傅立叶OCT和海德堡激光眼底扫描仪在开角型青光眼早期诊断中的应用

背景研究表明,视网膜神经纤维层（RNFL）缺损是青光眼早期损害的重要表现,如何准确地定量检测RNFL的厚度变化是青光眼早期诊断及监测青光眼病情进展的关键步骤之一。目的对傅立叶OCT、海德堡激光眼底扫描仪（HRT—Ⅲ）测量青光眼患者的RNFL厚度以及视盘的各项参数进行分析,对二者在青光眼早期诊断中的作用进行临床评价。方法收集可疑开角型青光眼（SOAG）患者26例40眼、原发性开角型青光眼（POAG）患者29例48眼以及正常对照组27例48眼。应用傅立叶OCT、HRT—Ⅲ、Humphrey 750-i型全自动视野计对所有研究对象分别进行视盘面积,视杯面积,杯盘面积比,盘沿面积,盘沿容积,视盘上方、下方、颞侧、鼻侧象限的RNFL厚度等参数测定和视野检查,对不同受检者测得的各项参数进行分析和比较,分别与视野平均缺损值做相关分析,评价不同参数对于青光眼RNFL损伤的诊断价值。结果傅立叶OCT和HTR—Ⅲ检测对正常对照组检查结果均证实RNFL从厚到薄依次为视盘下方、上方、颞侧、鼻侧象限,SOAG组和POAG组RNFL厚度变薄的顺序依次为视盘下方、上方、颞侧、鼻侧象限,各部位厚度改变的差异均有统计学意义（P〈0．05）,SOAG组和POAG组患者盘沿面积、杯盘面积比、视杯面积、盘沿容积与正常对照组比较,差异均有统计学意义（P〈0．05）。对3组患者的检测表明,傅立叶OCT与HTR-Ⅲ检测视盘上方象限、下方象限的测定之间存在着正相关关系（r=0．362、r=0．441、r=0．395,P〈0．05）;2种检查方法所测得3个组视杯容积、视杯面积、盘沿容积、杯盘面积比呈正相关（P〈0．05）。在POAG组中,傅立叶OCT测得视盘参数中的盘沿面积、盘沿容积、视杯容积、杯盘面积比与视野的平均缺损值间的相关系数分别为0．284、0．286、0．340、0．371（P〈0．05）;HRT-Ⅲ测得视盘参数中的盘沿面积、盘沿容积、杯盘面积比与视野的平均缺损值间的相关系数分别为0．339、0．859、0．422（P〈0．05）。结论傅立叶OCT和HRT-Ⅲ检测的视盘参数结果接近,且均与视野的平均缺损值有较好的相关性;所检测杯盘面积比、盘沿面积和视盘上方象限、下方象限的RNFL厚度的改变在青光眼早期诊断中均有重要价值。     

海德堡激光眼底扫描仪对POAG患者视盘结构的研究分析

目的:评价海德堡激光眼底扫描仪(HRT-Ⅲ)对原发性开角型青光眼(primary open angle glaucoma,POAG)不同发展阶段的诊断能力。方法:采用海德堡激光眼底扫描仪对POAG患者65例116眼和正常人60例114眼进行视盘断层扫描获取视盘结构各参数;将正常人和POAG患者以及各期POAG患者的视盘参数进行对比分析;将POAG患者的视盘结构参数与视野平均缺损值进行相关分析。结果:POAG患者与正常人的视杯面积、盘沿面积、视杯容积、盘沿容积、杯盘面积比、盘沿视盘面积比、线性杯盘比、平均视杯深度、最大视杯深度、平均RNFL厚度的差异有统计学意义。早期、进展期、晚期POAG患者的视杯面积、盘沿面积、视杯容积、盘沿容积、杯盘面积比、盘沿视盘面积比、线性杯盘比、平均视杯深度、平均视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度的差异有统计学意义。POAG患者的视杯面积、视杯容积、杯盘面积比、线性杯盘比、平均视杯深度与视野平均缺损值呈正相关,而盘沿面积、盘沿容积、盘沿视盘面积比、平均RNFL厚度则与视野平均缺损值呈负相关。结论:HRTⅢ能够有效地反映POAG各阶段的视盘改变,与视野相关性好,为POAG的诊断提供了依据。     

