原发性开角型青光眼HRT视盘参数和视野缺损的关系

目的 :探讨原发性开角型青光眼视盘参数和视野平均缺损之间的关系。方法 :用海德堡视网膜断层扫描仪和自动视野计测定 5 5名原发性开角型青光眼患者的视盘参数 (杯盘面积比、盘沿面积、盘沿容积、视杯容积、视杯形态测量、视杯高度变异轮廓和平均神经纤维层厚度 )和静态光阈值。视盘参数与视野平均缺损作相关分析和多元线性回归分析。结果 :盘沿面积与平均缺损显著相关 (r =0 3 5 0 ,P <0 0 5 )。盘沿面积每减少 1mm2 ,视野缺损绝对值增加 8 0 81dB。本研究没有发现其它 6个参数与平均缺损相关关系的显著性。结论 :盘沿面积在HRT众多参数中最能反映青光眼的视野平均缺损程度。     

原发性开角型青光眼HRT视盘结构参数与视野缺损相关性研究

目的探讨出现视野缺损与未出现视野缺损的原发性开角型青光眼视盘结构参数的异同及视盘参数与视野平均缺损（MD）的相关性。方法应用海德堡视网膜断层扫描仪（HRT-Ⅱ）和Octopus101视野G2程序对29例（50只眼）原发性开角型青光眼患者进行检查,对出现视野缺损与未出现视野缺损的原发性开角型青光眼视盘结构参数进行比较,检测结果进行t检验;对出现视野缺损的原发性开角型青光眼组的视盘各参数与视野平均缺损进行简单相关分析。结果视野出现缺损组与未出现缺损组的原发性开角型青光眼患者的视盘参数除视盘面积和轮廓线高度变化值外,其余各视盘参数间差异均有显著性（P〈0．01）;对出现视野缺损的原发性开角型青光眼患者HRT视盘各参数与MD进行相关分析显示,盘沿面积与MD间相关性最强（r=0．65,P=0．001）。结论HRT视盘参数能够较准确反映与视野损害相一致的青光眼性视盘改变,盘沿面积在HRT众多参数中最能反映青光眼的视野平均缺损程度。     

原发性开角型青光眼 HRT 视盘参数与视野缺损计分的关系

目的探讨原发性开角型青光眼(primary open an-gle glaucoma,POAG)病例的海德堡视网膜断层扫描仪(Hei-delberg retinal tomoscanner,HRT-Ⅱ)视盘参数与视野缺损计分的关系。方法对29例(30眼)POAG患者采用HRT-Ⅱ进行视盘检测;采用Humphrey视野计进行视野检查,运用AGIS计分系统并稍加改动对视野缺损情况进行计分,HRT参数包括视盘面积、视杯面积、盘沿面积、视杯容积、杯盘面积比、线性杯/盘比、平均视杯深度、视盘最大深度、平均视网膜神经纤维层厚度、视杯形态测量,将HRT视盘参数与视野计分进行相关统计学处理。结果HRT视盘参数中盘沿面积、视杯容积、杯盘面积比、平均视网膜神经纤维层厚度、视杯形态测量与视野缺损计分有直线相关关系。对视盘参数与视野计分进行逐步回归筛选变量时盘沿面积被选入,建立回归方程Y=12.351-5.123X(Y表示视野缺损计分,X表示盘沿面积)。结论POAG的视盘参数中盘沿面积与视野缺损计分关系最密切,视野缺损计分能对视野损害程度进行准确量化。     

