正常眼压性青光眼中眼压与视野间的关系

目的 :探讨正常眼压性青光眼 (normalpressureglaucoma ,NPG)的眼压、视野和相互关系。方法 :分析 98例新诊断NPG患者的眼压曲线和视野状态。结果 :眼压曲线呈单峰式波动 ,双眼对称 ,总体平均水平位于 16mmHg上下 ,波动幅度 <2mmHg。患者男性眼压均值右眼为15 70± 2 5 7mmHg、左眼为 15 46± 2 %41mmHg ,女性右眼为 16 5 2± 1 97mmHg、左眼为 16 45± 2 0 1mmHg ,眼压与年龄相关不显著 (P >0 0 5 )。患者各相应年龄组的眼压均高于正常老年人 (分别P <0 0 2 ,P <0 0 1,P <0 0 0 1)。在 98例患者 196眼的视野中 ,5 2例患者为单眼损害 ,14 4眼的视野损害在损害形态和部位上与眼压升高的原发性开角型青光眼 (hp -POAG)相符合 ,但旁中心损害侵入中心固视区者约占 2 2 2 2 %。在两眼视野损害相对轻重的划分中 ,视野损害不同分级状态下眼压的平均值、最高值和波动差二者间差异不显著 (P >0 0 2 ) ,单侧视野损害患者患眼与对侧眼眼压差异不显著 (P >0 0 5 ) ,但同侧视野损害较重且眼压较高眼数的构成比最大 ,约占 5 5 1%(P <0 0 1)。结论 :NPG患者的眼压状态在单值水平、波动幅度和双眼对称性上均与一般群体生理眼压相一致 ,但平均眼压高于年龄可比的正常老年人。视野损害特征与hp -POAG相符合 ,     

健康体检中的正常眼压性青光眼

目的 探讨健康体检人群中的正常眼压性青光眼（normal tension glaucoma,NTG）的发病率及视野改变,为NTG的筛选提供有益的经验。方法 对健康体检眼底检查中发现的461例813眼视盘有异常改变者,应用Humphrey 750型电脑视野分析仪检查,采用中心30-2程序自动检测,对结果异常者进行随访复查。结果 461例中141例224眼视野有异常表现,占30.59%,其中62例112眼表现出青光眼特征性视野改变,被诊断为正常眼压性青光眼,占总检查人数的13.45%,占视野异常者的43.97%。结论 健康体检中,NTG有相当比例的发病率。电脑视野计的应用对NTG的早期诊断和早期视野损害的认识,提供了一种较为敏感的检查手段。     

正常眼压性青光眼与原发性开角型青光眼24小时眼压曲线的比较

目的 通过24 h眼压的测量来深入分析比较正常眼压性青光眼(NTG)与原发性开角型青光眼(POAG)的眼压曲线特征.方法 前瞻性病例对照研究.收集2006年4月至2009年4月在上海市闸北区北站医院和复旦大学附属眼耳鼻喉科医院门诊就诊的NTG患者131例及POAG患者102例,测量24 h眼压,用非接触性眼压计从8 am起每隔2 h测一次眼压,0 am至6 am之间测得的为唤醒后即刻坐位眼压.主要观察指标为眼压波动曲线、平均眼压、峰值时间及眼压、谷值时间及眼压和眼压波动值.采用独立样本t检验和卡方检验比较各指标在两组之间的差异.结果 NTG组双眼平均眼压为(14.2±2.1)mmHg,低于POAG组[(19.9±3.5)mmHg];NTG组双眼峰值眼压为(17.0±2.4)mmHg,低于POAG组[(24.7±4.3)mmHg];NTG组双眼谷值眼压为(11.8±2.2)mmHg,低于POAG组[(16.5±3.1)mmHg];NTG组双眼眼压波动值为(5.2±1.8)mmHg低于POAG组(8.2±3.1)mmHg];两组的平均眼压、峰值、谷值及眼压波动值的差异均有统计学意义(t=-14.52、-16.44、-13.16、-8.90,P均＜0.01).NTG组63.3%患者、POAG组73.5%患者的峰值眼压位于门诊工作时间以外;尤其是NTG组有51.5%患者、POAG组有64.7%患者的峰值位于0 am至6 am时间段,两组差异有统计学意义(X2=8.150,P=0.017).结论 NTG及POAG患者24 h眼压曲线的变化规律具有相似性,是诊断和个体化治疗方案制订的依据,并可用作治疗随访中评价疗效和调整方案的重要参考指标.     

