统计学分析;对77只眼的FFA检查结果与视野检查结果一致性进行对比分析.结果 视野检查结果显示,典型下半视野缺损者48只眼,占34.5%;弓形暗点者24只眼,占17.3%;不典型弓形暗点者24只眼,占17.3%;全视野缺损者20只眼,占14.4%;上半视野缺损者10只眼,占7.2%;上半视野缺损+下方弓形暗点者5只眼,占3.6%;下半视野缺损+上方弓形暗点者8只眼,占5.8%.患眼视野平均缺损值(MD值)为-3.0～-32.0,平均MD值为-17.9±7.9.77只眼中,FFA荧光缺损区与视野缺损区非常一致者7只眼,占9.1%;大部分一致者26只眼,占33.8%;小部分一致者39只眼,占50.6%;完全不一致者5只眼,占6.5%.多元线性回归分析结果显示,红细胞平均体积(MCV)(β=0.203,t=2.005)、胆固醇(CHOL)(β=0.230,t=2.244)是影响患眼视野MD值的因素(P＜0.05).结论 NAION视野损害呈现多样化表现;血MCV、CHOL可能是影响视野缺损程度的主要因素.

Abstract：

Objective To study the visual field defects and its correlation factors in nonarteritic anterior ischemic optic neuropathy (NAION). Methods One hundred and thirty-nine patients of NAION with complete visual field examination results were included in this study. There were 65 males (46.7%)and 74 females (53.3%), with an average age of (56.2±10. 8) years. All the patients had undergone the examinations of visual acuity, refraction, refractive media, slit lamp ophthalmoscope, color fundus photography, visual field, blood pressure, blood routine test and blood biochemistry test. Fundus fluorescein angiography (FFA) was carried out in 125 patients. The visual field characteristics and its correlation factors were statistically analyzed, and the FFA and visual field results of 77 eyes were comparatively analyzed. Results The visual field examination showed typical inferior defect in 48 eyes (34. 5%), arcuate scotoma in 24 eyes (17.3%), atypical arcuate scotoma in 24 eyes (17. 3%), defuse defect in 20 eyes ( 14.4% ), superior defect in 10 eyes (7. 2 % ), superior defect with inferior arcuate scotoma in five eyes (3.6 %), inferior defect with superior arcuate scotoma in eight eyes (5.8%). The mean defect (MD) value ranged from -3.0 to -32.0,with an average of - 17.9±7.9. Among 77 eyes with FFA data,the FFA and visual field defect area were highly consistent seven eyes (9. 1%), consistent in 26 eyes (33.8%), some kind of consistent in 39 eyes (50. 6%), completely inconsistent in five eyes (6.5%).Multiple lineal regression analysis showed that mean red cell volume (MCV) (β=0. 203, t= 2. 005) and cholesterol level (CHOL) (β=0. 230, t=2. 244) were correlation factors of MD (P＜0. 05). Conclusion The visual field defect of NAION shows a variety of patterns which may be mainly influenced by MCV and CHOL.     

中心视野检查联合周边视野检查在青光眼诊断中的价值

目的探讨中心视野检查联合周边视野检查是否能减少青光眼诊断的漏诊率。方法病例组（青光眼患者）84例（165只眼）与对照组（按性别、年龄、文化程度与病例组相配比的正常人群）110例（220只眼）分别使用Octopus101自动电脑视野计进行中心视野检查和周边视野检查,将中心视野检查及中心与周边视野检查的联合结果请三位医生在盲法的情况下独立进行分析评价,最后将评价结果进行统计学的分析,计算出漏诊率。结果病例组中中心视野检查结果异常的有129只眼,而中心视野检查联合周边视野检查结果异常的有153只眼;对照组中中心视野检查结果异常的有17只眼,而中心视野检查联合周边视野检查结果异常的有36只眼。将其中的中心视野检查结果与联合视野检查结果相比较,使用SPSS11.5统计软件进行分析可知：中心视野检查联合周边视野检查漏诊率为7.3%,单独的中心视野检查的漏诊率为21.8%,P=0.000〈0.05,具有统计学意义。结论使用Oc-topus101自动电脑视野计中心视野检查联合周边视野检查能减少青光眼诊断的漏诊率。     

