原发性开角型和低压性青光眼早期视野及视网膜神经纤维层损害的比较

目的探讨原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎ－ａｎｇｌｅｇｌａｕｃｏｍａ，ＰＯＡＧ）和低压性青光眼（ｌｏｗｔｅｎｓｉｏｎｇｌａｕｃｏｍａ，ＬＴＧ）早期视野损害及视网膜神经纤维层缺损的特点。方法应用ＱＺＳ－２型自动视野计全阈值程序对２６例（４１只眼）早期ＰＯＡＧ和１３例（１５只眼）早期ＬＴＧ进行定量视野测定，所有患者散瞳做视盘和视网膜神经纤维层照像，分析视网膜神经纤维层缺损的类型和程度。结果早期ＰＯＡＧ和ＬＴＧ视野损害多表现为局限性视网膜光敏感度下降，少数表现为弥漫性光敏感度下降，视野损害主要位于中心视野，少数可合并周边视野损害。中心视野平均光敏感度和短期波动与正常对照组之间差异有显著性，两型青光眼早期视野损害和视网膜神经纤维层缺损的类型及损害部位分布差异无显著性。结论早期ＰＯＡＧ和ＬＴＧ视野损害特征及视网膜神经纤维层缺损形态一致     

青光眼旁中心区光阈值及短期波动的初步探讨

青光眼视野改变的发生和发展是一渐进性过程。近年来,国外许多学者致力于自动定量视野计光阈值及其波动的研究,以期在青光眼视野缺损出现前,发现有意义的最早期视功能改变。Hart和Bocker(1582)提出,青光眼最早期的视野改变不是相对暗点,而是光阈值的升高。Flammer(1084)报道,青光眼阈值的波动明显大于正常人,而且,这种波动的增加是将出现视野缺损的先兆表现,我们采用Humphrey自动视野计对一组青光眼患者进行光阈值定量检查,以探讨光阈值改变及其短期波动在青光眼早期诊断中的意义。     

早期糖尿病患者中心视野改变分析

目的通过检测早期糖尿病患者和正常人群中心视野(30°)改变,分析探讨糖尿病视网膜病变早期的损伤机制。方法应用国产TEC3全自动视野检查仪对早期糖尿病眼底血管无异常改变的患者38例76眼和正常对照组32例64眼,行常规中心视野检查:检测平均光敏感度、平均缺损和短期波动。检测结果行统计学处理。结果早期糖尿病患者组76眼中有40眼出现中心视野异常,占52.63%;与正常对照组相比,平均光敏感度、平均缺损、短期波动3项指标均相差非常显著(P<0.01)。结论糖尿病患者的糖代谢紊乱首先影响了视网膜的感觉神经功能,中心视野检查对糖尿病视网膜病变前期有一定的临床诊断价值。     

一种评价青光眼视野损害的新方法——上下方Bjerrum区静态光阈值不对称

鉴于早期青光眼视野缺损具有上下方视野不对称特点,根据不对称视野计分可能发现早期青光眼视野损害。通过比较同一跟上下Bjerrum区相对应点群的平均光敏感度,分析54只已有早期或中期视野缺损的青光眼和105只正常眼的自动视野计资料。94.44%(51/54)的青光眼和92.38%(97/105)的正常眼被正确鉴定。此分析方法简单,对于检测青光眼视野缺损有较高的敏感性和特异性。     

