原发性开角型与低眼压性青光眼视乳头结构比较

比较原发性开角型青光眼和低眼压性青光眼视乳头形态结构的差异。利用计算机图像分析技术比较开青和低青患者视乳头表面结构参数。开青组的视杯深度大于低青组；低青组鼻侧区的盘沿高度高于开青组。低青组鼻侧区与颞侧区的沿盘面积比大于开青组。低青组的盘沿总平均高度及总沿盘面积比均大于开青组。开青与低青患者的视乳头三维立体结构存在一定差异。     

原发性开角型青光眼视乳头盘沿高度与视野的一致性研究

据《中华眼科杂志》2000年7月36卷第4期报道 北京医科大学第一医院眼科潘英姿等,为探讨原发性开角型青光眼(开青)相对视乳头盘沿高度(NRD)与视野检查结果的一致性,采用计算机图像分析技术对开青患者颞上方和     

可疑青光眼视乳头盘沿形态与静态阈值视野改变的观察

原发性闭角型青光眼是我国老年人常见的致盲眼病之一，本文重点探讨可疑青光眼视乳头盘沿形态与静态闻值视野改变的关系。视乳头凹陷的扩大和视野缺损是青光眼所致视功能损害的重要表现形式，也是青光眼诊断的重要依据。但青光眼视乳头凹陷的扩大和生理性大杯在临床上易混淆。近年有学者研究表明，按盘沿的形态可以很好地区别两者。即生理性大杯的盘沿下方大于上方，上方大于鼻侧，鼻侧大于颞侧，青光眼视乳头凹陷的扩大盘沿下方小于上方。     

海德堡视网膜断层扫描仪在青光眼诊断中的价值

目的评价海德堡视网膜断层扫描仪Ⅱ型（HRT-Ⅱ）在青光眼诊断中的应用价值。方法对正常组98例（98只眼）和闭角型青光眼（PACG）组59例（59只眼）、开角型青光眼（POAG）组36例（36只眼）分别行HRT-Ⅱ检查,比较各组间视盘结构参数的差异,并用ROC曲线下面积分析不同参数的诊断灵敏度和特异度。结果正常组与开角型青光眼组间杯盘面积比、视杯容积、盘沿容积、杯型测量及平均神经纤维层厚均有显著性差异。正常组与闭角型青光眼组只有杯形测量及平均神经纤维层厚有显著性差异。结论 HRT-Ⅱ对青光眼的诊断有很大帮助。     

体视学技术在视乳头血管的定量分析

目的观察和测定原发性开角型青光眼患者视神经乳头的血管形态、数量变化,探讨血循环障碍对青光眼所致视神经损害的影响并提供病理依据.方法将青光眼患者和正常人视神经乳头标本连续半薄垂直切片,采用计算机图像分析和生物体视学方法测定血管的体积密度、数量密度和相对面积比率.结果血管的体积密度和相对面积比率均较对照组显著降低,而两组的血管数量密度无明显差异.结论原发性开角型青光眼视乳头筛板区的血管形态发生变化,提示原发性开角型青光眼患者存在视乳头血循环障碍.     

海德堡视网膜断层扫描仪在青光眼诊断中的价值

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：对对照组98例（98只眼）和闭角型青光眼（Primary angle closure glaucoma,PACG）59例（59眼）,开角型青光眼（primaryopen angle glaucoma,POAG）36例（36眼）分别行HRT-Ⅱ检查,比较各组间视盘结构参数的差异,并用Roc曲线下面积分析不同参数的诊断灵敏度和特异度。结果：正常组与开角型青光眼组间杯盘面积比、视杯容积、盘沿容积、杯型测量及平均神经纤维层厚均有显著性差异。正常组与闭角型青光眼间只有杯形测量及平均神经纤维层厚有显著性差异。结论：HRT-Ⅱ对青光眼的诊断有很大帮助。     