70例垂体瘤的眼部改变分析

目的　总结 70例 (14 0只眼 )垂体瘤的眼部改变情况 ,分析其误诊原因。方法　疑为垂体瘤者行颅 X摄片 ,头颅 CT、视野检查 ,常规视功能检查。结果　经手术证实垂体瘤 70例 ,其中视力减退者 12 0只眼 (86 % ) ,原发性视神经萎缩 88只眼 (6 2 % ) ,视野缺损者 10 6只眼 (83% ) ,误诊 12只眼 (11.5 % )。结论　垂体瘤为一慢性发展的良性肿瘤 ,临床上遇有双颞侧视野偏盲或进行性视力减退都应想到有垂体瘤可能 ,争取尽早诊断及时治疗     

光学相干断层扫描在判断垂体瘤患者术后视功能预后中的应用

目的应用光学相干断层扫描（OCT）测量视网膜神经纤维层（RNFL）厚度,探讨其在判断垂体瘤患者术后视功能预后的作用。方法选取2007年1月至2008年12月经蝶窦垂体腺瘤切除术病理检查、MRI确诊的垂体瘤伴视交叉压迫患者16例（32眼）,其中男性7例,女性9例,年龄23—67岁,平均（44．4±14．71岁。在术前、术后1周、术后3个月,分别采用标准对数视力表、Stratus OCT Ⅲ和Humphrey视野分析仪．检测患者的矫正视力、平均RNFL厚度、4个象限的RNFL厚度和视野指数平均缺损（MD）。根据术前视野缺损情况及随访变化,将研究对象分为3组：A组即术前有视野缺损,术后视野缺损无改善或加重;B组即术前有视野缺损,术后视野缺损改善;C组为术前及术后均无视野缺损。对所得数据进行相关统计学分析。结果16例（32眼）患者中,A组10眼,B组11眼,C组11眼。术前有视野缺损者,平均RNFL越厚,视野缺损改善的比例越大（OR=1．189,P=0．020）;下方RNFL厚度对视野缺损改善有显著影响fOR=6．093,P=0．000）,而术前MD对术后视野缺损改善无显著影响（OR=0．955,P=0．509）。术后1周及术后3个月,B组的视力均较术前提高（t=3．893,P=0．003;t=4．310,P=0．002）,而A组和C组视力较术前差异均无统计学意义。术后3个月,A组平均RNFL厚度及颞侧RNFL厚度均较术前变薄（t=-2．378,P=0．041;（t=-2．630,P=0．025）,而上方、下方及鼻侧RNFL厚度较术前差异均无统计学意义：B组的平均RNFL厚度、鼻侧及颞侧RNn．厚度均较术前增厚（t=2．438,P=0．035;t=2．630;Pl-0．025;t=4．457,P=0．001）;C组平均RNFL厚度及4个象限RNFL厚度手术前后差异均无统计学意义。结论运用OCT检测垂体瘤患者的平均RNFL厚度及下方RNFL厚度,可作为判断患者术后短期视功能预后的较敏感指标：手术前后RNFL厚度的变化与视野缺损的变化具有较好的一致性。     

视野检查在先天性青光眼疗效评价中的应用

目的探讨视野在原发性先天性青光眼疗效观察中的价值.方法对17例28眼先天性青光眼的视野资料进行回顾性分析,并就视力、眼压、杯盘比值、手术次数、手术年龄等因素与视野的关系进行探讨.结果初次检查视野的年龄4～16岁,平均11.52±3.47岁,视野检查距手术的时间1～14年,平均6.7年.矫正视力≥0.4者占78.579%,其中＞0.8者占46.439%.22眼具有青光眼性视野缺损,占78.579%,其中旁中心暗点5眼,鼻侧阶梯9眼,弓形缺损6眼,管视和/或颞岛7眼.早、中、晚三期视野损害所占比例分别为:32.14%、21.439%、25.00%.8例13眼有视野随访,随访时间3～13年,平均6.6年,6眼有视野进展.手术次数≥2次组的视野损害较≤1次手术组重(P＜0.05).杯盘比值≥0.6组的视野损害明显重于C/D＜0.6组(P＜0.05).结论视野是评价先天性青光眼疗效的一个重要指标,先天性青光眼患者经训练后能够完成视野检查.     