P-ERG与盘沿面积测量在原发性开角型青光眼早期诊断中的应用比较

目的观察图形视网膜电图（P—ERG）检查与海德堡视网膜断层扫描仪（HRT—Ⅲ）测量盘沿面积在原发性开角型青光眼（POAG）的早期诊断中的应用价值。方法选择早期POAG患者25例（25只眼）,可疑青光眼患者25例（25只眼）,正常对照组25冽（25只眼）,分别进行HRT—Ⅲ及P-ERG检查,观察检查结果异常率,并分析HRT-Ⅲ盘沿面积与P-ERG N95振幅的相互关系。结果在早期POAG组,P-ERG、HRT—Ⅲ检测异常率分别为72％、32％,差别具有显著意义（P〈0．05）;可疑青光眼组,HRT-Ⅲ、P-ERG检测异常率分别为20％、60％,差别具有显著意义（P〈0．05）;正常对照组,HRT-Ⅲ、P-ERG检测异常率分别为20％、12％,差别无显著意义（P〉0．05）。在早期POAG组,盘沿面积与N95波振幅在颞上、鼻下、鼻上区存在正相关,相关系数r分别为0．478、0．418、0．444;可疑青光眼组,盘沿面积与N95波振幅在颞下区存在正相关,相关系数r为0．496;正常对照组,盘沿面积与N95波振幅在鼻上,鼻下区存在正相关,相关系数r分别为0．449、0．438。结论在POAG的早期诊断中,P-ERG的检测异常率明显高于HRT-Ⅲ,且盘沿面积与N95波振幅存在一定相关性,联合检查将更有助于POAG的早期诊断。     

海德堡视网膜断层扫描仪在开角型青光眼视盘检测中的意义

目的 探讨海德堡视网膜断层扫描仪(HRT)检测开角型青光眼视盘参数与视野损害的关系。评价HRT在早期诊断青光眼中的意义。方法 正常人26例(41只眼)，高眼压11例(16只眼)、原发性开角型青光眼28例(38只眼)。采用Humphrey全自动视野计、HRT分别进行视野、视盘形态检测。比较正常组、高眼压组、青光眼组HRT视盘检测参数．分析青光眼组视野检测的平均缺损(MD)与HRT视盘检测参数的关系。结果 正常组、高眼压组、青光眼组视杯面积、杯／盘面积比、盘沿面积、视杯形态测量指数、视网膜神经纤维层厚度差异有显著性。青光眼组的盘沿面积、杯／盘面积比、视杯形成测量指数、视网膜神经纤维层厚度与视野检测的平均缺损有显著相关。结论 HRT能够反映青光眼视盘改变，为临床早期诊断青光眼提供更多的信息。     

慢性闭角型青光眼与正常眼压性青光眼视盘形态比较

目的探讨眼压依赖型与非眼压全依赖型青光眼患者视盘损害的形态异同。方法用回顾性配对设计研究。选择具有青光眼性视野缺损（MD〈10dB）的慢性闭角青光眼（CACG）和正常眼压青光眼（NTG）患者各20例20眼,年龄、视野平均偏差（mean deviation,MD）一对一相匹配。应用海德堡视网膜断层扫描仪（HRT-Ⅱ）进行定量视盘参数检查,并对检查结果进行比较。结果CACG组视盘总体和颞下、鼻下、鼻上分区的盘沿面积大于NTG组;差异有统计学意义（P〈0.05）;CACG组视盘总体和各分区（除颞侧外）视杯容积小于NTG组,两组间差异均有统计学意义（P〈0.05）;CACG组视盘总体和各分区（除颞侧及颞下外）视杯平均深度及视杯形态测量值小于NTG组,两组间差异均有统计学意义（P〈0.05）。结论CACG与NTG在疾病早中期视盘形态明显不同,提示眼压依赖型与非眼压全依赖型青光眼可能具有不同的视神经病变发生机制。     

海德堡视网膜断层扫描仪在开角型青光眼中的应用

介绍海德堡视网膜断层扫描仪（HRT）在开角型青光眼中的应用。HRT检查提供的视乳头及神经纤维层厚度参数,是客观准确的指标,对原发性开角型青光眼的早期诊断有很大的帮助。     

原发性开角型青光眼视盘形态变化分析33例(英文)