应用海德堡视网膜断层扫描仪（HRTⅢ）分析视乳头参数与近视性屈光度、年龄、性别的关系

目的:研究视乳头参数与近视性屈光度、年龄和性别因素的关系及对原发性开角型青光眼早期诊断的影响.方法:应用海德堡视网膜断层扫描仪HRT Ⅲ的青光眼模块对89例单纯性近视患者进行视乳头检测,获得一系列视乳头参数.结果:①盘沿体积(rim volume,RV)、轮廓线高度变异(height variation contour.HVC)、平均神经纤维层厚度(mean RNFL thickness,mRNFLT)、神经纤维层横截面积(RNFL cross section area,RCSA)与屈光度呈正相关(P＜0.05),相关系数分别为:0.377 8、0.321 7、0.346 6、0.366 3.②视乳头各参数与年龄无相关性.③轻度近视组中视乳头面积(disc area,DA)、盘沿面积(rim area,RA)、RV、RCSA,中度近视组中mRNFLT、RCSA,高度近视组中HVC分别与性别因素明显相关.结论:①近视性屈光度及性别因素影响HRT Ⅲ的视乳头参数检测值,年龄因素的影响须进一步研究分析.②参考平面的设定使近视眼的mRNFLT的检测值较实际值偏大,影响伴有近视眼的原发性开角型青光眼的早期诊断.③需建立适用于不同近视性屈光度及性别的数据库,设定更适应视乳头形状变化的参考平面,进一步提高检测的有效性.     

盘沿容积与盘沿面积比在原发性开角型青光眼诊断作用的研究

目的探讨盘沿容积与盘沿面积比在原发性开角型青光眼（POAG）诊断中的作用．方法选取38例（76眼）正常人和62例（84眼）POAG患者．将所有人选按年龄分段，每隔10年为一段，共3段（31-40岁．41．50岁，51．60岁），用HRT检测视盘，对两组的盘沿容积（RV）与盘沿面积（RA）比进行比较．并将3组POAG的RV／RA、RV、RA分别与平均视野缺损（MD）的关系作一比较．结果RV／RA正常组与青光眼每个年龄段两组间差异均有显著性（P〈0．05）；只有41-50岁POAG组RV／RA与MD呈正相关，其余年龄POAG组RV／RA及所有RV、RA与MD均无相关性．结论盘沿容积与盘沿面积比在原发性开角型青光眼早期诊断中是一敏感参数．     

健康体检中原发性开角型青光眼的机会筛查

目的了解太原市50岁以上健康体检人群中原发性开角型青光眼的患病率及眼底视乳头大视杯的情况。方法对山西医科大学第一医院体检中心接受体检的≥50岁受检者进行问卷调查及双眼免散瞳眼底照相,对垂直杯盘比≥0．6且上方或下方盘沿变窄的体检者进行青光眼筛查检查。结果目标人数为3255人,大视杯人数为428人,占目标人数的13．15％;大视杯在年龄比较中,3组总体比较有统计学意义,大视杯性别比较中,左眼组男女比较有统计学意义,其余无统计学意义。参加青光眼筛查检查者为59人,应答率为58．41％;通过筛查检查,12例被诊断为原发性开角型青光眼;通过问卷,有18人次知道自己患有青光眼。结论大视杯在人群中所占比率随着年龄增加而增加,大视杯在男女性别比较中总体无差别。国人的健康意识仍需进一步提高,机会筛查中运用影像学确定的杯盘比在青光眼的早期发现中具有临床意义。     

