原发性开角型青光眼视盘及视网膜血流的研究

目的探讨原发性开角型青光眼患者和正常人视盘及其周边视网膜血液供应是否存在差异.方法本研究采用了一种新型共焦扫描激光多普勒血流仪--海德堡视网膜血流仪(heidelberg retina     

冷激发对原发性开角型青光眼患者视网膜 光敏感度的影响

目的研究原发性开角型青光眼(primary open angle glauc oma,POAG)患者在寒冷刺激时的视盘血流、视网膜光敏感度变化及二者的相互关系。方法33例眼压已控制的POAG患者的33只患眼和13个正常人 的13只眼纳入研究。用海德堡视网膜血流仪和Topcon计算机自动视野计测量POAG患者及正常人在基础状态和冷激发后的视盘血流及视网膜光敏感度的变化。结果POAG患者在冷激发后视盘平均血流量下降31.5,血管容积下降1.1,视网膜光敏感度下降0.78dB,均较其自身基础状态显著下降(P<0.05),而正常对照组无此趋势。POAG患者冷激发前后的血流变化值与其视网膜光敏感度的变化密切相关(r=0.615,P＜0.001)。在冷激发时,有偏头痛病史的 POAG患者视盘血流下降幅度更大(P<0.001)。结论冷激发可使部分POAG患者的视盘血管痉挛,血流减少,视网膜光敏 感度下降。视网膜光敏感度下降程度与视盘血流减少量密切相关。(中华眼底病杂志, 2001,17:37-40)     

抗青光眼手术对原发性开角型青光眼血流动力学的影响

目的 探讨原发性开角型青光眼（primary open-angle glaucoma,POAG）眼血流动力学变化,观察抗青光眼手术对眼血流动力学的影响。方法 利用标准化彩色多普勒成像（color Doppler imaging,CDI）技术检测POAG患者16例20眼手术前后的眼球后血流状态。结果 抗青光眼术后视网膜中央动脉和睫状后短动脉血流速度较术前明显提高,血流阻力下降。结论 抗青光眼术后眼血流可得到改善,有益于保护视功能。CDI检测技术应标准化,实现检测结果的可比性。     

原发性开角型青光眼血流动力学研究

目的：探讨原发性开角型青光眼（primary open angle glaucoma,POAG)眼血流动力学的变化, 分析眼血流与视野、视力、眼压、杯盘比的关系。方法：利用彩色多普勒成像（color Doppler imaging,CDI)技术检测POAG患者与正常人各30例59眼的球后血流状态,其中10例,10眼行眼底荧光血管造影（fundus fluorescein angiography,FFA)检测。结果：POAG眼血流速度明显降低（P＜0．01）,血流速度与视功能具有相关性。POAG组表现FFA异常：早期视盘弱荧光,相对性、绝对性视盘局部充盈缺损, 后期视盘强荧光。结论：POAG患者视盘及视网膜血液供应不良,与视神经损害和视野缺损密切相关,首次提出CDI技术检测标准化,实现检测结果的可比性。     

原发性开角型青光眼

原发性开角型青光眼李美玉青光眼是由于眼压升高引起的视乳头损害和视野缺损的一种眼病。个体眼球对眼压的耐受力不同，有些眼球眼压高于２．８ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）可产生视乳头和视野损害，形成真正的青光眼；有些眼压虽高出正常值，却不产生视乳头和视野...     

合并近视的原发性开角型青光眼眼血流动力学研究

目的：利用彩色多普勒血流显像研究合并近视的原发性开角型青光眼（Ｐｒｉｍａｒｙ Ｏｐｅｎａｎｇｌｅ Ｇｌａｕｃｏｍａｗｉｔｈ Ｍｙｏｐｉａ,ＭＰＯＡＧ）眼部血流动力学变化。方法：对３８ 例６３ 只合并近视（平均－６．９２ ±３ ．７９Ｄ）高眼压性（ 平均眼压３２ ．００±９．３６ｍｍＨｇ）ＰＯＡＧ、３２ 例５１ 只单纯原发性开角型青光眼（Ｓｉｍｐｌｅ Ｐｒｉｍａｒｙ Ｏｐｅｎａｎｇｌｅ Ｇｌａｕｃｏｍａ,ＳＰＯＡＧ） 、１５ 例３０ 只正常眼分别测量眼动脉、视网膜中央动脉、睫状后动脉的收缩期血流峰值速度（ＰＳＶ） 、舒张末期血流速度（ＥＤＶ） 、阻力指数（ＲＩ） 。结果：①与正常组比较：ＭＰＯＡＧ组及ＳＰＯＡＧ组视网膜中央动脉及睫状后动脉的ＲＩ升高（ Ｐ＜０．０５,Ｐ＜０ ．０１） ;ＭＰＯＡＧ 组眼动脉的ＥＤＶ值减低（Ｐ＜０．０５） 。②与ＳＰＯＡＧ 组比较：ＭＰＯＡＧ组眼动脉ＥＤＶ值明显减低（Ｐ＜ ０．０１）。结论：ＭＰＯＡＧ 患者眼部血流速度减低,血管阻力升高,有血流灌注不足的表现。提示眼压及血管因素在高眼压性ＭＰＯＡＧ 的视功能损害中均起着重要作用。     

