OCT3检测视盘参数与视野的相关性研究

目的:研究第三代光学相干断层扫描仪(stratus optical co-herence tomography3000,OCT3)检测原发性开角型青光眼(primary open angle glaucoma,POAG)视盘参数与视野平均缺损(mean defect,MD)的相关性,评估OCT3检测视盘参数在POAG早期诊断中的价值。方法:正常人43例(43眼)、48例原发性可疑型青光眼(SOAG)、55例(55眼)原发性开角型青光眼(POAG)。采用OCULUS Easyflied视野计和OCT3分别进行视野和视盘形态检测。比较OCT3检测三组间视盘参数的差异,分析青光眼组视野检测的视野平均缺损(MD)与OCT3视盘参数的关系。结果:OCT3检测三组间的视盘参数均存在显著性差异(P<0.01)。在原发性开角型青光眼组,RA与MD相关性最好(P<0.05)。结论:OCT3能够检测到青光眼的早期视盘结构的改变,且与MD有基本一致的较好相关性。OCT3检测视盘参数可用于POAG的早期诊断。     

图形视网膜电图与视网膜神经纤维厚度检测在青光眼早期诊断中的临床意义

目的:比较图形视网膜电图(patter nelectroretinograms,PERG)、图形视诱发电位(pattern visual evoked potenlials,PVEP)、光学相干断层成像术(optical coherence tomo-graphy,OCT)测量视网膜神经纤维厚度的方法在原发开角型青光眼和正常眼压型青光眼早期诊断中的临床意义。方法:选择36例(72眼)早、中晚期青光眼患者,其中包括原发性开角型青光眼22例(44眼),正常眼压型青光眼14例(28眼)进行PERG,PVEP和OCT及视野检查,并对检查结果进行统计学分析,配对χ2检验比较各种检查方法在青光眼早期诊断中的敏感性。结果:PERG与PVEP差异具有显著性意义(P<0.01),PERG与OCT差异具有显著性意义(P<0.01),PVEP与OCT差异无统计学意义。PERG,PVEP和OCT检查在早期青光眼的异常率分别为80%,37%和33%。结论:在青光眼的早期诊断中,PERG的敏感性高于OCT和PVEP,但PERG在诊断中的特异性可受到其他眼疾和多种因素的影响,但OCT对眼底的检查有其特异性,所以联合多种检查方法对青光眼的早期诊断和监测具有一定的临床意义。     

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。     

369例老年人及88例老年前期视盘形态的调查

青光眼的诊断主要依靠眼压、视野、视神经盘形态的变异来判断,眼压和视野已有较精确的测定方法,而对视神经盘的变异尚未能充分认识,60年代人们才开始对视盘进行研究,对老年人视盘的变异国内尚未见报导。在开角型青光眼,早期视盘凹陷的变异常比视野缺损出现得早,甚至眼压尚无持续性升高时已有视盘形态的变化,故眼底检查可更早发现青光眼的线索。     

光学相干断层成像与视野检查在早期青光眼诊断中的应用

目的:探讨光学相干断层成像(optical coherence tomo-graphy,OCT)自动视野检查法(standard automatic perme-try,SAP)在早期青光眼诊断中的应用。方法:青光眼患者42例68眼,双眼50眼,单眼18眼,男29例48眼,女13例20眼,左32眼,右36眼,其中开角型青光眼18眼,闭角型青光眼50眼,年龄为36～82(平均60.8±9.2)岁。应用自动视野检查法和光学相干断层扫描仪检查视盘C/D及视网膜神经纤维层的厚度。结果:自动视野检查和光学相干断层扫描(OCT)两种检测方法的阳性率分别为84.37%,93.75%,特别是对于开角型青光眼患者的早期诊断OCT的阳性率更明显。结论:青光眼患者视网膜神经纤维层的丧失或(和)变薄早于视野缺损;视野和OCT的联合应用对青光眼视野缺损进行定性、定量客观评诂。     