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。     

应用海德堡视网膜断层扫描仪检测开角型青光眼的视盘改变

目的探讨海德堡视网膜断层扫描仪(Heidelberg retinal tomography,HRT)检测青光眼性视盘改变是否与视野损害的部位相一致,了解正常眼压性青光眼(normal tension glaucoma,NTG)与原发性开角型青光眼(primary open angle glaucoma,POAG)早或中期视盘形态是否异同.方法对64例(64只眼)仅有半侧视野异常的开角型青光眼(POAG27只眼、NTG37只眼)患者进行HRT检测,将Humphery视野与HRT的检测结果以0°～180°为界,分成上下两部分进行对应分析.结果与正常半侧视野对应的1/2视盘比较,显示异常半侧视野对应的1/2视盘HRT参数中,杯盘面积比、视杯形态测量值显著增大,而盘沿面积、视网膜神经纤维层厚度及视网膜神经纤维层横断面积值显著减少 (t=-2.625～3.025,P=0.003～0.05);NTG眼和POAG眼对应与异常半侧视野的HRT视盘参数差异无显著性(t=-0.98～1.511,P=0.14～0.97).结论 HRT参数能较准确反映与视野损害相一致的视盘变化,其中尤以杯盘面积比、盘沿面积、视杯形态测量、平均视网膜神经纤维厚度及视网膜神经纤维层横断面积测量值较为准确.NTG和POAG眼的视盘形态相似,可能具备某些相似的视神经损害发生机制.     

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。     

原发性开角型青光眼HRT视盘参数和视野缺损的关系

目的 :探讨原发性开角型青光眼视盘参数和视野平均缺损之间的关系。方法 :用海德堡视网膜断层扫描仪和自动视野计测定 5 5名原发性开角型青光眼患者的视盘参数 (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 )和静态光阈值。视盘参数与视野平均缺损作相关分析和多元线性回归分析。结果 :盘沿面积与平均缺损显著相关 (r =0 3 5 0 ,P <0 0 5 )。盘沿面积每减少 1mm2 ,视野缺损绝对值增加 8 0 81dB。本研究没有发现其它 6个参数与平均缺损相关关系的显著性。结论 :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。     

眼压降低后原发性慢性青光眼视野的变化

目的了解原发性开角型青光眼（POAG）和原发性慢性闭角型青光眼（PACG）在眼压降低后视野是否发生改变及相关因素分析。方法原发性慢性青光眼32例（44眼）,其中PACG19例（25眼）,POAG13例（19眼）。眼压治疗前及治疗后1个月全部患者均行Humphrey静态自动视野（HFA）24-2全阈值视野检查。比较眼压降低前后视野平均缺损（MD）、模式标准差（PSD）的变化,分析眼压降低幅度、年龄及视神经杯盘比与视野MD改变是否相关。结果治疗前MD为-13．58±9．31,治疗后MD为-12．08±8．37,治疗前后MD比较差异有统计学意义（t=3．35,P=0．002）;治疗前后MD差值与眼压降低幅度呈正相关（r=0．341,P=0．027）。协方差分析结果表明,校正年龄和HRT的杯盘面积比后,治疗前后视野MD的改变与眼压降低幅度呈正相关（F=4．706,P=0．037）。结论原发性慢性青光眼眼压降低后视野有所改善,视野改善的程度与降压幅度有关。     

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.     

用Heidelberg视网膜断层扫描仪对正常眼压性青光眼与正常人视盘形态结构的对比研究

目的 比较正常人(本文所指正常人指非青光眼者)和正常眼压性青光眼(Normal Tension Glaucoma，NTG)视盘形态结构参数之间的差异，以指导正常眼压青光眼的早期诊断。方法 用Heidelberg视网膜断层扫描仪(Heidelberg Retina Tomograph Ⅱ，HRTⅡ)对正常人40例(80眼)及NTG30例(60眼)的视乳头进行断层扫描，获得视乳头平均地形图像和视乳头结构诸参数。结果 正常人与NTG视乳头结构各参数中视盘面积、视杯面积、杯盘比、盘沿面积、视杯容积、平均视杯深度、最大视杯深度、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能在活体对视乳头结构进行准确分析，视盘面积可能是青光眼的一个易感因素，对NTG早期诊断具有帮助。     

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。     

Optic disc morphology in primary open-angle glaucoma versus primary angle-closure glaucoma in South India