垂体瘤患者视野缺损与视野检查浅析

视野检查是视路疾病诊断的重要辅助检查之一,尤其在垂体瘤诊断中有其特殊地位。垂体瘤患者的术前视野缺损以双眼或单眼颞侧视野损害为特征,具有以“中线为界”的特点,并受肿瘤大小和位置的影响。术后,垂体瘤患者的视野则分三个时相改善。本文就垂体瘤患者术前和术后的视野缺损特征及视野检查在垂体瘤诊治中的应用予以阐述。     

Octopus 101自动视野计GKP模块在眼科的应用

目的 评价Octopus101视野计动态视野GKP (Goldmann Kinetic Perimetry)模块在眼科的应用.方法 对已确诊明确有视野缺损患者67例(107只眼)行动态视野GKP模块检查;其中青光眼24例(38只眼)、前部缺血性视神经病变18例(21只眼)、偏盲25例(48只眼),并对同一患者动、静态视野配对图进行一致性分析;同时检测GKP模块的重复性.结果 67例患者中男性27例,女性40例;平均年龄(50.7±12.7)岁(18～82岁);视力范围在0.3～1.2之间;青光眼组、前部缺血性视神经病变组、偏肓组平均动态视野GKP检查时间分别为(8.43±2.21) min、(8.52±1.49) min、(6.89±2.06)min;各组Ⅲ4e和Ⅰ4e两种视标参数等视线面积相比差异具有统计学意义(均P＜0.01);同一患者动、静态视野图形匹配在青光眼组76.32％ (29/38);前部缺血性视神经病变组83.33％ (15/18);偏盲组100％ (48/48);Ⅲ4e和Ⅰ4e两种视标参数在两次重复检查(GKP1,GKP2)等视线面积差异均无统计学意义(分别P=0.68,P=0.59),两次重复检查结果相关性好(Spearman线性相关分析,均P＜0.001).结论 Octopus101 GKP模块可应用于青光眼、前部缺血性视神经病变、偏盲患者的诊断和定量随访,并重复性好.     

准分子激光原位角膜磨镶术前后蓝／黄视野分析

目的研究准分子激光原位角膜磨镶术（laser in situ keratomileusis,LASIK）对患者视野的影响。方法用Octopus101全自动视野计G2程序的TOP／BY分程序对LASIK手术的近视患者于术前、术后6个月行视野检查。结果术后视野的平均敏感度（meansen sitivity。MS）与术前比较，差异无显著性（P〉0．05）。术后视野的指数平均缺损（mean defect，MD）与术前比较。差异有显著性（P〈0．01）。手术前、手术后视力与手术前后各自视野MS、MD均无显著相关性（P〉0．05）。手术前后MS和MD平均差值与术前屈光度数、角膜切削百分比、激光切削时间、负压吸引时间、瞳孔直径、年龄、性别等行Spearman相关分析显示均无相关性（P〉0．05）。结论手术对视网膜和视神经结构和功能影响还不足以导致临床上明显的功能损伤，没有表现出有临床意义的功能改变。LASIK手术前后视野无明显变化。蓝，黄视野计与标准白色视野计检测的视野结果一致，说明两者检测敏感性相当。     

Visual field assessment in glaucoma: comparative evaluation of manual kinetic Goldmann perimetry and automated static perimetry

PURPOSE: To compare the detection and assessment of progression of visual field defects in primary open-angle glaucoma with manual suprathreshold perimetry on Goldmann perimeter and automated static threshold perimetry on Humphery visual field (HVF) analyzer. METHODS: 105 eyes of 54 patients of primary open-angle glaucoma were followed up with 3-monthly perimetry on Goldmann perimeter and HVF analyzer, for a period of 9 months. RESULTS: HVF analyzer picked up visual field defects in 48 (46%) eyes whereas Goldmann perimeter picked up visual field defects in 26 (25%) eyes. HVF analyzer demonstrated progression in 14 eyes whereas Goldmann perimeter detected progression in 7 eyes during follow up of 9 months. CONCLUSIONS: HVF analyzer is superior to Goldmann perimeter to document and to demonstrate progression of visual field defects in primary open-angle glaucoma.     