原发性开角型青光眼血管学说的研究进展

青光眼是临床上常见的眼病之一,致残致盲率极高,特别是开角型青光眼(POAG)疗效较差,其病因及发病机理较复杂。既往研究表明眼内压增高改变了视神经乳头筛板的结构,造成神经纤维的机械性损伤,即机械学说。但眼压正常的POAG也有同样的视盘改变及视野缺损,而且有些青光眼患者即使用药物或者手术控制眼压后,视盘及视野损害仍然继续,提示还有其他因素影响着POAG的发生,其中血管学说一血流动力学的改变是其研究热点之一,本文就近年来有关开角型青光眼血流动力学发病机理研究及进展作一综述。     

生活方式对原发性开角型青光眼患者的影响

原发性开角型青光眼(POAG)患者应遵守医生制定的治疗方案进行治疗,定期复查,并坚持目前普遍认同的健康生活方式如拒绝吸烟、适量运动、多吃水果蔬菜等。根据现有的研究结果,POAG患者应尽量避免可能升高眼压的活动如某些瑜伽动作、长时间吹奏管乐器、过量饮用咖啡等,以最大限度降低青光眼进展的风险,保护视神经。     

早期原发性开角型青光眼视盘血流密度的分析研究

目的:探讨早期原发性开角型青光眼(POAG)、高眼压症患者和健康者的视盘血流密度的差异。方法:横断面研究。收集2019-01/2021-04于福州东南眼科医院青光眼科门诊就诊患者,早期POAG组45例70眼,其中男32例49眼,女13例21眼,年龄48.50(26.75,64.50)岁,高眼压症组37例65眼,其中男17例29眼,女20例36眼,年龄37.00(27.00,47.00)岁,健康组51例94眼,其中男23例39眼,女28例55眼,年龄46.00(34.50,56.50)岁。分别对三组进行常规的眼科检查包括最佳矫正视力(BCVA)、眼压、视野、视网膜神经纤维层厚度(RNFL)、中央角膜厚度(CCT)等,通过光相干断层扫描血管成像检查(OCTA)采集并测量三组的视盘中心区、内层区、外层区和完整区的视盘血流密度。结果:三组眼压比较有差异(H=146.876,P<0.001),早期POAG组和高眼压症组与健康组的眼压值有差异(均P<0.01),早期POAG组和高眼压症组患者的眼压无差异(P=0.132)。早期POAG组和高眼压症组的BCVA、RNFL、MD值比较有差异(P=0.005、0.01、<0.01),早期POAG组和健康组两者的BCVA、RNFL、MD值比较有差异(P=0.013、<0.01、<0.01),高眼压症组和健康组两者的BCVA、RNFL、MD值比较无差异(P=1.000、0.660、1.000)。早期POAG组和健康组之间CCT无差异(P=0.074),早期POAG组和高眼压症组之间CCT比较有差异(P=0.006),高眼压症组和健康组之间CCT比较有差异(P<0.01)在中心区、内层区、完整区,早期POAG组和高眼压症组的血流密度比较有差异(均P<0.01),早期POAG组和健康组的血流密度比较有差异(均P<0.01),高眼压症组和健康组比较无差异(均P=1.000)。在外层区,早期POAG组和健康组的血流密度比较有差异(P=0.001),高眼压症组和早期POAG组及健康组比较有差异(P=0.067、0.877)。结论:早期POAG的视盘血流密度相比高眼压症和健康者是减少的,与视野MD、RNFL参数的变化是相一致的,早期POAG视盘不同区域血流密度均减少。     