Purpose:The aim of this study was to investigate the optic disc morphology in primary angle-closure glaucoma (PACG) versus primary open-angle glaucoma (POAG) in South Indians.Methods:A total of 60 patients (60 eyes) with PACG and 52 patients (52 eyes) with POAG were included in a cross-sectional observational study. The glaucoma diagnosis was based on a glaucomatous appearance of the optic disc correlating with visual field defects. The glaucoma was graded as early, moderate, or severe, depending upon perimetric loss. All patients underwent an ophthalmic evaluation, including visual field examination and planimetric analysis of 30° stereoscopic color optic disc photographs.Results:The POAG and PACG groups did not differ significantly in a disc or rim area, rim width, and frequencies of disc hemorrhages or rim notches. However, early POAG group (n = 15) had a significantly deeper cup depth (P = 0.01), larger beta zone (P = 0.01), and a higher frequency of localized retinal nerve fiber layer (RNFL) defects (P = 0.02) than early PACG (n = 20).Conclusion:In the early stage of the disease, POAG compared to PACG may be characterized by deeper disc cupping, a larger beta zone of peripapillary atrophy, and a higher frequency of localized RNFL defects. Such differences in early glaucoma may suggest differences in pathophysiology in POAG and PACG.     

Correlation analysis of visual field thresholds and scanning laser ophthalmoscopic optic nerve head measurements in glaucoma

In a cross-sectional study of 50 consecutive primary open-angle glaucoma cases, full threshold 30-2 visual fields on Humphrey Visual Field Analyser were correlated to stereometric parameters obtained using a scanning laser ophthalmoscope (HRT II). The strength of linear correlation between the stereometric parameters and visual thresholds was used to generate a correspondence map between the optic disc and the visual field. Rim/disc area ratio and cup/disc area ratio correlated with the visual thresholds at the highest number of points in the visual fields. Thresholds at superior hemifield locations correlated best with the rim/disc area ratio and cup/disc area ratio in the inferonasal sector and the ones in the inferior hemifield correlated best with the rim/disc area ratio and cup/disc area ratio in the superotemporal sector. Optic disc parameters correlated better with inferior field locations and non-edge points than superior field locations and edge points. The data indicate that rim/disc area ratio and cup/disc area ratio measurements on HRT II have a good correlation with visual field damage seen on automated visual fields.     

Phacotrabeculectomy in Treatment of Primary Angle-closure Glaucoma and Primary Open-angle Glaucoma

Purpose To evaluate the surgical outcome of combined phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy (phacotrabeculectomy) in patients with primary angle-closure glaucoma (PACG) or primary open-angle glaucoma (POAG).Methods The records of 57 consecutive patients (65 eyes) with PACG or POAG that were treated with phacotrabeculectomy were reviewed retrospectively. There were 31 eyes with PACG and 34 with POAG. The mean follow-up period was 21.0 ± 8.3 months. The visual acuity, intraocular pressure (IOP), number of medications, and complications were evaluated.Results The mean IOP and the number of glaucoma medications decreased significantly after phacotrabeculectomy in both groups. The mean IOP reduction was significantly greater in eyes with PACG (P < 0.05). The absolute success rates were 87.1% and 70.6% in PACG and POAG, respectively. The difference in the success rates was not significant (P = 0.297). The early postoperative complication rates were similar in both groups.Conclusions Phacotrabeculectomy results in greater IOP reduction in eyes with PACG than in those with POAG, but the overall success rates were not significantly different. Jpn J Ophthalmol 2004;48:408–411 © Japanese Ophthalmological Society 2004     

Comparing glaucomatous optic neuropathy in primary open angle and chronic primary angle closure glaucoma eyes by optical coherence tomography