Detection of Visual Field Loss in Pituitary Disease: Peripheral Kinetic Versus Central Static

Visual field assessment is an important clinical evaluation for eye disease and neurological injury. We evaluated Octopus semi-automated kinetic peripheral perimetry (SKP) and Humphrey static automated central perimetry for detection of neurological visual field loss in patients with pituitary disease. We carried out a prospective cross-sectional diagnostic accuracy study comparing Humphrey central 30-2 SITA threshold programme with a screening protocol for SKP on Octopus perimetry. Humphrey 24-2 data were extracted from 30-2 results. Results were independently graded for presence/absence of field defect plus severity of defect. Fifty patients (100 eyes) were recruited (25 males and 25 females), with mean age of 52.4 years (SD = 15.7). Order of perimeter assessment (Humphrey/Octopus first) and order of eye tested (right/left first) were randomised. The 30-2 programme detected visual field loss in 85%, the 24-2 programme in 80%, and the Octopus combined kinetic/static strategy in 100% of eyes. Peripheral visual field loss was missed by central threshold assessment. Qualitative comparison of type of visual field defect demonstrated a match between Humphrey and Octopus results in 58%, with a match for severity of defect in 50%. Tests duration was 9.34 minutes (SD = 2.02) for Humphrey 30-2 versus 10.79 minutes (SD = 4.06) for Octopus perimetry. Octopus semi-automated kinetic perimetry was found to be superior to central static testing for detection of pituitary disease-related visual field loss. Where reliant on Humphrey central static perimetry, the 30-2 programme is recommended over the 24-2 programme. Where kinetic perimetry is available, this is preferable to central static programmes for increased detection of peripheral visual field loss.     

Patterns of visual loss associated with pituitary macroadenomas

Purpose: To describe the patterns of visual loss associated with pituitary macroadenomas compressing the anterior visual pathway.
Method: A prospective survey of 29 patients with pituitary macroadenomas who presented to the neurosurgical unit at St Vincent's Hospital, Melbourne. Selected patients had histologically verified pituitary macroadenomas, and visual defects (acuity, colour and/or field loss) consistent with anterior visual pathway compression.
Results: All patients had visual field defects detected on perimetry, and the majority were asymmetrical. Bitemporal defects were most common but field defects ranged from monocular defects to generalised constriction. Four patients (13.8%) did not report visual symptoms, and of those who had symptoms, blurred vision was the most common complaint. Ninety-six per cent of eyes had field loss, 56% had decreased colour vision, 46% had decreased acuity, 31% had optic disc pallor, and 2% had an ophthalmoplegia.
Conclusions: Patients with visual pathway compression by pituitary macroadenomas may be asymptomatic despite having field defects. Perimetry is the most sensitive method of identifying compression, followed by colour vision, visual acuity, then the presence of optic atrophy. Automated static threshold perimetry appears to show early field defects better than manual kinetic perimetry. All patients with pituitary macroadenomas should have thorough ophthalmological examinations, including perimetry to document visual deficits secondary to compression.     

Use of Fieldmaster automated perimeter for the detection of early visual field changes in glaucoma

The efficacy of automated suprathreshold perimetry with Fieldmaster automated perimeter (model 101 PR and 200) was evaluated in the screening for very early glaucomatous visual field defects which failed to be detected with kinetic perimetry using a Goldmann perimeter. Evaluation of 117 eyes with elevated intraocular pressure revealed a small, relative defect in the central field in 14 eyes which was confirmed by static perimetry with a Tübinger perimeter. Although Fieldmaster model 200 is equipped with more target positions than model 101 PR, detectability of early defects was almost identical between two models. Automated suprathreshold perimetry with either model of Fieldmaster perimeter is useful in detecting the early changes which may be missed by kinetic perimetry with a Goldmann perimeter. Based on the difference in the false positive rate (45.6% with model 200 vs 26.7% with model 101 PR) the screening with 101 PR seems to be more rewarding.     

Relationship between visual acuity and nasal field thresholds in patients with temporal hemianopia.

The area of nasal field found with Goldmann static perimetry and the sum of decibels by Humphrey threshold 30/2 was calculated in normal subjects and in subjects with chiasmatic lesions, temporal field loss, and normal or abnormal visual acuity. There was a significant reduction of the mean of the area of the nasal field by static Goldmann perimetry and of the mean of decibels in the nasal field on Humphrey perimetry in patients with temporal field loss and chiasmatic lesions, as compared with normal controls. There were significant correlations of nasal field depression (Goldmann) and visual acuity and for sums of nasal field decibels (Humphrey) and visual acuity. Thus, a generally depressed nasal field was found in patients with chiasmatic lesions and temporal field loss when accompanied by lowering of visual acuity. This would appear to be the earliest stage of nasal field involvement.     