慢性闭角型青光眼未发病眼视网膜神经纤维层的厚度

目的:采用偏振激光扫描仪(GDxVCC系统)检测正常眼、慢性闭角型青光眼(chronicangle-closureglaucoma,CACG)有明显视野缺损的患眼及其视野未受损害的另眼(未发病眼)的视网膜神经纤维层(retinalnervefiberlayer,RNFL)厚度,并进行比较,了解未发病眼RNFL厚度变化有无改变,探讨GDxVCC系统在慢性闭角型青光眼早期诊断中的价值。方法:前瞻性对照研究。慢性闭角型青光眼患者26例,1眼具有可重复性视野缺损,其另眼视野检查正常(如:差异概率图上≤1个测试点在5%概率水平以下),将视野正常的未发病眼定为CACG-视野正常组,有视野缺损的已确诊眼为CACG-视野缺损组;24例48眼年龄相匹配的正常人作为对照组。所有入选对象进行视野和GDxVCC系统检查。采用方差分析,对CACG-视野正常组、CACG-视野缺损组、正常对照组的RNFL参数进行两两比较GDxVCC检测RNFL厚度。结果:与正常对照组相比,CACG患者视野未受损组眼的视网膜神经纤维层变薄。但视野未受损眼的RNFL明显厚于视野缺损眼。3组的各RNFL参数差异均有显著统计学意义;CACG—视野正常组与正常对照组间下方平均值和神经纤维指数(P=0.073,P=0.054)差异无显著统计学意义,但其椭圆平均值、上方平均值及TSNIT标准差与正常对照组相比有极显著统计学意义(P=0.002,P=0.002,P=0.010)。结论:GDxVCC系统可以更早地检测出CACG未发病眼RNFL结构损害,对临床处理早期CACG具有指导意义。     

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。     

青少年近视合并高眼压的静态阈值视野改变

目的：探讨合并高眼压青少年近视的静态视野改变的特点及其临床意义。方法：应用Octopus101型全自动视野计对45例(87只眼)青少年近视合并高眼压和36例(72只眼)正常眼压青少年近视进行定量视野测定，并分析其视野缺损形式及视野指数与眼压、屈光度的关系。结果：合并高眼压青少年近视的视野损害发生率明显高于正常眼压青少年近视。视野损害多表现为生理盲点扩大，特征性青光眼视野缺损。与正常眼压青少年近视有显著性差异。平均敏感皮MS值、平均缺损MD值、缺损变异LV值均与正常眼压青少年近视有显著性差异，且在正常眼压青少年近视组中，随着近视度数增加，MS值逐渐下降，MD及LV值逐渐升高。结论：高眼压是青少年近视人群中发展为青光眼性视野损害的一个重要因素。眼压应列为青少年近视的眼科常规检查项目。采用全自动视野计检测是早期发现青少年近视青光眼性视野损害的最敏感最有特异性的检查方法。     

正常人周边视野正常值及共与青光眼周边视野的比较：阈上值自动定…

使用ＹＤＳ－１０３型全视野立体定量分析仪检测１１６只正常眼和９２只青光眼的视野，表明正常人周边视岛不同层次上缺损的立体角值随年龄增长而增加，随层次加深渐减少，并建立了不同年龄组视野立体角缺损正常值的范围，对青光眼组的分析表明，表光眼的中心与周边视野缺损在定性、定位和定量上均表现出良好的一致性。     

可疑青光眼中心视野分析

用TBC－1微机中心视野分析仪对可疑青光眼537眼进行检查，发现有249眼出现了神经纤维束型视野缺损占46．4％，从灰度看（视野缺损总体积）绝大多数为早期改变。视野损害以Seidle暗点、生理盲点扩大及旁中心暗点为最多，在眼压与眼底两顶指征中，有一项有明显改变时视野损害的可能性也明显增多。     

