大视杯与早期青光眼视盘形态的对比研究

目的了解海德堡视网膜断层扫描(HRT-Ⅱ)视盘参数对青光眼早期视盘变化的灵敏性。设计横断面调查研究。研究对象 21例(36眼)生理性大视杯(C／D≥0．7)和27例(31眼)早期青光眼(C／D≥0.7、MD≤3dB)。方法对所有入选的患者进行视野及HRT-Ⅱ检测,对两组患者的视盘诸参数进行比较。主要指标 HRTⅡ检测的视盘诸参数,包括视盘面积、视杯面积、盘沿面积、视杯容积、盘沿容积、杯盘面积比、平均视杯深度、最大视杯深度、视杯形态测量、视杯高度变异轮廓、平均视网膜神经纤维层(RNFL)厚度和视神经纤维层横断面积。结果 HRTⅡ参数中,生理性大视杯组的盘沿面积、盘沿容积、平均RNFL厚度、RNFL 横断面积的值比早期青光眼组大,差异有显著性(t=2．247-3．714,P=0.000-0．028)。结论在鉴别早期青光眼与生理性大视杯时, 应重点关注上述HRT-Ⅱ参数。     

海德堡视网膜断层扫描仪Ⅱ型在青光眼诊断中的应用

目的：评价海德堡视网膜断层扫描仪Ⅱ型(Heidelberg retina tomograph-Ⅱ，HRT-Ⅱ)在青光眼诊断中的应用价值。方法：对青光眼组46例(46只眼)和对照组64例(64只眼)分别行HRT-Ⅱ检查，比较两组间视盘结构参数的差异，并应用ROC曲线分析不同参数的诊断灵敏度和特异度。结果：两组间年龄、视杯面积、盘沿面积、视杯容积、盘沿容积、杯盘面积比、平均杯深、视杯形态、平均神经纤维层厚度、神经纤维截面面积均有显著性差异。杯盘面积比诊断价值最大(灵敏度和特异度分别为82．6％和82．8％)。应用多因素分析可以提高诊断的灵敏度和特异度。     

原发性慢性闭角型青光眼与正常眼HRT-Ⅱ视盘形态结构的对比研究

目的 比较慢性闭角型青光眼（chronic angle-closure glaucoma,CACG）和正常眼视盘形态结构参数之间的差异,评价HRT-Ⅱ在原发性慢性闭角型青光眼早期诊断中的意义方法 用Heidelberg视网膜断层扫描仪（Heidelberg retina tomograph,HRT）对早期、进展期CACG 36例（60只眼）及正常人30例（60只眼）的视盘进行断层扫描,获得视盘平均地形图像和视盘结构诸参数.结果 CACG与正常人视盘结构各参数中视杯面积、杯盘面积比、盘沿面积、视杯容积、盘沿容积、视杯形态测量、平均视神经纤维层厚度及视神经纤维层横截面积存在明显差异.结论 HRT-Ⅱ能够反映慢性闭角型青光眼视盘改变,为临床早期诊断CACG提供依据.     

原发性青光眼早期视盘参数与视野缺损的关系

目的 探讨应用海德堡视网膜断层扫描仪(HRT-Ⅱ)检测原发性青光眼患者视盘参数改变及其与Humphrey 750检测视野改变间的关系.方法 49例原发性青光眼患者和30例对照个体分别行Humphrey 750视野与HRT-Ⅱ检查,每例患者的双眼间视盘损害与视野缺损间的对应关系彼此独立,双眼均被纳入研究.比较对照个体、慢性闭角型青光眼(CACG)、开角型青光眼(POAG)和正常眼压性青光眼(NTC)患者视乳头参数的差异,分析视乳头各项参数分别与各自视野指数(MD)间的相关性.将对照个体与原发性青光眼患者的视盘参数进行逐步判别分析,建立判别函数,筛选出诊断青光眼的敏感参数.结果 HRT-Ⅱ和Humphrey 750检测对照组、CACG组、POAC组和NTG组四组间视野平均缺损(1VID)、视杯面积(CA)、视盘面积(DA)、盘沿面积(RA)、视杯容积(CV)、盘沿容积(RV)、杯盘面积比(CDAR)、线性杯盘比(LCDR)、平均视杯深度(MCD)、最大视杯深度(max CD)、视杯形态(CSM)、视杯高度变异轮廓(HVC)、平均视网膜神经纤维层厚度(MRNFLT)、视神经纤维层横截面积(RCSA)等差异具有显著统计学意义(P<0.01).对照组中LCDR和MD呈直线线性相关,POAG组中DA、CA和MD呈直线线性相关,NTG组中CA、RA、CV、CDAR、HVC和MD呈直线线性相关.经逐步回归筛选的变量中,CV和HVC是其中2个有意义的参数,得出回归方程MD=4.475×CV+5.338×HVC-0.480.诊断敏感的视盘参数为RA、RV、MRNFLT、CSM、HVC,判别函数式为D=2.767+0.312×RA +3.731×RV+4.294×MRNFLT-3.668×CSM-4.024×HVC.结论 临床上应用HRT-Ⅱ检测视盘参数与Humphrey750检测视野结果结合对照分析有助于原发性青光眼的早期诊断.     