原发性开角型青光眼和正常眼压性青光眼危险因素的研究

目的：探讨原发开角型青光眼（POAG）和正常眼压性青光眼（NTG）发病相关的危险因素。方法：对592例（1156眼）原发开角型青光眼和53例（100眼）正常眼压青光眼患者进行眼科常规检查,视野检查,屈光,血糖,血压检测,家庭史及药物史和全身病调查,结果：NTG组与POAG组相比较,在患病年龄的分布上有差异：POAG组以20－40岁年龄最常见,而NTG组以50－60岁年龄最常见;两组患者均有较高的近视患病率（POAG组为42．1％,NTG组为66．04％）,NTG组低血压患病率67．92％）,阳性家族史为20．75％,两者均明显高于POAG组,差异有显著性,结论：年龄,近视,低血压,青光眼家族史可能是POAG和NTG发病的重要因素。     

药物降低眼压对正常眼压青光眼的治疗意义

目的　探讨对正常眼压青光眼人群合理用药降低眼压对视功能的保护作用。方法　对 18例 2 8眼正常眼压青光眼患者进行前瞻性研究。随机分成两组 ,一组为非治疗组 ;另一组为治疗组 ,予以 0 5 %噻吗心安治疗 ,每日 2次 ,随访时间为 3～ 4年 ( 4 1 18± 3 77)个月。采用Humphrey 63 0型视野分析仪的中心 3 0 2检查程序 ,观察和记录每次视野和眼压检查结果 ,并对数据进行相关分析。结果　治疗组眼压明显低于非治疗组 ,差异有显著性 (P <0 0 5 )。两组视野平均缺损深度均较观察前加深 ,对照组与观察前相比有显著性差异 (P <0 0 5 ) ,而治疗组的差异无统计学意义 (P >0 0 5 ) ,两组相比结果有非常显著性差异 (P <0 0 1) ;治疗组与对照组相比 ,出现新的视野缺损的人数比例明显低于后者(P <0 0 5 )。MD值与眼压存在明显相关关系 (r =0 92 ,P <0 0 1)。结论　眼压对正常眼压青光眼的视野改变有直接影响 ,合理用药降低眼压可以延缓正常眼压青光眼 (NTG)的视功能损害。除眼压外 ,还存在其他因素影响疾病发展。     

正常眼压性青光眼的诊断及治疗

正常眼压性青光眼由于发病隐匿,症状不典型,与原发性开角型青光眼临床症状相似,因此诊断治疗较为困难,并常被忽视.本文对其临床特点、诊断及治疗最新进展进行综述,以期对正常眼压性青光眼有更深入了解和进行更有效的治疗.     

正常眼压青光眼与原发性开角型青光眼的比较

正常眼压青光眼（ＮＴＧ）的发病率逐渐增加,日益受到眼科工作者的重视。ＮＴＧ发病隐蔽,早期诊断较其它青光眼显得更为困难和复杂,其发病机制、诊断标准及其与原发性开角型青光眼（ＰＯＡＧ）的异同等一系列问题仍无统一意见。就ＮＴＧ与ＰＯＡＧ的诊断标准,发病机制,临床表现,治疗原则以及相互关系等问题的研究进展等进行综述。     

正常眼压性青光眼的诊断和病因研究

眼压在青光眼的发病中是一个极其重要的因素 ,对于有些青光眼患者 ,眼压虽然在正常范围内 ,却发生了典型的青光眼视神经及视野损害 ,称为正常眼压性青光眼 (norm al tension glaucoma,NTG或 normal pressureglaucoma,NPG)。本文就正常眼压性青光眼的有关诊断及病因问题作一综述。     