正常人及青光眼患者中心30°视野光敏感度的定量分析

目的检测正常人及青光眼（有或无早期视野损害）患者中心视野光敏感度的差异,并提出早期视野损害的识别标准。方法对７５例（１０８只眼）正常人,年龄２０～７８岁;５３例（８２只眼）早期开角型或闭角型青光眼患者,年龄３０～７０岁;采用美国Ｈｕｍｐｈｒｅｙ６１０型视野分析仪,中心３０２程序,检测３０°视野内７６个点的光敏感度。结果正常组与青光眼组间性别与眼别光敏感度差异无显著性。正常眼组２０～４５岁与４６～７８岁组间的光敏感度差异有显著性。计算正常年龄组２０～４５岁和４６～７８岁两个年龄组中心视野每一检测点的８０％正常范围的下限值,距中心每隔１０°光敏感度降低２或３ｄＢ,下方视野光敏感度高于上方视野１或２ｄＢ,鼻侧与颞侧间的光敏感度差异无显著性。有视野缺损的青光眼患者,视野中多个检查点显示光敏感度下降４～８ｄＢ;无视野缺损患者与正常对照组比较,光敏感度降低１或２ｄＢ。结论根据正常眼与８０％正常范围的光敏感度下限值比较结果,提出青光眼视野损害分级标准：Ⅰ级：视野中有数个聚集点的光敏感度下降１～３ｄＢ;Ⅱ级：视野中有数个聚集点的光敏感度下降４～６ｄＢ;Ⅲ级：视野中有数个聚集点的光敏感度下降＞６ｄＢ。     

Cluster analysis in visual field quantification

The central visual fields of 2165 normal and 106 glaucoma eyes were measured using a threshold related suprathreshold strategy. The effects of altering the cluster radius in normals and glaucoma eyes sheds light on the nature of defects in these two groups. It is estimated that approximately 13% of normals have clusters; the great majority of these individuals have one cluster of two defects. Most clusters in normals are formed artefactually due to angioscotoma and/or physiological variations in the blind spot position. Clusters due to other factors occur rarely. Clusters are found with equal frequencies in the superior and inferior fields in normal eyes, but with a greater frequency in the superior field in glaucoma eyes.The use of clusters in quantification is both sensitive and specific. Using results from this large sample and looking at other visual field properties, it is possible to devise weighted probability indices to score visual fields.     

多点静态定量视野计检查开角型青光眼

目的 比较采用多点静态定量视野分析仪（Ｆｒｉｅｄｍａｎｎ ｖｉｓｕａｌ ｆｉｅｌｄ ａｎａｌｙｓｅｒ,ＦＶＦＡ）与中心平面视野屏检查视野在青光眼诊断中的作用。方法 应用两种视野计对４８例（９５只眼）开角型青光眼患者进行视野检查。结果 ２６只眼在视野屏上用２／１０００视标查出小的视野缺损,而用ＦＶＦＡ检查出完全相似者２３只眼（８８％）;２６只眼在ＦＶＦＡ查出早期青光眼视野缺损,而在视野屏上必须用１／     

Absolute filling defects of the optic disc in fluorescein angiograms in glaucoma--a retrospective clinical study

BACKGROUND: Analysis of clinical importance of the size of filling defects in fluorescein angiograms in primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), ocular hypertension and subjects with physiological excavations in comparison to visual field loss, optic nerve head morphology and hemodynamics. PATIENTS AND METHODS: 75 patients (POAG, NTG, ocular hypertension) and 10 healthy subjects with physiological excavations were included in this study. In digitized video fluorescein angiograms (Scanning Laser Ophthalmoscope) the size of absolute filling defects of the optic disc was quantified in the early venous phase and expressed by percentage of the optic disc. Visual fields were obtained by conventional static perimetry (Humphrey 24-2) and graded in stages of glaucoma visual field defects (Aulhorn I-V). Optic disc excavations were evaluated as cup-to-disc-area-ratios. RESULTS: The filling defects correlated with the visual-field loss stages of Aulhorn and the visual field indices MD (mean deviation), PSD (pattern standard deviation) and CPSD (corrected pattern standard deviation). There was no correlation with the index SF (short-term fluctuation) and with systemic hemodynamics (blood pressure, perfusion pressure) or the IOP. Absolute filling defects correlated with the cup-to-disc-area-ratio in NTG. The absolute filling defects were larger in patients with glaucoma (POAG, NTG) in comparison to patients without glaucomatous visual field loss (ocular hypertension, glaucoma-like discs). No difference of filling defects was found in the glaucoma group (POAG, NTG). Patients with NTG had larger excavations and lower systolic blood pressures than patients with POAG. CONCLUSION: The size of fluorescein filling defects may be useful as a parameter for the evaluation of an ischemic lesion of the optic nerve head. Absolute filling defects may differentiate POAG from ocular hypertension and NTG from glaucoma-like discs without field defects. The results support the hypothesis that in POAG and NTG disturbances of the circulation result in similar filling defects of the optic disc and visual field loss.     