国际闭角型青光眼新分类中Humphrey视野及HRT-Ⅱ参数的相关性

目的:分析海德堡视网膜断层扫描仪-II(HRT-II)和Hum-phrey视野计检查平均视野缺损(mean defect,MD)间的相关性及其临床价值。方法:闭角型青光眼患者69例117眼,按照国际闭角型青光眼分类法分为可疑原发性房角关闭(primary angle-clo-sure suspect,PACS)38眼,原发性前房角关闭(Primary an-gle-closure,PAC)53眼和原发性闭角型青光眼(primary angle-closure glaucoma,PACG)26眼,利用HRT-Ⅱ和Hum-phrey视野计检查正常人30例60眼和各类闭角型青光眼患者的视盘形态、视网膜神经纤维层(RNFL)厚度和视野,获得视杯面积、视盘面积、盘沿面积、视杯容积、盘沿容积、杯盘面积比、线性杯盘比、平均视杯深度、最大视杯深度、视杯形态测量、视杯高度变异轮廓、平均视网膜神经纤维层厚度、视神经纤维层横截面积和MD等参数,对比分析正常人和各类闭角型青光眼患者之间的各参数的差异。并将各类闭角型青光眼的HRT-Ⅱ的各参数与MD进行相关性分析。结果:HRT-Ⅱ和Humphrey视野计检测对照组与PACS、PAC和PACG4组间各视盘参数和MD差异具有统计学意义(P<0.01)。对照组中LCD和MD呈直线相关,PACS组中DA、CA和MD呈直线相关,PAC中CA,RA,CV,CDAR,HVC和MD呈直线相关。经逐步回归筛选的变量中,CV和HVC是其中2个有意义的参数,PAC组中CV和HVC与MD之间的Pearson相关系数为0.290和0.301,得出CV和HVC与MD之间回归方程:Y=4.475X1+5.338X2-0.480(Y表示MD,X1表示CV,X2表示HVC)。结论:HRT-II和Humphrey视野检查参数在新的闭角型青光眼分类具有一定的临床价值,MD与CV和HVC相互参照分析有助于判断闭角型青光眼的发展。     

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。     

HRT-Ⅱ在青光眼随访中的应用

目的:应用HRT-Ⅱ检测青光眼视神经乳头的形态改变及视网膜神经纤维的丢失,探讨HRT-Ⅱ在青光眼随访中的意义。方法:已确诊的青光眼患者50例63眼纳入本研究,利用HRT-Ⅱ每6～12mo观察视盘及视神经纤维的变化。结果:盘沿面积、盘沿体积、最大视杯深度、平均视网膜神经纤维层(RNFL)厚度、RNFL截面面积等视盘参数前后2次检查结果差异有显著性意义(P<0.05)。结论:HRT-Ⅱ能够快速、可重复性地测量视盘形态及视神经纤维层的改变,并且可以重复分析视盘参数的变化。     

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。     

HRT视盘参数在原发性开角型青光眼早期诊断中的作用

目的:在众多海德堡视网膜断层扫描仪(heidelberg retina tomogragh,HRT)测定的视盘参数中,筛选出最有助于青光眼早期诊断的视盘参数。方法:用HRT测定23例视野损害较轻的青光眼患者和23例正常人的视盘参数(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)作逐步判别分析。结果:盘沿面积和杯盘面积比对青光眼早期诊断最有帮助,其诊断敏感度和特异度分别为87%和96%。结论:本组资料盘沿面积和杯盘面积比是区分青光眼和正常眼最好的判别因素。     