FD-OCT测量视盘周围视网膜神经纤维层和视神经乳头参数在青光眼早期诊断中的意义

目的:探讨RTVue傅里叶域光学相干断层扫描成像仪(fourier-domain optical coherence tomography, FD-OCT)测量视盘周围视网膜神经纤维层(retinal nerve fiber layer, RNFL)及视神经乳头(optic nerve head,ONH)各项参数在青光眼早期诊断中的作用?方法:应用RTVue FD-OCT测量青光眼患者50例76只眼及正常人45例80只眼的视盘周围RNFL厚度及ONH各项参数,比较正常眼与各期青光眼的差异,用受试者工作特征曲线下面积(area under the receive operating characteristic curve, AUROC)评价其在青光眼早期诊断中的作用?结果:不同阶段青光眼患者各象限及平均RNFL厚度均比正常人减少,差异有统计学意义(P < 0.001)?除视盘面积,其余ONH参数(视杯面积?盘沿面积?盘沿容积?视神经容积?视杯容积?杯盘比?水平杯盘比?垂直杯盘比)在正常组与青光眼组之间差异均有统计学意义(P < 0.001)?正常组与青光眼组之间平均RNFL?垂直杯盘比?杯盘比和视杯面积的AUROC最大?正常组与早期组之间平均RNFL?杯盘比?视杯面积AUROC最大?结论: RTVue FD-OCT测量视盘周围RNFL厚度及ONH参数有助于青光眼早期诊断?     

原发性开角型青光眼视盘参数OCT测量的可重复性

目的评价光学相干断层扫描(OCT)在原发性开角型青光眼病人视盘各项参数检测中的可重复性。方法由同一名操作者对原发性开角型青光眼病人28例(48眼)进行OCT检查,每眼连续扫描3次,获得视盘面积(DA)、视杯面积(CA)、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)、视盘竖径(DV)、视盘横径(DH)9个视盘参数,通过类内相关系数(ICC)评价各视盘参数测量的可重复性。结果 9个视盘参数的ICC值均较高,为0.775~0.948。结论 OCT测量视盘参数具有较好的可重复性,在原发性开角型青光眼的早期诊断和随访观察中具有重要价值。     

原发性开角型青光眼OCT评估视网膜神经纤维层厚度与视盘参数的关系

目的:使用光学相干断层成像术(OCT)评估原发性开角型青光眼(POAG)各个病程时期的视网膜神经纤维层(RNFL)与视盘参数的差异,从而探讨青光眼RNFL厚度的变化与盘沿面积和杯盘面积比(C/D AR)之间的关系,确定OCT检测参数对青光眼病程变化的参考意义。方法:应用OCT检查技术分别对40例(60只眼)的POAG患者的RNFL及视盘进行检测。数据包括颞侧(TEMP)、上方(SUP)、鼻侧(NAS)、下方(INF)RNFL厚度以及平均RNFL厚度与盘沿面积和C/D AR。按青光眼诊断标准和视野分期法分为早期、中期和晚期3组。比较和分析3组的RNFL变化趋势以及与视盘参数的相关性。结果:青光眼早期、中期和晚期3组之间RNFL和视盘参数的比较具有显著性差异(P<0.01)。RNFL平均厚度与盘沿面积有正相关性,r=0.719,P<0.01;与C/D AR有负相关性,r=-0.712,P<0.01。结论:POAG各个时期中RNFL厚度逐渐变薄,同时盘沿面积减少和C/D AR扩大。盘沿面积占影响RNFL厚度的因素比重较大,比C/D AR更能反映RNFL的变化。青光眼的病程发展能通过RNFL的减少变化来反映。OCT的客观检查所得的各项参数也对原发性青光眼的病情发展的评估具有一定的意义。     

海德堡视网膜断层扫描仪在开角型青光眼诊断中的价值

目的 评价海德堡视网膜断层扫描仪 (Heidelberg retina tomograph,HRT)在开角型青光眼(primary open angl glaucom,POAG)诊断中的应用价值.方法 对照组98例(98眼)和POAG组36例(36眼)分别行HRT检查,比较各组间视盘结构参数的差异,并用ROC曲线下面积分析不同参数的诊断灵敏度和特异度.结果 对照组与POAG组间杯盘面积比、视杯容积、盘沿容积、视杯形态测量指数及平均视网膜神经纤维层厚度差异均有统计学意义(P＜0.05).ROC曲线下面积分析特异度最高的为视杯形态测量指数,灵敏度最高的为平均视网膜神经纤维层厚度.结论 HRT检查对开角型青光眼的诊断有很大帮助.     