Multifocal Pattern Electroretinogram does not demonstrate localised field defects in glaucoma

Purpose: To determine if a multifocal PERG could be recorded in normals, and to examine changes in the multifocal PERG in glaucoma patients. To compare the ability of multifocal PERG and multifocal VEP responses in the same individuals to identify localised field defects in glaucoma. Methods: Using the VERIS Scientific^TM system multifocal PERGs were recorded from 19 sites of the visual field according to pseudo-random binary m-sequence. Twenty normals and 15 glaucoma subjects were tested. Multifocal pattern VEPs were also recorded in the glaucoma cases using a cortically scaled stimulus. Results: The second order kernel of the PERG shows a consistent signal. The overall PERG amplitude decreases with age in normals. In glaucoma the PERG amplitude was reduced across the field, but reductions did not correspond to the area of the scotoma. The VEP showed localised signal reductions in all 15 cases of glaucoma. Conclusion: A multifocal PERG can be recorded in normals. However it did not reflect localised ganglion cell losses, whereas the multifocal pattern VEP recorded to a very similar stimulus in the same individual did show losses in the scotoma area. This revised version was published online in July 2006 with corrections to the Cover Date.     

变化角膜补偿器偏振光激光扫描仪对青光眼的临床观察

目的　评价使用变化角膜补偿器的偏振光激光扫描仪 (GDx -VCC)对青光眼患者的定量观察。方法　对青光眼患者 91人 165眼根据有无视野异常及程度分为 :青光眼视野正常组 87眼 ,早期青光眼 5 6眼及中晚期青光眼 2 2眼 ,正常人组 3 6人 3 6眼进行GDx -VCC检查。统计各组平均视神经纤维层厚度 (RNFL)、上方及下方神经纤维层厚度、平均视盘周神经纤维层厚度标准差及视神经纤维索引因素 (NFI)。对各组值进行多组比较统计处理。结果　正常人平均视神经纤维层厚度、上方及下方神经纤维层厚度与视野有异常的青光眼各组值方差分析P <0 0 0 1;与视野正常的青光眼组各对应区域的神经纤维层厚度比较P =0 0 0 9、 0 0 0 5及 0 0 64。结论　使用变化角膜补偿器的偏振光激光扫描仪测量视神经纤维层厚度对正常人与青光眼患者有区别能力 ,能更早于视野反映视神经纤维层异常。     

Progressive visual field defects from experimental glaucoma: measurements with white and colored stimuli.

PURPOSE: Our purpose was to study the effects of using monochromatic test stimuli to measure the relative rate of progression of visual field defects caused by experimental glaucoma. METHODS: Visual field measurements were obtained by static perimetry from trained macaque monkeys with laser-induced, unilateral glaucoma. The visual field defects were assessed by perimetric (global) indices derived from comparisons of experimental visual fields to the expected normal fields of monkeys. Three types of perimetry stimuli were used, the conventional white Goldmann III and two monochromatic (460 and 620 nm) Goldmann V test stimuli. The relationships between field defects with white and monochromatic stimuli were investigated by linear regression of the Z-scores for the perimetric indices. RESULTS: The correlations between the mean deviation global indices for chromatic vs. white stimuli were high (r > 0.9) and linear throughout the period of progression of field defects. The slopes of the regression lines typically were greater than unity, indicating that statistical significance was higher for visual field defects measured with chromatic stimuli than with white light stimuli. The higher significance level for defects measured with chromatic stimuli was not explained by a difference in visual thresholds, because the thresholds with chromatic and white light were highly correlated across the full range of visual field defects, from initial-onset to end-state. This result also suggests that the early detection of glaucomatous visual defects with monochromatic stimuli does not reflect a selective loss of retinal ganglion cells. CONCLUSIONS: Although these experiments do not suggest an alternative neural mechanism for the clinical utility of perimetry with chromatic light for the early detection of glaucoma, it is very likely that the combinations of neural and/or analytical factors that explain the utility of perimetry with chromatic stimuli will also provide an explanation for the higher sensitivities in identifying early glaucoma reported for other prototype stimuli.     