目的:分析原发性开角型青光眼(POAG)视盘损害的进展和进展频率。方法:33例(66眼)POAG患者,男14例,女19例,年龄14 ～79岁,在随访的6a间(2000/2006),3次或更多次进行海德堡视网膜断层扫描仪Ⅱ(HRT Ⅱ)检查。对整体和节段的视盘参数进行回归分析判断视盘损害的进展。患者每年进行Octopus G1计算机视野分析检查一次。激光扫描视盘图像参数包括:盘沿面积(ra),杯盘比(C/D),盘沿体积(rv),平均视神经纤维层厚度(mRNFL)。扫描视神经的节段包括总体(G),颞侧(T),颞上(TS),颞下(TI),鼻侧(N),鼻上方(NS)和鼻下(NI)。结果:根据杯盘比C/D,总体上有34眼(51%)视盘损害进展,32眼(48%)没有进展。12眼(18%)颞侧(T),7眼(10.6%)颞上,14眼(21%)颞下,8眼(12%)鼻侧,7眼(10,6%)鼻上,13眼(20%)鼻下,视盘损害进展。5眼(8%)没有进展。结论:在鼻侧(N)及颞下方(TI)视盘损害进展最多,进展频率最高在颞下方(TI)和鼻下方(NI),频率最低在鼻上方(NI)。杯盘比C/D最敏感。节段扫描对POAG进展分析有重要意义。     

视盘损伤可能度与原发性开角型青光眼视盘结构和功能的关系

目的:探讨利用海德堡视网膜断层扫描仪-Ⅲ(HRT-Ⅲ)对原发性开角型青光眼(primary open angle glaucoma,POAG)进行视盘损伤可能度(disc damage likelihood scale,DDLS)评分,DDLS值能否反映POAG视盘结构和功能的变化。方法:共有60例POAG纳入本研究。对受检者进行HRT-Ⅲ和OCTOPUS-900视野检查,记录盘沿面积(rim area,RA)和视野平均缺损(mean defect,MD)值。根据HRT-Ⅲ的地形图、反射图和DDLS评分表,对受检者的视盘进行DDLS评分。对结果选用Persons相关系数分析各数值之间的相关性。结果:患者60眼中视盘面积3.09～3.43mm2有11眼,2.41～2.67mm2有36眼,1.64～1.81mm2有13眼。研究结果显示DDLS值与RA和MD相关;随视盘面积变化,DDLS值与MD相关性无明显变化。结论:应用HRT对POAG视盘进行DDLS分期,能够很好的对视神经结构和功能的损害程度进行分级。     

视盘形态分析在基层医院原发性开角型青光眼早期诊断中的作用

目的:探讨视盘形态分析在原发性开角型青光眼早期诊断中的作用。方法:选取72例视乳头杯盘比在0.5~0.8之间的受检者进行视力、裂隙灯、直接检眼镜检查、测眼压及24h眼压曲线、检影验光,并行房角镜、电脑视野和光学相干断层成像(optical coherence tomography,OCT)检查,并对上述检查结果进行分析。结果:视盘形态正常者仅有10例眼压在可疑范围,视野、OCT检查未见异常;而视盘形态异常者中眼压、视野及OCT异常者占较大比例。结论:视盘形态在原发性开角型青光眼早期诊断中是一敏感因素。     

Detection of optic disc change with the Heidelberg retina tomograph before confirmed visual field change in ocular hypertensives converting to early glaucoma

AIM: To determine whether analysis of sequential optic disc images obtained with the Heidelberg retina tomograph (HRT) is able to demonstrate optic disc change before the development of reproducible field defects in a group of ocular hypertensive (OHT) patients converting to early glaucoma. METHODS: Two groups were analysed: (1) 13 eyes of 13 OHT patients who subsequently developed reproducible field defects (converters); and (2) 13 eyes of 11 normal control subjects. Two sequential optic disc images were obtained using the HRT (median separation between images was 12 months for the converters and 13 months for the normals). The second image in the converter group was obtained before confirmed visual field loss. The optic disc variables were analysed both globally and segmentally using HRT software version 1.11. The Wilcoxon signed rank test was used to determine if there were any significant differences between the variables of the two image sets. RESULTS: Significant optic disc change was demonstrated in the group of converters: (1) global variables: the cup area increased by 9.7%, the C/D area ratio increased by 10.5%, and the rim area decreased by 6.9%; (2) segmental variables: the superonasal cup area increased by 11.0%, the superonasal C/D area ratio increased 11.7%, and the inferonasal cup volume increased by 28.4%. The temporal rim volume decreased by 15.6%, the inferotemporal rim volume decreased by 23.6%, and the rim area in the superonasal and superotemporal segments decreased by 6.6% and 6.9% respectively. CONCLUSION: Analysis of sequential optic disc images on the HRT allowed the detection of glaucomatous change before confirmed visual field change in a group of OHT patients converting to early glaucoma.     