Assessment of optic disk blood flow in patients with open-angle glaucoma

PURPOSE: To characterize optic disk blood flow in patients with open-angle glaucoma compared with age-matched healthy control subjects. METHODS: In this prospective cross-sectional study, 90 eyes of 90 patients with open-angle glaucoma and 61 eyes of 61 age-matched healthy control subjects were evaluated. Flow in the optic disk cup and the neuroretinal rim were assessed with scanning laser Doppler flowmetry. Fundus pulsation amplitude in the cup and the macula were assessed with laser interferometry. Visual field mean deviation was measured with the Humphrey 30 to 2 program. RESULTS: Flow in the neuroretinal rim (-18%, P =.002), and in the cup (-46%, P <.001) and fundus pulsation amplitude in the cup (-33%, P <.001) and in the macula (-24%, P <.001) were significantly lower in patients with open-angle glaucoma compared with healthy control subjects. A significant association between blood flow measurements in the cup and fundus pulsation amplitudes in the cup was observed in both study cohorts. A significant association was also observed between the mean defect from visual field testing and ocular hemodynamic parameters. CONCLUSIONS: Reduced optic disk perfusion in patients with open-angle glaucoma is evidenced from two independent methods in the present study. Moreover, our data indicate that reduced ocular blood flow in these patients is linked to visual field changes. It remains to be established whether compromised optic disk and choroidal blood flow contributes to optic disk damage in glaucomatous eyes or is a secondary functional phenomenon.     

Finger blood flow in patients with low tension glaucoma and primary open-angle glaucoma.

Finger blood flow was studied by means of laser Doppler flowmetry in 12 patients with low tension glaucoma (LTG), 12 patients with primary open-angle glaucoma (POAG) and 12 normal subjects. Baseline flow, flow after immersion of the hand in warm water (+40 degrees C), and flow after exposure of the hand in cold water (+4 degrees C) were measured. Statistically significant differences were not found in each flow between the three groups of the patients (p greater than 0.05). Vasospastic response to warm and cold water was observed in 25% of LTG patients, 17% of POAG patients, and 25% of normal subjects. There was no significant difference between LTG, POAG, and normal subjects in finger blood flow.     

Retrobulbar haemodynamics and morphometric optic disc analysis in primary open-angle glaucoma

BACKGROUND: Previous studies confirmed reduced retrobulbar haemodynamics in primary open-angle glaucoma (POAG). AIM: To investigate a correlation between retrobulbar haemodynamics and morphometric neuroretinal rim analysis in patients with POAG. METHODS: 51 patients with POAG (mean (standard deviation (SD)) age 65 (11) years) were included in this clinical study. Blood flow velocities (peak systolic velocity (PSV) and end-diastolic velocity (EDV)) of the ophthalmic artery, central retinal artery (CRA), posterior ciliary arteries (PCA) and central retinal vein were measured using colour Doppler imaging (Siemens Sonoline Sienna, Erlangen, Germany). Optic disc morphometry was carried out using scanning laser tomography (Heidelberg Retinal Tomograph II Heidelberg Egineering Heidelberg, Germany). The stereometric parameters of the neuroretinal rim (rim area, rim volume, cup shape measure and retinal nerve fibre layer (RNFL) cross-sectional area) were used for analysis. RESULTS: The PSV of the CRA was significantly (p<0.001) correlated with rim area (r = 0.50) and rim volume (r = 0.51). The minimum velocities of the central retinal vein were significantly (p<0.001) correlated with rim volume (r = 0.56) and RNFL cross-sectional area (r = 0.49). No correlations were found for the flow velocities of the ophthalmic artery and PCAs. CONCLUSION: Retrobulbar haemodynamics of the central retinal artery and vein are correlated with the neuroretinal rim damage in POAG.     