原发性开角型和低压性青光眼早期视野及视网膜神经纤维层损害…

探讨原发性开角型青光眼和低压性青光眼早期视野损害及视网膜神经纤维层缺损的特点。     

The full-field flicker test in glaucomas: influence of intraocular pressure and pattern of visual field losses

· Background: The purpose of this study was to evaluate how temporal contrast sensitivity (TCS) determined with full-field flicker stimuli is influenced by intraocular pressure and whether TCS is reduced in glaucoma patients with diffuse perimetric losses as well as in patients with localized visual field deficits. · Methods: TCS was determined with sinusoidally flickering light (37.1 Hz) in a full-field bowl. Perimetric mean defect (MD) and cumulative defect curves (Octopus G1) were used to distinguish between patients with localized and diffuse field deficits. Normal subjects (296), low-tension glaucoma patients (98) and open-angle glaucoma patients with previously elevated intraocular pressure (541) were classified into five subgroups taking into account the depth of their visual field losses. · Results: No significant correlation between full-field flicker sensitivity and prevailing intraocular pressure was found in normals (Y=1.36+0.006 X) or in patients (Y=0.95–0.0002 X). Analyses of validity at a predefined specificity of 90% reveal a reduction of TCS in patients with early (MD<5 dB) diffuse perimetric losses (sensitivity 69%) as well as in those showing localized visual field defects (sensitivity 65%). Sensitivity was 87% in patients with diffuse perimetric defects (MD 5–10 dB), 93% in a group of patients with both types of losses, and 100% in advanced glaucomas (MD>20 dB). The lack of TCS is similar in open-angle glaucomas and in field-loss-matched normal-tension glaucoma patients. · Conclusions: Significantly reduced TCS in patients with early diffuse perimetric losses as well as in those showing localized visual field defects indicates that localized damages can be associated with general deterioration of the ability to perceive flickering stimuli. Thus, this flicker test can be performed in a full-field bowl with no need for fixation. Considering its other clinical qualities (photopic conditions, low influence of prevailing intraocular pressure and media opacity) the test may be a useful, convenient supplementary procedure in glaucoma screening. Received: 12 March 1998 Revised version received: 11 January 1999 Accepted: 12 January 1999     

Visual field defects in high myopic glaucoma compared with moderate myopic glaucoma

PURPOSE: To demonstrate the visual field defects characteristic of high myopic glaucoma eyes. METHODS: Eighty-one high myopic glaucoma eyes (< or = -8 diopter(D)) and eighty moderate myopic glaucoma eyes(-3 D approximately -6 D) from patients under the age of 60 were enrolled in this study. Visual acuity, Mean Deviation (MD) of Humphrey visual field analyzer (HFA) central 30-2 program, and the pattern of central visual field defect especially at the early stage of glaucoma (MD > or = -10 dB) were compared between high and moderate myopic groups. RESULTS: HFA examination revealed significant differences in MD values between the high and moderate myopic groups (-11.8 +/- 8.9 dB and -8.4 +/- 6.9 dB, respectively, p = 0.02). Average logMAR visual acuity of the high myopic group was significantly worse than that of the moderate myopic group. The analyses of the pattern of visual field defects especially at an early glaucoma stage demonstrated that there was no specifically damaged area, such as cecocentral scotoma, in high myopic glaucoma subjects. The nasal upper area of the fixation point was the area most affected in both groups. CONCLUSIONS: High myopic glaucoma eyes demonstrated significantly lower MD and visual acuity compared to those of moderate myopic glaucoma eyes. However, at an early stage of glaucoma, no visual field defect characteristic of high myopia was observed.