Comparison of manual Goldmann and automated static visual fields using the Dicon 2000 perimeter in the detection of chiasmal tumors

We report that changes in the program (software) operating an automated perimeter (hardware) remarkably improved its ability to produce interpretable diagnostic information. A group of 11 postoperative patients with pituitary adenomas and other chiasmal tumors having stable visual field defects demonstrated by manual kinetic and suprathreshold Goldmann perimetry were re-examined with automated suprathreshold static perimetry performed by the Dicon model 2000 perimeter. During the study a program for two-zone (central and peripheral), three-level suprathreshold static perimetry became available. With optimum test administration and interpretation, the Dicon 2000 perimeter with the two-zone, three-level suprathreshold program can at least equal the performance of an experienced perimetrist using manual Goldmann kinetic and selective static perimetry in the detection of visual field defects resulting from chiasmal tumors. The two-zone, three-level suprathreshold suprathreshold program was superior to a single zone, one-level programs in examining this population.     

垂体瘤患者视网膜神经纤维层厚度和视野变化参数相关性研究

目的 观察继发视功能损害的垂体瘤患者的视网膜神经纤维层厚度和视野变化参数之间的相关性,并比较偏振激光扫描仪(GDxVCC)和Octopus自动视野计在垂体瘤(PTT)患者检查中的敏感性及特异性.方法 对确诊为垂体瘤的70例患者(140只眼)分别行GDxVCC检查和Octopus自动视野计TOP程序视野(VF)检查.分析GDxVCC检查所得的双眼视网膜神经纤维层(RNFL)平均厚度、上方厚度、下方厚度与相对应的视野检查所得的双眼平均敏感度(Ms)、平均缺陷度(MD)与丢失方差(LV)的平方根及神经纤维指数(NFI)与平均缺陷度(MD)的5组参数,探讨这两种检查方法对垂体瘤视功能损害的敏感性及特异性并比较相应参数的相关性.结果 Octopus自动视野计检测PTT的敏感性为70.00%,特异性为34.00%;GDxVCC检测PTT的敏感性为72.22%,特异性为56.00%;两种方法联合检测PTT的敏感性为83.33%,特异性为58.00%(差异有统计学意义).双眼GDxVCC的RNFL平均厚度与VF检查的MS,上、下方的RNFL平均厚度分别与下、上方的MS比较均呈线性正相关(P＜0.01);左眼均较右眼明显.双眼GDxVCC的NFI与MD呈线性正相关(P＜0.01)双眼RNFL平均厚度与LV的平方根呈线性负相关(P＜0.01) GDxVCC联合视野检查有助于提高继发视功能损害的垂体瘤检测的敏感性及特异性.GDxVCC可以客观定量地反映视网膜神经纤维的结构性损害,并与视野的缺损有一定的相关性.     

Eye tension and open angle glaucoma in a Burkina Faso hospital

PURPOSE: Studying the correlation between high intraocular pressure and glaucoma in black African patients. PATIENTS: and method: This study was retrospective and was based on 235 patients, i.e. 470 eyes examined from April 1993 to december 1998 for elevated eye pressure, at the Sanou Souro hospital of Bobo-Dioulasso, Burkina Faso. For each subject, we noted visual acuity, age, sex, ocular tonus, the result of optical disc examination with the three-mirror glass, and the visual field examined with Goldmann perimetry. We excluded infants, young children, glaucoma with normal pressure, and patients with incomplete files. RESULTS: The patients were from 14 to 80 years old, with 18.3% 40 years-old or less. Male subjects predominated with a sex ratio of 2.26. Visual acuity was lost in 191 eyes (40.6%) and optic disk excavation was total in 214 eyes (45.5%). The Goldmann perimetry visual field test revealed defects in 390 eyes (83%). Ocular tension, optic disk excavation of the glaucomatous type, and visual field defects were associated in 70.4% of the cases. CONCLUSION: This study shows that in 70.4% of the cases, there was a correlation between high intraocular pressure and glaucoma. This glaucoma is acute and appears in young subjects. Efforts will be made to alert our population and detect glaucoma precociously.