Rate of optic disc cup progression in treated primary open-angle glaucoma

PURPOSE: To quantitatively evaluate the rate of cup-to-disc ratio progression in treated patients with primary open-angle glaucoma and to identify clinical factors associated with cup progression. PATIENTS AND METHODS: Fifty one eyes of 51 treated primary open-angle glaucoma patients with a minimum of 9-year longitudinal series of stereoscopic optic disc photographs were studied. Eyes with any other ocular disease except for mild cataract were excluded. Each set of stereoscopic photographs was digitized and viewed stereoscopically on a computer screen using a hand-held stereoscope. Computer-aided planimetry was performed on each set of photographs with examiner-defined cup and disc margins using custom-made software. The software computed linear cup-to-disc ratios as well as peripapillary atrophy area. Both inter-observer and intra-observer reliabilities were evaluated in a masked, random fashion using intra-class correlation. Changes in linear cup-to-disc ratios and peripapillary atrophy were estimated using linear regression over time. All available clinical factors were evaluated for association with the rate of cup progression using a multiple regression model. RESULTS: All patients studied were Caucasian; 31(61%) were females. The mean age at the beginning of the study was 61.6 +/- 7.8 years (range 46-81). The mean follow-up period was 14.3 +/- 3.5 years (median 14.0, range 9.6-22.3). A total of 173 sets of stereo disc photographs were analyzed (3.4 +/- 1.3 per patient). The initial and final linear cup-to-disc ratios were 0.64 +/- 0.15 and 0.73 +/- 0.14 respectively. The inter-rater and intra-rater intraclass correlations were 0.76 (95% CI 0.61-0.87) and 0.97 (95% CI 0.93-0.98) respectively. Using linear regression the rate of linear cup-to-disc ratio change was 0.0068 +/- 0.0062 per year (range -0.0025- 0.0269). Three eyes had an increase in the peripapillary atrophy area. The higher yearly average intraocular pressure was significantly associated with faster rate of linear cup-to-disc ratios progression (P = 0.03). CONCLUSIONS: In treated patients with primary open-angle glaucoma, the rate of progressive optic disc cupping was slow (LCDR progression of 0.0068 per year). The higher yearly average intraocular pressure was significantly associated with a faster rate of cup progression.     

Different types of optic disc shape in patients with advanced open-angle glaucoma

Purpose  

To study the characteristics of patients with advanced open-angle glaucoma.     

Topographic changes in the optic disc in eyes with cotton-wool spots and primary open-angle glaucoma

Changes in the topography of the optic disc in 26 eyes with cotton-wool spots displaying defects in the retinal nerve-fiber layer and in 31 eyes with early primary open-angle glaucoma showing a similar degree of such defects were studied by computer-assisted optic disc analyzer and then compared with 27 controls. Changes in the cup-to-disc ratio, cup volume, and ratio of rim area to disc area were not significant in eyes with cotton-wool spots. The quotient of cup volume divided by cup-to-disc ratio eyes with of primary open-angle glaucoma was greater than that in eyes with cotton-wool spots. For the detection of nerve loss in eyes with cotton-wool spots, the image analyzer, which identified the notches in the horizontally sectioned contour line of the cup, was more sensitive than stereoscopic detection of the notches in the rim (P<0.05). The image analyzer enabled the detection of slight nerve-fiber loss by examination of the contour line of the cup in eyes with cotton-wool spots.This work was performed at: Department of Ophthalmology, Faculty of Medicine, Kyoto University. Thanks are due Topcon Japan (Tokyo) for technical assistance. This work was supported by grant-in-aid B02454403 for Scientific Research from the Ministry of Education, Science and Culture of the Japanese Government Offprint requests to: E. Chihara     

开角型青光眼患者视盘及脉络膜变化分析

目的　通过频域OCT检查探讨开角型青光眼（open-angle glaucoma,OAG）患者视网膜及脉络膜各参数的变化。方法　回顾性病例对照研究。临床检查确诊为OAG的19例（30眼）患者为OAG组,健康人15名（30眼）为对照组。采用频域OCT的EDI模式测量2组视盘周围神经纤维层厚度、视盘周围脉络膜厚度及黄斑中心凹处神经纤维层厚度、黄斑中心凹处脉络膜厚度,并作对比。结果　OAG组受检眼6方位视盘周围神经纤维层厚度均明显低于对照组,差异均有统计学意义（均为P＜0.05）;5方位（颞上方、颞侧、鼻上方、鼻侧及鼻下方）视盘周围脉络膜厚度均明显低于对照组（均为P＜0.05）,尤其以鼻侧及鼻下方变薄更明显。OAG组黄斑处神经纤维层厚度［（11.27±1.93）μm］及黄斑中心凹处脉络膜厚度［（217.37±11.46）μm］与正常对照组［（11.57±1.65）μm、(215.65±12.42)μm］相比,差异均无统计学意义（均为P>0.05）;两组间黄斑部直径3 mm的内环鼻侧、颞侧区域和直径6 mm的外环鼻侧、颞侧区域脉络膜厚度差异均无统计学意义（均为P>0.05）。结论　OAG患者与正常人相比,视盘周围脉络膜厚度减少,且视盘鼻侧及鼻下方脉络膜厚度变薄更为显著,可能与脉络膜血供减少造成的青光眼缺血性损伤相关。OAG患者黄斑部脉络膜厚度并未发生明显变化。