Characteristics of optic disc parameters and its association in normal Chinese population: the Handan Eye Study

Background Assessment of the optic disc and retinal nerve fiber layer （RNFL） is essential for the diagnosis and monitoring of glaucoma.Knowledge of normal optic disc topography provides a benchmark for evaluating glaucomatous pathologic changes,especially in its early stages.The purpose of this study was to evaluate the characteristics and correlation factors of the optic disc parameters using the Heidelberg Retina Tomograph Ⅱ （HRT Ⅱ） in a large sample of normal eyes of adult Chinese subjects.Methods Disc data were obtained from 6 830 subjects aged ＞30 years from the Handan Eye Study.All participants underwent comprehensive eye examinations and physical examinations.The associations of gender,age,body mass index,blood pressure,waist-to-hip ratio; refractive error,intraocular pressure,axial length,and disc area were assessed using simple and multiple regression analysis.The correlation between HRT Ⅱ parameters was evaluated.Results Of the 7 557 eligible subjects,6 830 took part in the study （90.4％ response rate） and 2 633 normal eyes with good-quality HRT Ⅱ images were selected.The mean disc area was 2.28 mm2 （standard deviation （SD） 0.43） and mean neural rim area was 1.80 mm2 （SD 0.29）.In multiple regression analysis,optic disc area significantly correlated with age,gender,and axial length （P ＜0.001）.All optic disc parameters showed a significant correlation with disc area （0.054 ＜r ＜0.736,P ＜0.01）.The association between mean RNFL thickness and rim area is statistically significant but not strong （regression linear equation：rim area =1.42 × mean RNFL thickness ＋ 1.32 mm2,P ＜0.001; R2=0.070）.The global RNFL cross-sectional area was significantly associated with global rim area （regression linear equation：rim area =1.14× RNFL cross-sectional area ＋ 0.44 mm2,P ＜0.001; R2 =0.271）.Conclusions The optic disc area in rural Chinese population is larger than reported in white and Japanese populations,similar to that of Indian population and urban Chinese population.Most optic disc measurements were moderately or weakly affected by disc area.In addition to the RNFL,there may be other factors affecting the rim area.The relationship between optic disc and axial length may suggest a link between larger disc area,thinning of the lamina cribrosa,and increased glaucoma susceptibility in myopic eyes.     

不同年龄正常人群视乳头形态结构检测

目的建立正常人视乳头形态结构参数的正常值,探讨性别、眼别、年龄对视盘参数的影响。方法应用海德堡视网膜断层扫描仪（HRT）对300例（600眼）正常人视乳头结构进行扫描,按年龄分成5组,获取视盘参数值并分析性别、眼别、年龄和参数的关系。结果300例（600只眼）视盘面积（DA）为（2.1969±0.4611）mm2,视杯面积（CA）为（0.5262±0.3204）mm2,盘缘面积（RA）为（1.6627±0.3774）mm3,杯盘面积比（C/DR）为0.2307±0.1150,视杯容积（CV）为（0.1209±0.1175）mm3,盘缘体积（RV）为（0.4983±0.1571）mm3,杯的平均深度（MCD）为（0.2286±0.0951）mm,视杯的最大深度（MxCD）为（0.6498±0.2343）mm,沿轮廓线的视网膜表面的高度变化最大值（HVC）为（0.4582±0.1400）mm,视杯三维形状的测量值（CSM）为（-0.1911±0.0697）mm,平均视网膜神经纤维层厚度（mRNFLT）为（0.2964±0.0742）mm,平均视网膜神经纤维层截面面积（RNFLA）为（1.5210±0.3875）mm2。300例视盘参数不同眼、不同性别差异无显著性（〉0.05）。44岁以前与44岁以后的各年龄组比较mRNFLT、RNFLA差异有显著性（〈0.05）,而44岁以前的各年龄组比较差异无显著性（〉0.05）。结论正常人视乳头参数值变异较大,随年龄增加,视网膜神经纤维层逐渐变薄,年龄越大退变越明显。视盘参数不同眼、不同性别差异无显著性。     