OCT血管成像在原发性开角型青光眼早期诊断中的应用

目的：探讨光学相干断层扫描( optical coherence tomography,OCT)血管成像技术对原发性开角型青光眼( primary open angle glaucoma,POAG)早期诊断的价值。方法：观察31例31眼早期POAG患者视盘血流情况。以分光谱振幅去相关 OCT血管成像技术测量视盘周围毛细血管密度及视盘大血管直径,分析与患者视网膜神经纤维层厚度及视野平均缺损度的相关性。结果：视盘上方毛细血管平均密度为7.34±1.40根/mm,与上方视网膜神经纤维层平均厚度呈正相关(P<0.05);视盘下方毛细血管平均密度为7.76±1.34根/mm与下方视网膜神经纤维层平均厚度呈正相关(P<0.05)。视盘大血管平均直径为94.71±11.20μm,与视野平均缺损度呈正相关(P<0.05)。结论：OCT血管成像可以方便无创观察青光眼患者视盘血流情况,可以作为原发性开角型青光眼早期诊断的参考指标。     

HRT-Ⅱ和OCT3检测视网膜神经纤维层厚度在原发性开角型青光眼早期诊断中的应用

目的:探讨海德堡激光眼底扫描仪(HRT-Ⅱ)和光学相干断层扫描仪(OCT3)检测视网膜神经纤维层厚度(retinal nerve fiberlayer,RNFL)在青光眼早期诊断中的价值.方法:可疑开角型青光眼(suspected open angle glaucoma,SOAG)48例、原发性开角型青光眼(primary open angle glaucoma,POAG)55例与年龄相匹配的正常人43例.采用Oculus-Easyfield视野计flied视野计、HRT-Ⅱ和OCT3分别进行视野、视盘形态和视网膜神经纤维层厚度的检测.选用HRT-Ⅱ所测视盘参数中的平均mRNFL、截面面积RNFLA和OCT3所测的mRNFL做比较分析.测的平均视网膜神经纤维层厚度(RNFL)做分析比较.采用方差分析,对HRT-Ⅱ和OCT3检测3组间的参数进行两两比较;对HRT-Ⅱ视盘参数中的mRNFL,RNFLA和OCT3所测的mRNFL厚度及各自与视野平均缺损值(mean defect,MD)做相关分析.结果:HRT-Ⅱ视盘参数中的mRNFL,RNFLA及OCT3所测的mRNFL均存在显性差异(P＜0.05);在POAG组,HRT-Ⅱ的mRNFL,RNFLA及OCT3所测的mRNFL显著性相关(P＜0.05),且与视野平均缺损值(MD)有不同程度的相关.结论:HRT-Ⅱ和OCT3均能够区分青光眼的不同状态.HRT-Ⅱ所测mRNFL,RNFLA与OCT3所测的mRNFL有较好的相关性且均与视野平均缺损值相关.     

OCT3和HRT-Ⅱ检测视盘参数在青光眼早期诊断中的应用价值

目的应用OCT3和HRT-Ⅱ检测正常眼、可疑性开角型青光眼(suspected open-angle glaucoma,SOAG)和原发性开角型青光眼(primary open-angle glaucoma,POAG)患者的视盘结构参数,探讨OCT3和HRT-Ⅱ检测视盘参数的相关性及OCT3视盘分析在青光眼早期诊断中的价值。方法用OCT3和HRT-Ⅱ检测48例SOAG、55例POAG和年龄相匹配的43例正常人的视盘参数。从视盘参数中选择视盘面积、视杯面积、盘沿面积、视杯容积、盘沿容积、杯盘面积比进行分析。对两种仪器检测视盘参数的一致性及与视野平均缺损值的相关性做对比分析;建立青光眼ROC曲线图,根据ROC曲线下面积比较两种仪器诊断青光眼的能力。结果OCT3与HRT-Ⅱ检测正常人、SOAG和POAG三组间各视盘参数差异均有极显著性(P<0.01)。三组中任意两组间比较,两种仪器所测大部分视盘参数差异有显著性(P<0.05)。OCT3与HRT-Ⅱ检测视盘参数有较好的一致性(r=0.358～0.798),且与视野平均缺损值有较好的相关性。两种仪器诊断青光眼的最优参数均为盘沿面积和盘沿容积,且具有基本相等的ROC曲线下面积值。结论OCT3和HRT-Ⅱ检测视盘有较好的一致性,且与视神经损害状态密切相关,两种仪器均能检测到青光眼视盘参数改变。在青光眼组,OCT3和HRT-Ⅱ所测视盘参数与视野缺损都有一定程度的相关。OCT3与HRT-Ⅱ检测视盘参数在青光眼早期诊断中具有同等重要的价值。     