HRT在青光眼与近视眼中的研究

青光眼是以进行性视神经损害为特征的不可逆性致盲眼病,其病理基础是视网膜神经节细胞及其纤维的进行性丧失;近视眼是开角型青光眼的易患因素,合并近视的青光眼患者其检查结果又有自身的特点,这给我们早期的准确诊断增加了难度;HRT是一种自动化的电子计算机控制的共焦激光眼底断层扫描仪。利用HRT(heidelberg retinatom ograph)可以获取视盘的三维地形图,通过对图像的分析处理,得到视盘和视网膜神经纤维层厚度的定量描述,并且可用于地形图变化的定量分析。本文就HRT在青光眼和近视眼特别是近视合并青光眼中的诊断和在视神经损害监测中的研究作一综述。     

慢性闭角型青光眼的HRT-Ⅱ研究

目的使用HRT-Ⅱ检测正常人和慢性闭角型青光眼(CACG)患者的视盘结构参数,并判断Moorfields回归分析 (MRA)和线性判别函数(LDF)对CACG诊断的敏感性和特异性。设计前瞻性对照研究。研究对象 51例(77眼)CACG患者及年龄和屈光度数相匹配的正常人32例(64眼)。方法对CACG患者及正常人进行静态视野和HRT-Ⅱ检测。CACG组被研究眼根据视野平均缺损值(MD)及视野异常评判标准分为无视野缺损组(MD≤2dB或视野评判标准阴性)和视野缺损组(MD>2dB及视野评判标准阳性)。比较正常组、无视野缺损组和视野缺损组三组间及任意两组间各视盘参数的差异。采用MRA和LDF诊断 CACG的敏感性和特异性。主要指标 HRT-Ⅱ视盘结构参数,MD,视野评判标准,诊断敏感性和特异性。结果正常人组和CACG 组间除视盘面积无明显差异外,其余各参数两组间差异均有显著统计学意义(P<0．05)。除视盘面积和轮廓线高度变化值三组间无明显差异外,其余各参数三组间差异均有极显著性意义(P<0．01)。正常组和视野缺损组除视盘面积外,无视野缺损组和视野缺损组除视盘面积和轮廓线高度变化值外,其余各视盘参数两组间均有显著性差异(P<0．05)。正常组和无视野缺损组视盘参数比较,仪盘沿容积和视网膜神经纤维层横截面积两个参数有显著性差异(P<0．05)。对已出现视野缺损的CACG诊断的敏感性和特异性,MRA分别为74．42％及95．31％;LDF则分别为69．77％和92．19％。对临床上诊断的CACG,MRA的敏感性和特异性准确性分别为55．84％和95．30％;LDF则分别为49．35％和92．19％。结论 HRT-Ⅱ对CACG和正常人的视盘检测显示两者视盘的结构具有明显的差异;盘沿容积和视网膜神经纤维层横截面积在正常人和早期CACG存在显著差异;HRT-Ⅱ对已出现视野损害的 CACG诊断的准确性较好,但对早期CACG的诊断仍不明确;HRT-Ⅱ诊断系统中,MRA对CACG诊断的敏感性和准确性较好。     

海德堡视网膜断层扫描仪测量正常人视盘参数

目的 :建立正常人群海德堡视网膜断层扫描仪 (Heidelbergretinatomograph ,HRT)视盘参数的正常值 ,明确哪些因素对正常人HRT视盘参数有影响。方法 :选用 10 2例 (13 2只眼 )正常人 ,用HRT进行视盘扫描 ,视盘参数包括视盘面积、视杯面积和容积、盘沿面积和容积、视杯形态、视杯平均深度和最大深度、杯 /盘面积比、沿 /盘面积比、平均视网膜神经纤维层(retinalnervefiberlayer,RNFL)厚度和横截面积、水平C/D和垂直C/D。计算正常人视盘参数范围 ,用直线回归的方法判断视盘大小和年龄对视盘参数的影响。结果 :正常人左右眼和男女间视盘各参数差异无显著意义 (P >0 0 5)。年龄与RNFL厚度及横截面积呈负相关 ,相关系数分别为 -0 2 3 4和 -0 2 3 5,其余各参数与年龄无关。盘沿容积和视杯最大深度不受视盘大小的影响 ,其余各参数均与视盘大小呈线性相关。结论 :HRT可定量检测正常人视盘参数 ;正常人视盘参数变异很大 ,盘沿容积不受视盘大小的影响 ,是一个区分正常与早期青光眼的很好的参数     