正常眼压性青光眼24小时眼压波动的研究进展

正常眼压性青光眼(normal-tension glaucoma, NTG)是一种慢性进行性视神经病变, 发病时眼压在正常范围内。NTG在开角型青光眼中的占比较高。在NTG的诊断中, 24 h眼压测量尤其重要, 是与原发性开角型青光眼相鉴别的主要体征。NTG患者24 h眼压监测通常表现为夜间出现眼压峰值, 且其眼压的昼夜波动幅度往往比正常人大。且24 h眼压的平均眼压、短期和长期眼压波动幅度、最小眼压值都显示为NTG疾病进展中的预测参数。这使得NTG患者24 h眼压监测及根据其24 h眼压波动特点进行个体化治疗变得尤为重要。(国际眼科纵览, 2023, 47:24-29)     

HRT-Ⅱ在正常眼压性青光眼诊断中的应用

目的探讨海德堡视网膜断层扫描仪-Ⅱ(HRT-Ⅱ)在正常眼压性青光眼(normal tension glaucoma,NTG)诊断中的意义.方法对24例48眼NTG患者进行HRT-Ⅱ检测和自动视野计检查,统计分析HRT-Ⅱ检测的敏感性、与视野的对应关系、参数和病变分区特点.结果 24例48眼中视野异常41眼,HRT-Ⅱ检测异常41眼;视野异常和HRT-Ⅱ异常对应为91.67%;单眼视野异常组7例有对侧2眼视野正常而HRT-Ⅱ检测异常,对侧5眼视野正常而HRT-Ⅱ检测也正常.视盘参数为视盘面积(1.567±0.349)mm2,视杯面积为(1.447±0.263)mm2,盘沿容积为(0.163±0.147)rm3,盘沿面积为(0.682±0.390)mm2,C/D为0.738±0.134,平均视杯深度(0.327±0.120)mm,平均视网膜纤维厚度为(0.193±0.161)mrm.颞下象限盘沿面积异常占69.77%(30/43),颞上为60.47%(26/43),鼻下为76.74%(33/43),鼻上为60.47%(26/43),颞侧为48.84%(21/43),鼻侧为60.47%(26/43).结论 (1)HRT-Ⅱ检测是NTG诊断的方法之一,敏感性良好;(2)HRT-Ⅱ检测和视野改变有良好的对应关系,而NTG患者HRT-Ⅱ异常可能早于视野改变,可以用于NTG的早期诊断.     

正常眼压性青光眼发病机制研究进展

正常眼压性青光眼在临床上被认为是眼底和视野出现特征性青光眼损害,而眼压始终正常的一种状态.正常眼压性青光眼在分类上被认为是原发性开角型青光眼的一个亚型,迄今有关其视神经损伤机制的研究主要集中在机械压力因素、血管及血流动力学因素、免疫调节因素及遗传因素等方面.     

Comparison of corneal biomechanical properties in normal tension glaucoma patients with different visual field progression speed

AIM: To compare the corneal biomechanical properties difference by ocular response analyzer (ORA) in normal tension glaucoma (NTG) patients with different visual field (VF) progression speed. METHODS: NTG patients with well-controlled Goldmann applanation tonometer (GAT) who routinely consulted Kitasato University Hospital Glaucoma Department between January 2010 and February 2014 were enrolled. GAT and ORA parameters including corneal compensated intraocular pressure (IOPcc), Goldmann estimated intraocular pressure (IOPg), corneal hysteresis (CH), corneal resistance factor (CRF) were recorded. VF was tested by Swedish interactive threshold algorithm (SITA)-standard 30-2 fields. All patients underwent VF measurement regularly and GAT did not exceed 15 mm Hg at any time during the 3y follow up. Patients were divided into four groups according to VF change over 3y, and ORA findings were compared between the upper 25th percentile group (slow progression group) and the lower 25th percentile group (rapid progression group). RESULTS: Eighty-two eyes of 56 patients were studied. There were 21 eyes (21 patients) each in rapid and slow progression groups respectively. GAT, IOPcc, IOPg, CH, CRF were 12.1±1.4 mm Hg, 15.8±1.8 mm Hg, 12.8±2.0 mm Hg, 8.4±1.1 mm Hg, 7.9±1.3 mm Hg respectively in rapid progression group and 11.5±1.3 mm Hg, 13.5±2.1 mm Hg, 11.2±1.6 mm Hg, 9.3±1.1 mm Hg, 8.2±0.9 mm Hg respectively in slow progression group (P=0.214, <0.001, 0.007, 0.017, 0.413, respectively). In bivariate correlation analysis, IOPcc, IOPcc-GAT and CH were significant correlated with m△MD (r=-0.292, -0.312, 0.228 respectively, P=0.008, 0.004, 0.039 respectively). CONCLUSION: Relatively rapid VF progression occurred in NTG patients whose IOPcc are rather high, CH are rather low and the difference between IOPcc and GAT are relatively large. Higher IOPcc and lower CH are associated with VF progression in NTG patients. This study suggests that GAT measures might underestimate the IOP in such patients.     