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。     

应用眼底断层扫描检测青光眼视盘改变与视野的一致性研究

目的 探讨眼底断层扫描（Heidelberg Retina Tomograph HRT）检测开角型青光眼患者与正常对照个体视盘参数与其相应视野改变的一致性.方法 对100例正常个体、32例开角型青光眼进行HRT及视野检查,将结果进行对照分析.结果 100例正常对照组视野检查、HRT检查均正常,开角型青光眼患者视野、HRT则出现不同程度改变.对于开角型青光眼在视野缺损一侧HRT检查显示视盘参数改变较视野正常一侧杯盘面积比、缘面积、纤维层厚度等特异性指标改变更加明显.这一结果表明视野出现不对称性改变,盘缘组织亦出现不对称,HRT参数反映出视盘的改变与视野损害的部位一致.结论 应用HRT及视野检查可以早期发现开角型青光眼,且HRT较视野具有更高的重复性、敏感性、特异性,二者同时进行检查,有助于在开角型青光眼尚未出现症状时早期发现和早期治疗.     

Morphology of the optic papilla in glaucoma. I. Primary open-angle glaucoma

BACKGROUND: Previous studies have shown that the chronic open-angle glaucomas form a heterogeneous spectrum of diseases which have in common an open anterior chamber angle and glaucomatous optic nerve damage. Purpose of this study was to evaluate whether the appearance of the optic disc differs among the various types of primary open-angle glaucoma. METHODS: Color stereo optic disc photographs of 683 patients with primary open-angle glaucoma (POAG), and 481 normal eyes were morphometrically evaluated. RESULTS: Morphologic characteristics of the glaucoma types were as follows: Highly myopic POAG: secondary macrodiscs with abnormal shape; shallow, flat, concentric disc cupping; low frequency of disc hemorrhages; large parapapillary atrophy or myopic crescent; medium to low intraocular pressure. Juvenile-onset POAG: Optic disc of normal size and shape; deep and steep disc cupping; low frequency of broad rim notches or large disc hemorrhages; small parapapillary atrophy; high minimal and maximal intraocular pressure measurements. Age-related atrophic POAG: Optic disc of normal size and shape; shallow, flat and concentric disc cupping; medium to low frequency of disc hemorrhages; large parapapillary atrophy; medium to low intraocular pressure. Eyes with normal-pressure glaucoma: Optic disc of normal size and shape; deep and steep cupping; relatively small parapapillary atrophy; high frequency of disc hemorrhages and rim notches. CONCLUSIONS: These characteristics in the appearance of the optic disc may be helpful for clinical diagnosis and therapy and may give pathogenetic hints.     

Can frequency-doubling technology and short-wavelength automated perimetries detect visual field defects before standard automated perimetry in patients with preperimetric glaucoma?

PURPOSE: To assess the ability of frequency-doubling technology (FDT) perimetry and short-wavelength automated perimetry (SWAP) to detect glaucomatous damage in preperimetric glaucoma subjects. PARTICIPANTS: Two hundred seventy-eight eyes of 278 subjects categorized as normal eyes [n=98; intraocular pressure <20 mm Hg, normal optic disc appearance, and standard automated perimetry (SAP)]; preperimetric glaucoma eyes (n=109; normal SAP and retinal nerve fiber layer defects or localized optic disc notching and thinning); and glaucoma patients (n=71; intraocular pressure >21 mm Hg, optic disc compatible with glaucoma, and abnormal SAP). METHODS: The preperimetric glaucoma group underwent at least 2 reliable full-threshold 24-2 Humphrey SAPs, full-threshold C-20 FDT, full-threshold 24-2 SWAP, optic disc topography using the Heidelberg Retina Tomograph II, laser polarimetry using the GDx VCC, and Optical Coherence Tomography (Zeiss Stratus OCT 3000). Receiver operating characteristic curves were plotted for the main Heidelberg Retina Tomograph, Optical Coherence Tomography, and GDx VCC parameters for the normal and glaucoma patients. The area under the receiver operating characteristic curve was used to determine the parameters indicating glaucomatous damage in the optic disc or retinal nerve fiber layer, which were used to establish additional subgroups of patients with preperimetric glaucoma. FDT and SWAP sensitivities were calculated for the patient subsets with structural damage and normal SAP. RESULTS: At least 20% of the patients with preperimetric glaucoma demonstrated functional losses in FDT and SWAP. The more severe the structural damage, the greater the sensitivity for detecting glaucomatous visual field losses. CONCLUSIONS: FDT and SWAP detect functional losses in cases of suspected glaucoma before glaucomatous losses detected by SAP.     