Diagnostic capability of Fourier-Domain optical coherence tomography in early primary open angle glaucoma

Background Optical coherence tomography （OCT） is a high resolution noncontact imaging modality which can quantitatively detect the optic disc and retinal structure.This study was designed to evaluate the diagnostic capability of parameters of the optic disc, retinal nerve fiber layer thickness, and ganglion cell complex （GCC） using a new technology called Fourier-domain OCT （FD-OCT） for early primary open angle glaucoma （POAG） patients.Methods Two groups of patients, early perimetric damage POAG and normal subjects were included in this observational cross-sectional study.All patients underwent FD-OCT and visual field examination in addition to full ophthalmic examinations.Receiver operating characteristic curves （ROC） were studied for all parameters.The sensitivity and specificity for distinguishing between normal and early glaucomatous eyes, the areas under the receiver operating characteristic curves （AROC） and positive, negative likelihood ratios were evaluated for all the single parameters and selected combined parameters using arbitrary cutoffs.Results Thirty-four eyes of 34 early POAG patients and 42 eyes of 42 normal subjects were analyzed.Cup/disc （C/D）vertical ratio presented the best sensitivity and positive likelihood ratio for selected specificities （95% and 85%） which were 79.4% and 88.2%, 33.4 and 7.4, respectively.Among all single parameters, the C/D vertical ratio demonstrated the highest AROC which was at 0.930.The average thickness of circumpapillary RNFL on 3.45 mm showed the highest AROC among all of the peripapillary RNFL parameters.The sensitivity at selected specificity and AROC of GCC were not as high as C/D vertical ratio and RNFL AT on 3.45 mm.When the C/D vertical ratio, RNFL AT on 3.45 mm, and rim area were combined using a logistical diagnostic model, the AROC was raised to 0.949 but not significantly different from the top single parameter, C/D vertical ratio.Conclusions The key parameters obtained by FD-OCT were able to show the significant differences of optic discs,thickness of RNFL and GCC between POAG patients and normal subjects.According to sensitivity, specificity, likelihood ratio and AROC, the top three parameters from FD-OCT for early diagnosis of POAG were C/D vertical ratio, RNFL AT on 3.45 mm, and the rim area.     

Comparative study of optic disc measurement by Copernicus optical coherence tomography and Heidelberg retinal tomography

Background  Copernicus optical coherence tomography (SOCT) is a new, ultra high-speed and high-resolution instrument available for clinical evaluation of optic nerve. The purpose of the study was to compare the agreements between SOCT and Heidelberg retinal tomography (HRT).

Methods  A total of 44 healthy normal volunteers were recruited in this study. One eye in each subject was selected randomly. Agreement between SOCT and HRT-3 in measuring optic disc area was assessed using Bland-Altman plots. Relationships between measurements of optic nerve head parameter obtained by SOCT and HRT-3 were assessed by Pearson correlation.

Results  There was no significant difference in the average cup area (0.306 vs. 0.355 mm, P=0.766), cup volume (0.158  vs. 0.130 mm, P=0.106) and cup/disc ration (0.394 vs. 0.349 mm, P=0.576) measured by the two instruments. However, other optic disc parameters from SOCT were significantly lower compared with HRT-3. The Bland-Altman plot revealed good agreement of cup area and cup volume measured by SOCT and HRT-3. Bad agreement of disc area, rim area, rim volume and cup/disc ratio were found between SOCT and HRT-3. The highest correlations between the two instruments were observed for cup area (r²=0.783, P=0.000) and cup/disc ratio (r²=0.669, P=0.000), whereas the lowest correlation was observed for disc area (r²=0.100, P=0.037), rim area (r²=0.275, P=0.000), cup volume (r²=0.005, P=0.391) and rim volume (r²=0.021, P=0.346).

Conclusions  There were poor agreements between SOCT and HRT-3 for measurement of optic nerve parameters except cup area and cup volume. Measurement results of the two instruments are not interchangeable.