生理性大视杯视盘形态结构参数的研究

目的 观察生理性大视杯视盘的结构参数特征。 方法 海德堡断层扫描仪对100 只生理性大视杯眼和74只正常视杯眼的视盘进行断层扫描，对比分析两组之间视盘面积、视杯面积、杯盘面积比、盘沿面积、视杯容积、盘沿容积、平均杯深、最大杯深、杯形测量、 轮廓线高度变化、平均视网膜神经纤维层厚度、视网膜神经纤维层横截面积等视盘结构参数差异，分析生理性大视杯眼视盘上方、下方、鼻侧、颞侧4个象限的特征。 结果 生理性大视杯眼视盘面积、视杯面积、杯盘面积比、视杯容积、平均视杯深度、杯形测量、最大视杯深度测量值均显著大于正常视杯眼；轮廓线高度变化、平均视网膜神经纤维层厚度、视网膜神经纤维层横截面积测量值显著小于正常视杯眼。盘沿面积鼻侧大于上方，盘沿容积颞侧显 著小；视网膜神经纤维层横截面积测量值按上、下、鼻、颞侧递减。 结论 生理性大视杯视盘结构参数特征表现为视盘面积显著大于正常视杯眼，盘沿面积鼻侧大于上方；平均 视网膜神经纤维层厚度较正常视杯眼薄。 （中华眼底病杂志，2008，24：213-216）     

Cup electrode for human ERG

This report describes a cup electrode for measuring the human electroretinogram which improves the comfort of a subject while providing sufficiently large signal-to-noise ratios for most applications. The cup electrode is demonstrated by measuring the electroretinogram for small-amplitude flash stimuli.     

Cup/disc ratio in early open-angle glaucoma

Summary At the earliest stage of clinical detection of open-angle glaucoma with visual field defect namely that of initial diagnosis prior to significant symptoms, one can already demonstrate a significant deviation of the distribution of C/D ratio from that of individuals with similar pressure readings who are free from glaucomatous visual field defect. This difference consists of a markedly reduced frequency of small C/D values in glaucomatous eyes and a great increase in large C/D values.In addition, one can demonstrate at this stage enlargement of the optic cup as evidenced by the increased frequency of a difference between the ratios of the two eyes which is > 0.2. In general, the C/D ratio was greater in the affected eye in monocular involvement and in the eye with greater field defect. It is hypothesized that the C/D ratio is one of the factors involved in determining the vulnerability of the visual field to higher ocular pressure in openangle glaucoma. This relationship results in a great increase in the relative frequency of involvement of the visual field by the glaucomatous process in eyes with large C/D ratios and a reduction of that frequency in eyes with small C/D ratios. It was also hypothesized that different sets of factors operate in the production of field defect in eyes with different C/D ratios.From the clinical standpoint, the findings emphasize the importance of ophthalmoscopic evaluation of the optic nerve in the early suspicion and detection of open-angle glaucoma. This evaluation should include a careful estimation, recording and monitoring in time the characteristics of the optic cup.

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Zusammenfassung Es konnte gezeigt werden, daß schon in den Anfangsstadien eines Weitwinkelglaukoms mit Gesichtsfeldveränderungen das Verhältnis des horizontalen Durchmessers der Exkavation zum horizontalen Durchmesser der Papille (C/D) sich von dem unterscheidet, welches man bei Kranken mit gleichem Augendruck, aber ohne für Glaukom charakteristische perimetrische Störungen findet. Bei den ersteren sind die niedrigen C/D Werte viel seltener und die hohen Werte häufiger.Außerdem läßt sich bereits in diesem Stadium eine Erweiterung der Exkavation dadurch nachweisen, daß an dem einem Auge der C/D Wert öfter um mehr als 0,2 größer ist als an dem anderen. Im allgemeinen entspricht der höhere Wert dem mehr erkrankten Auge.Es scheint, daß der C/D Wert die Empfindlichkeit des Gesichtsfelds pathologischen Druckwerten gegenüber mitbestimmt. Dies würde die relative Häufigkeit von Gesichtsfelddefekten in Glaukomaugen mit hohen C/D Werten, wie auch die Seltenheit bei niedrigen Werten erklären. Man kann aber auch vermuten, daß noch andere Faktoren hierbei im Spiele sind.Jedenfalls ist vom klinischen Standpunkt aus die genaue Aufstellung des C/D Wertes wichtig. Dieser sollte schon bei Glaukomverdacht oder bei der ersten Feststellung eines Weitwinkelglaukoms genau registriert und später regelmäßig beobachtet werden.