OCT参数对原发性开角型青光眼性视神经损伤的诊断价值

目的:探究频域光学相干断层成像技术(OCT)对原发性开角型青光眼性视神经损伤的诊断价值。方法:选择2018-01/2020-03我院收治的80例80眼原发性开角型青光眼患者及100例100眼健康受试者作为研究对象,将原发性开角型青光眼患者分为早期组、中期组及晚期组,采用OCT测定各组患者上方、下方、鼻侧、颞侧视乳头旁视网膜神经纤维层(pRNFL)厚度值及上方、下方黄斑区视网膜神经节细胞复合体(mGCC)厚度值,比较各组受试者OCT参数之间差异,采用Spearman相关性分析OCT参数与视野缺损程度的相关性,绘制受试者特征工作曲线(ROC)计算OCT参数诊断原发性开角型青光眼的价值。结果:入组患者早期组24例、中期组39例、晚期组17例,各组患者pRNFL、mGCC参数均有差异(P<0.05),晚期组青光眼患者上方、下方、鼻侧pRNFL、平均pRNFL及上方、下方、平均mGCC显著低于早期组、中期组,中期组患者各指标显著低于早期组(P<0.05)。Spearman相关性分析示,pRNFL、mGCC参数与原发性开角型青光眼严重程度呈负相关关系(P<0.05)。ROC曲线显示,上方pRNFL、下方pRNFL、鼻侧pRNFL、颞侧pRNFL、平均pRNFL诊断原发性开角型青光眼视神经损伤的曲线下面积为0.693、0.846、0.676、0.579、0.844,上方mGCC、下方mGCC及平均mGCC诊断原发性开角型青光眼视神经损伤的曲线下面积分别为0.542、0.677、0.676;平均pRNFL联合平均mGCC诊断原发性开角型青光眼视神经损伤的曲线下面积为0.883。结论:OCT测定pRNFL、mGCC参数与开角型青光眼视神经损伤程度密切相关,两者有较高的诊断价值,临床可将其用于诊断及病情评估。     

Screening relatives of patients with familial chronic open angle glaucoma

PURPOSE: To describe the value and the results of screening of family members of individuals with familial chronic open-angle glaucoma (COAG) for the disease. DESIGN: Cross-sectional study of families with COAG. PARTICIPANTS: Eighty-six individuals from 15 families with COAG. TESTING: Complete ophthalmologic examinations, automated perimetry, and optic nerve photography. MAIN OUTCOME MEASURES: Disease status as glaucoma patient (at least two of three parameters abnormal: intraocular pressure, visual field, or disc appearance), glaucoma suspect (one of three parameters abnormal), or normal. RESULTS: Twenty-six relatives were diagnosed with COAG. The diagnosis was most frequently made on the basis of intraocular pressure readings and automated perimetry. Twenty-three relatives were classified as glaucoma suspects; automated perimetry was the most useful modality for the detection of abnormalities in these individuals. Siblings of COAG patients had the highest risk of COAG developing (64.7%) compared with children (13.2%) or other blood relatives (22.2%). CONCLUSIONS: When COAG is present in more than one family member, immediate and other relatives should be evaluated for glaucoma by means of clinical examination and automated perimetry.     