多种视觉电生理联合视野检查对原发性开角型青光眼早期诊断的敏感性

目的 探讨多种视觉电生理联合全自动视野计检查对原发性开角型青光眼早期诊断的敏感性，为临床早期诊断提供客观敏感的指标。方法 选择10例(20眼)原发性开角型青光眼患者和正常对照者10例(20眼)分别进行闪光视网膜电图(F-ERG)、图形视网膜电图(P-ERG)、图形视诱发电位(P-VEP)检查；还对正常对照组、青光眼组中各5例10眼进行多焦视网膜电图(mERG)检查；青光眼组10例(20眼)和正常对照组8例(16眼)行蓝黄视野(B／Y)、标准视野(W／W)检查。结果 P-ERG的N95潜伏期延长较敏感；P-VEP的P100波振幅降低，潜伏期延长但与对照组无明显差异；mERG二阶反应振幅下降，并随离心度的增大而明显降低；B／Y视野检查的视野异常阳性率显著高于W／W视野。结论 B／Y视野检查联合多种视功能检查对原发性开角型青光眼早期诊断较敏感。在眼底杯／盘比未出现改变的早期诊断中，B／Y视野和PERG敏感性较高。     

Long-term evaluation of trabeculectomy in primary open angle glaucoma and chronic primary angle closure glaucoma in an Asian population

Purpose: A retrospective cohort study was undertaken to evaluate and compare the long‐term results of trabeculectomy in primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) in an Asian population. Methods: Yearly diurnal measurements of intraocular pressure (IOP), best‐corrected visual acuity, optic disc and visual field records of patients having primary adult glaucomas who had undergone trabeculectomy, without anti­mitotic agents, with a minimum of 5 years follow up were evaluated. Only one eye of each patient was studied. The success rates for IOP control in POAG and CPACG were statistically analysed. Results: Sixty‐four eyes of 64 patients were studied. The overall probability of success of trabeculectomy in controlling IOP to ≤21 mmHg with or without additional topical antiglaucoma medication was 0.94 and 0.88 at 5 and 10 years, respectively. There was no statistically significant difference in the qualified and absolute success rates for IOP control between POAG and CPACG eyes (log rank test P= 0.6, 0.88, respectively). Twelve of 38 CPACG eyes had a two‐line decrease in visual acuity as compared to four of 26 POAG eyes (P = 0.17). Progression or development of a cataract was the most common cause of visual decline. Conclusions: Trabeculectomy without antimetabolite use appears to be efficacious in lowering IOP and in visual field preservation over a period of 10 years in both POAG and CPACG. Development/progression of cataract especially in eyes with chronic angle closure glaucoma after trabeculectomy must be considered an important issue.     

原发性开角型青光眼视野损害进展相关因素的随访研究

目的：探究原发性开角型青光眼(POAG)患者视野损害进展的相关因素,为临床POAG患者更准确高效的随访提供思路。

方法：前瞻性病例系列研究。将POAG患者39例77眼纳入随访研究,详细询问病史后,进行眼内压(IOP)测量,视野检查及神经纤维层(RNFL)厚度测量,每3mo 1次,共连续随访7次。对患者的家族史、吸烟及饮酒史、年龄、性别、是否手术、IOP波动、基线视野缺损程度、随访期间RNFL厚度变化与视野损害进展进行相关性分析。

结果：随访期间RNFL厚度变化程度与视野损害进展呈正相关(P<0.05)。基线视野缺损程度与视野损害进展有关,中度基线视野缺损与视野损害进展相关性最大,轻度次之,重度最小。

结论：RNFL的厚度变化可能为POAG患者进展性随访提供有用信息; 轻度和重度视野缺损患者进展性的判断应结合视野外信息。     

Comparing glaucomatous optic neuropathy in primary open angle and chronic primary angle closure glaucoma eyes by optical coherence tomography