PURPOSE: To comparatively evaluate the optic nerve head (ONH) using Optical Coherence Tomography (OCT) in normal subjects, primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) patients. METHODS: A total of 138 normal eyes (138 subjects) and 139 glaucomatous eyes (139 patients), were evaluated in this cross-sectional observational study. The ONH was imaged on OCT using the optic disc scan. Disc area, cup area, rim area, vertical integrated rim area (VIRA), rim volume (horizontal integrated rim volume), average cup/disc ratio, horizontal and vertical cup/disc ratios, and cup volume were evaluated. Additionally, cup depth and slope of the temporal ONH were also measured. These ONH parameters were compared between normal subjects and eyes with early POAG and CPACG. Correlation of mean deviation and corrected pattern standard deviation on full threshold 30-2 perimetry, with measured ONH parameters was carried out amongst the two groups. RESULTS: There was a significant difference in disc area (2.38 +/- 0.5, 2.77 +/- 0.4, 2.62 +/- 0.4 mm(2), p < 0.01), cup area (0.88 +/- 0.6, 1.99 +/- 0.7, 1.60 +/- 0.7 mm(2), p < 0.01), rim area (1.48 +/- 0.4, 0.86 +/- 0.4, 0.96 +/- 0.4 mm(2), p < 0.01), VIRA (1.64 +/- 0.3, 1.23 +/- 0.3, 1.22 +/- 0.4 mm(2), p < 0.01), rim volume (0.34 +/- 0.2, 0.1 +/- 0.1, 0.15 +/- 0.1 mm(3), p < 0.01) and cup/disc ratio (0.36 +/- 0.2, 0.69 +/- 0.1, 0.63 +/- 0.2, p < 0.01) in normal vs POAG vs CPACG eyes respectively. A comparison of ONH parameters between early POAG and early CPACG showed a significant difference in the disc area (2.85 +/- 0.3, 2.57 +/- 0.4 mm(2), p = 0.03), cup area (2 +/- 0.5, 1.34 +/- 0.5 mm(2), p < 0.01), rim area (0.96 +/- 0.4, 1.21 +/- 0.5 mm(2), p = 0.009), rim volume (0.12 +/- 0.1, 0.18 +/- 0.1 mm(3), p < 0.01) and cup/disc ratio (0.67 +/- 0.1, 0.53 +/- 0.2, p < 0.01). The parameters with the highest area under the receiver operator characteristic (AROC) curves for differentiating normal and early POAG eyes were rim volume, 0.89, VIRA, 0.84, and rim area, 0.76. The AROC values (normal vs early CPACG eyes) were 0.75 for rim volume, 0.72 for VIRA, and 0.66 for rim area. CONCLUSION: OCT may serve as a useful diagnostic modality in distinguishing a normal optic disc from a glaucomatous one, even in the early stages of glaucoma. Rim volume, VIRA and rim area can be used to differentiate normal from early glaucoma (both early POAG and CPACG), and most efficiently early POAG eyes. CPACG eyes have smaller discs, a smaller cup, smaller cup/disc ratio, and a larger rim area when compared with eyes with POAG.     

The Heidelberg retina tomograph ancillary study to the European glaucoma prevention study: study design and baseline factors

Purpose: To describe the study design and baseline factors of the Heidelberg Retina Tomograph ancillary study within the EGPS. Furthermore, to examine the relationship between HRT optic disc topographic measurements and baseline demographic and ocular factors. Methods: Four hundred and eighty‐nine ocular hypertensive participants were included. Each participant completed HRT imaging at least annually. The associations between HRT measurements and IOP, central corneal thickness (CCT), baseline photographic estimates of vertical CDR ratio (CDR), asymmetry between the two eyes in CDR ratio and baseline visual field indices were assessed using regression analysis. Results: Associations between HRT measurements and vertical CDR by photographs were found for almost all stereometric optic disc parameters in both univariate and multivariate analysis. The strongest association was found between vertical CDR measurements and disc, cup and rim area; cup and rim volume, CDR area, linear CDR, mean and maximum cup depth and cup shape measure (all p < 0.0001). In multivariate analysis, pattern standard deviation (PSD) and HRT disc area had significant associations with several HRT optic disc measurements. Furthermore, CCT was significantly associated with reference height and the glaucoma probability score (GPS, outside normal limits). Conclusions: The EGPS is the first multicentre, placebo‐controlled randomized clinical trial to use HRT for monitoring optic disc changes in participants with ocular hypertension. We found strong associations between stereophotographic vertical CDR estimates, HRT disc area, PSD and several HRT parameters. We found, furthermore, that the parameters reference height and GPS were significantly related to central corneal thickness.     

Optic disc topography as measured by confocal scanning laser ophthalmoscopy and visual field loss in Japanese patients with primary open-angle or normal-tension glaucoma

PURPOSE: To determine whether differences in the optic disc topography and those in the relation between the optic disc topography and visual field indices exist between Japanese patients with primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). METHODS: The study included consecutive Japanese patients with POAG (n = 60) or NTG (n = 60). Using the Heidelberg Retina Tomograph (HRT), we measured disc area, cup area, cup-to-disc area ratio, rim area, cup volume, rim volume, cup shape measure, and height variation contour. Each HRT parameter was measured in the total optic disc and in its four 90 degree quadrants (superior, temporal, inferior, and nasal). The mean deviation for the entire field and the sum of the total deviation values corresponding to each optic disc quadrant were calculated using the Humphrey full-threshold 30-2 program. RESULTS: No significant differences were found between the POAG and NTG groups for any HRT parameter either globally or regionally. There were no significant differences between the two groups in the correlation coefficients between any HRT parameter and the corresponding visual field indices either globally or regionally. CONCLUSION: No significant differences were apparent between Japanese patients with POAG and NTG both in the optic disc parameters as measured by HRT and in the degree of correlation between HRT parameter and the corresponding visual field indices.