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Résumé Dès la découverte d'un glaucome à angle ouvert présentant des anomalies du champ visuel sans autres symptomes significatifs, on peut démontrer que le rapport diamètre horizontal de l'excavation: diamètre horizontal de la papille (C/D) diffère de celui constaté chez des sujets ayant une pression oculaire analogue, mais aucune altération périmétrique, caractéristique du glaucome. Dans les premiers cas les petites valeurs du C/D sont beaucoup plus rares; les valeurs élevées y deviennent plus fréquentes.De plus, on peut dès ce stade mettre en évidence un élargissement de l'excavation, étant donné que le rapport C/D à un oeil dépasse plus souvent celui de l'oeil adelphe de plus de 0,2. C'est en général l'oeil le plus atteint qui présente le rapport le plus élévé.On peut supposer que le rapport C/D joue un rôle dans la vulnérabilité du champ visuel soumis à des pressions intra-oculaires pathologiques. Ainsi s'expliquerait la relative fréquence des anomalies périmétriques dans des globes hypertendus ayant des C/D élevés et leur rareté en présence d'un rapport peu important. Toutefois, d'autres facteurs peuvent également intervenir. Quoiqu'il en soit, du point du clinique, l'évaluation ophtalmologique soigneuse du rapport C/D parait importante dès la suspicion ou la détection d'un glaucome à angle ouvert, comme au cours de son évolution.

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This investigation was supported in part by research grant CD-00017 from the National Center for Health Services Research and Development Health Services and Mental Health and NB-07328 from the National Institute of Neurological Diseases and Blindness, United States Public Health Service, Bethesda, Maryland.     

Observer experience and Cup:Disc ratio assessment.

BACKGROUND: The validity of the Cup:Disc (C:D) ratio as a clinical measure depends on the level of agreement among observers. In this study, we investigated the effect of observer experience on interobserver and intraobserver agreement in C:D ratio estimation. METHODS: Nine 3rd-year (Yr3) and nine 4th-year (Yr4) optometry students and nine optometrists (Opt), determined C:D ratios from 26 optic disc photographs viewed monoscopically and stereoscopically. Observer agreement was investigated using weighted kappa (Kw) analysis. RESULTS: Interobserver agreement was higher (p < 0.01) among optometrists than among 4th-year students and higher (p < 0.01) among 4th-year than among 3rd-year students (mean Kw: Opt = 0.61; Yr4 = 0.51; Yr3 = 0.39). Stereoscopic estimates of C:D ratios were higher (p < 0.0001) than monoscopic estimates, and interobserver agreement was higher (p < 0.001) when evaluating the vertical rather than the horizontal C:D ratio. Intraobserver agreement (mean Kw: Opt = 0.67; Yr4 = 0.66; Yr3 = 0.62) did not vary significantly (p = 0.78) with experience. CONCLUSIONS: The extent to which an observer reproducibly assesses the C:D ratio from optic disc photographs (intraobserver agreement) does not increase with experience. However, the agreement between different observers in assessing the C:D ratio (interobserver agreement) increases with experience.     

Early Loss of Optic Cup with Increased Intracranial Pressure

A 54-year-old woman developed increased intracranial pressure due to chronic dural venous sinus thrombosis in the absence of significant comorbidity. In the years preceding diagnosis, the patient underwent routine diabetic retinopathy screening; however, gradual loss of optic cup and disc swelling was only retrospectively noted after marked papilloedema was evident at an optometry visit. The patient made a full recovery once the diagnosis was established. This case is novel in the literature as routine photographs, taken for diabetic retinopathy screening, demonstrate the natural history of papilloedema before medical intervention. Interestingly, these images show that a traditionally “late” sign of papilloedema – loss of cup – can be the sentinel abnormality. This finding may have significant clinical implications and reinforces the need for clinicians to compare investigation results with historical patient data.     

Cup/disk ratio in branch retinal vein occlusion.

Recent reports have been attempted to evaluate, without obtaining a positive result, whether the reduction in size of the optic disc may influence the pathogenesis of central retinal vein occlusion. Cup/disc ratios in the fellow eye of 67 patients with branch retinal vein occlusion were compared with the ratios of 67 controls matched to cases for age, sex and refractive defect. There was no significant difference between cup/disc ratios of the two groups. These results suggest that the anatomical features of the optic disc are of no importance in the development of branch retinal vein occlusion.     

Is There a Racial Difference in Physiologic Cup Size?

Although many clinicians believe that there is a racial difference in the size of the physiologic cup, this premise has not been studied. To evaluate this, we prospectively examined 100 black and 100 white volunteers. Stereoscopic optic disc photographs taken of each subject were masked to block out the fundus pigmentation, randomized, and then evaluated by an experienced clinician. The average cup/disc ratio in blacks (0.35) was significantly greater (P less than 0.0001) than that in whites (0.24) for both right and left eyes. Forty percent of the optic discs of blacks and 14% of the optic discs of whites had a cup/disc ratio greater than or equal to 0.4.     

正常视力大生理杯眼的眼压及CSF初步观察

对688只正常视力眼中C/D≥0.5的145只眼做了详细的观察.其中78只眼同时进行了眼压和对比敏感度测定。结果发现三者之间存在着相关性.提示对正常视力大生理杯的患者进行追踪观察是十分重要的。