分离格栅视觉诱发电位与蓝黄视野检查诊断开角型青光眼的性能比较

目的:评估分离格栅视觉诱发电位(IC-VEP)在诊断开角型青光眼中的表现,并将其与蓝黄色视野检查法(B/YP)和光学相干断层扫描(OCT)进行比较。方法:通过回顾性分析,对来自中国的101例受试者(正常组35例;早期青光眼30例,中晚期青光眼患者36例)分别进行IC-VEP、蓝黄色视野检查和OCT等检查。计算IC-VEP、视野检查法和OCT对检测青光眼的敏感度以及这三种方法之间的一致性,以评估其临床表现。结果:早期POAG组的IC-VEP、蓝黄色视野检查和OCT的敏感度分别为70.00%、70.00%、63.33%。在中晚期POAG组中,IC-VEP、OCT和蓝黄色视野检查的敏感度分别为86.11%、88.89%、91.67%。其中IC-VEP的特异性为91.43%。IC-VEP的结果与OCT和蓝黄色视野测试高度一致(kappa:0.721~1.000,P<0.05)。结论:作为视觉功能的客观检查手段,IC-VEP可用于青光眼的早期诊断,也可用于监测可疑青光眼患者的RGC功能。     

Optic disc morphology in pigmentary glaucoma

AIM—To evaluate the morphology of the optic nerve head in eyes with pigmentary glaucoma.
METHODS—Colour stereo optic disc photographs of 62 patients with pigmentary glaucoma and 566 patients with primary open angle glaucoma were morphometrically evaluated. By prestudy selection, mean visual field defect and neuroretinal rim area were not significantly different between the two groups (p=0.89 and p=0.45).
RESULTS—The pigmentary glaucoma group did not vary significantly (p >0.10) from the primary open angle glaucoma group in size and shape of the optic disc, configuration of neuroretinal rim, depth of optic cup, area of alpha zone of parapapillary atrophy, diameter of retinal vessels at the disc border, and frequency of disc haemorrhages and localised retinal nerve fibre layer defects. The beta zone of parapapillary atrophy was slightly, but not statistically significantly (p=0.06), smaller in the pigmentary glaucoma group. The mean maximal intraocular pressure and mean intraocular pressure amplitude were significantly (p<0.001) higher in the pigmentary glaucoma group.
CONCLUSIONS—In contrast with the characteristic morphology of the anterior segment and despite significantly higher intraocular pressure peaks and a larger pressure amplitude, eyes with pigmentary glaucoma compared with eyes with primary open angle glaucoma do not show a pathognomonic morphology of the optic disc and retinal nerve fibre layer. The slightly smaller beta zone of parapapillary atrophy may correspond to higher intraocular pressure in pigmentary glaucoma.

Keywords: optic disc morphology; pigmentary glaucoma; secondary open angle glaucoma     

OCT在病理性近视眼视盘神经纤维层厚度检测中的应用

目的：应用频域光学相干断层扫描成像（optical coherence tomography,OCT）技术研究病理性近视眼视盘神经纤维层厚度的变化特点及其与眼轴、性别和年龄的关系,为病理性近视合并原发性开角型青光眼的早期诊断提供帮助。方法：选取对照组正常眼96眼（眼轴23～24mm）和观察组病理性近视眼153眼（眼轴25～27mm 80眼,〉27mm 73眼）; 应用频域OCT检测视盘神经纤维层的厚度; 比较对照组与观察组视盘神经纤维层厚度的差异; 使用多元线性回归分析观察组视盘全周的平均厚度与眼轴、性别和年龄的关系。结果：观察组视盘神经纤维层的全周平均、上下及鼻侧象限平均厚度值均变薄,与对照组相比均具有统计学意义（P〈0.05）,颞侧象限相比较无统计学意义（P〉0.05）; 观察组视盘神经纤维层的全周平均厚度与眼轴的偏相关系数为-1.31,与性别的偏相关系数为5.21,与年龄的偏相关系数为-0.12。结论：病理性近视眼的视盘神经纤维层厚度较正常眼变薄,眼轴、性别和年龄是病理性近视眼视盘神经纤维层平均厚度的影响因素,对诊断合并病理性近视患者的青光眼视神经损害时应注意排除病理性近视对视盘神经纤维层厚度产生的影响。     

Normotensive glaucoma

Normal tension glaucoma is a form of primary open angle glaucoma where the intraocular pressure remains within the normal range. In this case the main challenge is to establish the correct diagnosis. The clinical evaluation of a patient suspected of a normal tension glaucoma must answer two questions: 1) is the intraocular pressure normal and 2) is it a glaucomatous optic neuropathy or another type of optic neuropathy?