Diffuse nerve fiber layer loss in normal tension glaucoma

14 eyes of 14 normal tension glaucoma (NTG) patients with the maximum intraocular pressure (IOP) 19 mmHg and 16 eyes of 16 NTG patients with the maximum IOP<19 mmHg were examined. All patients had a scotoma confined to the upper or lower hemifield. Eyes with the maximum IOP a 19 mmHg showed significantly diffuse retinal nerve fiber layer (RNFL) loss in the RNFL area corresponded to the spared visual hemifield as compared to those with the maximum IOP<19 mmHg. The result suggests that, even in NTG, IOP may be an important factor causing optic nerve damage.Abbreviations NTG Normal Tension Glaucoma     

Pulsatile ocular blood flow investigation in asymmetric normal tension glaucoma and normal subjects

AIMS—This study was designed to investigate pulsatile ocular blood flow (POBF) in normal tension glaucoma (NTG) patients and in normal controls. NTG patients with unilateral field loss were evaluated to compare POBF values between eyes with and without field loss.
METHODS—POBF measurements from more than 1500 subjects were collected during a period of 6 months from six optometric centres. Subjects with systemic vascular diseases (such as systemic hypertension and diabetes), ophthalmic diseases, a positive family history of glaucoma, and those individuals receiving treatment with systemic β blockers were excluded on the basis of a questionnaire. For comparison, 95 NTG patients with unilateral field loss, selected from 403 consecutive patients with NTG, underwent POBF testing. For each individual age, sex, intraocular pressure, refraction, and pulse rate were entered into a database.
RESULTS—Data from 777 subjects were included in the analysis. POBF measurements of patients and subjects were compared allowing for differences in age, sex, intraocular pressure, refraction, and pulse rate. POBF was significantly lower in eyes of NTG patients with and without field loss (p <0.001 and p = 0.01 respectively). Eyes of NTG patients with field loss showed significantly lower POBF than the contralateral eyes with normal field (p < 0.001).
CONCLUSIONS—POBF was significantly lower in eyes of NTG patients with and without field loss than in normal subjects, suggesting that differences in ocular blood perfusion are relevant to the development of NTG and are detectable from the early stage of the disease. Furthermore, the finding of lower POBF in NTG eyes with field loss than in the contralateral eyes with normal field suggests that haemodynamic differences between fellow eyes contribute to determine the side of onset of the disease.

Keywords: pulsatile ocular blood flow; normal tension glaucoma; visual field asymmetry     

New directions in the treatment of normal tension glaucoma

Glaucoma is a progressive optic neuropathy that causes characteristic changes of the optic nerve and visual field in relation to intraocular pressure (IOP). It is now known that glaucoma can occur at statistically normal IOPs and prevalence studies have shown that normal tension glaucoma (NTG) is more common than previously thought. While IOP is believed to be the predominant risk factor in primary open angle glaucoma (POAG), IOP-independent risk factors, such as vascular dysregulation, are believed to play an important part in the pathogenesis of NTG. Though certain distinguishing phenotypic features of NTG have been reported, such as an increased frequency of disc hemorrhages, acquired pits of the optic nerve and characteristic patterns of disc cupping and visual field loss, there is much overlap of the clinical findings in NTG with POAG, suggesting that NTG is likely part of a continuum of open angle glaucomas. However, IOP modification is still the mainstay of treatment in NTG. As in traditional POAG, reduction of IOP can be achieved with the use of medications, laser trabeculoplasty or surgery. Studies now show that the choice of medication may also be important in determining the outcomes of these patients. Though it is likely that future treatment of NTG will involve modification of both IOP and IOP-independent risk factors, current efforts to develop IOP-independent neuroprotective treatments have not yet proven to be effective in humans.     