PURPOSE: To comparatively evaluate the optic nerve head (ONH) using Optical Coherence Tomography (OCT) in normal subjects, primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) patients. METHODS: A total of 138 normal eyes (138 subjects) and 139 glaucomatous eyes (139 patients), were evaluated in this cross-sectional observational study. The ONH was imaged on OCT using the optic disc scan. Disc area, cup area, rim area, vertical integrated rim area (VIRA), rim volume (horizontal integrated rim volume), average cup/disc ratio, horizontal and vertical cup/disc ratios, and cup volume were evaluated. Additionally, cup depth and slope of the temporal ONH were also measured. These ONH parameters were compared between normal subjects and eyes with early POAG and CPACG. Correlation of mean deviation and corrected pattern standard deviation on full threshold 30-2 perimetry, with measured ONH parameters was carried out amongst the two groups. RESULTS: There was a significant difference in disc area (2.38 +/- 0.5, 2.77 +/- 0.4, 2.62 +/- 0.4 mm(2), p < 0.01), cup area (0.88 +/- 0.6, 1.99 +/- 0.7, 1.60 +/- 0.7 mm(2), p < 0.01), rim area (1.48 +/- 0.4, 0.86 +/- 0.4, 0.96 +/- 0.4 mm(2), p < 0.01), VIRA (1.64 +/- 0.3, 1.23 +/- 0.3, 1.22 +/- 0.4 mm(2), p < 0.01), rim volume (0.34 +/- 0.2, 0.1 +/- 0.1, 0.15 +/- 0.1 mm(3), p < 0.01) and cup/disc ratio (0.36 +/- 0.2, 0.69 +/- 0.1, 0.63 +/- 0.2, p < 0.01) in normal vs POAG vs CPACG eyes respectively. A comparison of ONH parameters between early POAG and early CPACG showed a significant difference in the disc area (2.85 +/- 0.3, 2.57 +/- 0.4 mm(2), p = 0.03), cup area (2 +/- 0.5, 1.34 +/- 0.5 mm(2), p < 0.01), rim area (0.96 +/- 0.4, 1.21 +/- 0.5 mm(2), p = 0.009), rim volume (0.12 +/- 0.1, 0.18 +/- 0.1 mm(3), p < 0.01) and cup/disc ratio (0.67 +/- 0.1, 0.53 +/- 0.2, p < 0.01). The parameters with the highest area under the receiver operator characteristic (AROC) curves for differentiating normal and early POAG eyes were rim volume, 0.89, VIRA, 0.84, and rim area, 0.76. The AROC values (normal vs early CPACG eyes) were 0.75 for rim volume, 0.72 for VIRA, and 0.66 for rim area. CONCLUSION: OCT may serve as a useful diagnostic modality in distinguishing a normal optic disc from a glaucomatous one, even in the early stages of glaucoma. Rim volume, VIRA and rim area can be used to differentiate normal from early glaucoma (both early POAG and CPACG), and most efficiently early POAG eyes. CPACG eyes have smaller discs, a smaller cup, smaller cup/disc ratio, and a larger rim area when compared with eyes with POAG.     

多焦视诱发电位在原发性开角型青光眼诊断中的应用

目的通过检测正常人和原发性开角型青光眼（primary open angle glaucoma，POAG）患者的多焦视诱发电位（multlfocal visual evoked potential，mf—VEP）并与Octopus101视野检查等进行对比性研究，客观评价mf—VEP在POAG诊断中的应用价值。方法对32例（64眼）正常人和35例（67眼）POAG患者分别进行眼科常规检查、眼压测定、眼底照相、Octopus101视野和mf—VEP检查。将POAG患者的mf—VEP检查结果与正常人进行对比性研究，并与视野检查进行相关性分析。结果mf-VEP在正常人和POAG组间潜伏期和振幅存在明显差异，经统计学检验差异有显著性。POAG患者mf-VEP潜伏期和振幅值与视野平均光敏感度值具有显著相关性。POAG患者mf—VEP振幅降低区与视野缺损区具有对应性和一致性。结论mf—VEP能客观地反映POAG患者不同视野部位的视功能损害，为POAG患者的诊断和视功能监测提供了新的途径。