正常眼压性青光眼病因学相关因素与分型

正常眼压性青光眼（NTG）的青光眼性视神经损伤和视野丢失在临床表现和发病机制上与原发性开角型青光眼（POAG）有一定差异。我们将NTG的发病机制可分为缺血缺氧型（存在低血压,合并心肌缺血、头痛和偏头痛、血浆内皮素-1水平增加、血小板聚集能力增加、缺血性颅脑病变等）、免疫异常型（存在单克隆丙种球蛋白血症以及抗视紫红质抗体、热休克蛋白的自身抗体、神经元特异性烯醇酶抗体、抗磷脂抗体异常）、神经退行性病变相关型（如Alzheimer病、Parkinson病）、内分泌异常型（如甲状腺功能低下）、眼压与颅内压失衡等,这将有助于NTG患者临床治疗方式的转变。（眼科,2012,21：19-23）     

Impact of intraocular pressure fluctuations on progression of normal tension glaucoma

AIM: To investigate short- and long-term intraocular pressure (IOP) fluctuations and further ocular and demographic parameters as predictors for normal tension glaucoma (NTG) progression. METHODS: This retrospective, longitudinal cohort study included 137 eyes of 75 patients with NTG, defined by glaucomatous optic disc or visual field defect with normal IOP (<21 mm Hg), independently from therapy regimen. IOP fluctuation, mean, and maximum were inspected with a mean follow-up of 38mo [standard deviation (SD) 18mo]. Inclusion criteria were the performance of minimum two 48-hour profiles including perimetry, Heidelberg retina tomograph (HRT) imaging, and optic disc photographs. The impact of IOP parameters, myopia, sex, cup-to-disc-ratio, and visual field results on progression of NTG were analyzed using Cox regression models. A sub-group analysis with results from optical coherence tomography (OCT) was performed. RESULTS: IOP fluctuations, average, and maximum were not risk factors for progression in NTG patients, although maximum IOP at the initial IOP profile was higher in eyes with progression than in eyes without progression (P=0.054). The 46/137 (33.5%) eyes progressed over the follow-up period. Overall progression (at least three progression confirmations) occurred in 28/137 eyes (20.4%). Most progressions were detected by perimetry (36/46). Long-term IOP mean over all pressure profiles was 12.8 mm Hg (SD 1.3 mm Hg); IOP fluctuation was 1.4 mm Hg (SD 0.8 mm Hg). The progression-free five-year rate was 58.2% (SD 6.5%). CONCLUSION: Short- and long-term IOP fluctuations do not result in progression of NTG. As functional changes are most likely to happen, NTG should be monitored with visual field testing more often than with other devices.     

正常眼压性青光眼的危险因素

正常眼压性青光眼（normal tension glaucoma,NTG）在临床特征上除了眼压在正常范围外,其余均与开角型青光眼有许多相同之处,故以往一直被认为是开角型青光眼的一个亚型.但随着对此疾病的认识逐渐加深,发现其危险因素与高眼压性开角型青光眼有所不同,全身情况及眼局部因素都对NTG的发生发展产生影响,主要包括性别、年龄、脑供血不足、眼压波动、眼轴长度、屈光度等方面.     

正常眼压性青光眼患者白内障术后房角参数的变化

目的利用眼前节光学相干断层扫描(optical coherence tomography,OCT)观察正常眼压性青光眼(normal tension glaucoma,NTG)患者白内障手术后前房角形态和眼压的变化。方法共有106例患者纳入本研究,其中单纯年龄相关性白内障患者67例67眼为对照组、NTG合并白内障患者43例43眼为观察组。2组患者均行白内障超声乳化吸出联合人工晶状体植入术治疗。在术前和术后1个月、6个月测量眼压、前节OCT检查房角,自动计算四个象限(颞侧、鼻侧、上方和下方)的中央前房深度(anterior chamber depth,ACD)、前房宽度(anterior chamber width,ACW)、房角开放距离(angle open distance,AOD)、小梁虹膜空间面积(trabecular iris area,TISA)、房角隐窝面积(angle recess area,ARA)。比较手术前后两组患者眼压、房角参数的变化。结果观察组术前眼压为(13.2±2.9)mmHg(1 kPa=7.5 mmHg),术后1个月、6个月眼压分别为(10.5±3.0)...