可疑视野缺损眼的蓝/黄视野检查

目的：探讨蓝／黄视野检查法(B／YP)在可疑视野缺损眼中的应用价值。方法：对42例(42眼)白／白视野检查法(W／WP)有可疑视野缺损的患者进行B／YP检查，并对两种视野检查法的视野指数和阈值点对点进行相关分析。结果：42只眼中3只眼(7．14％)B／YP检查视野正常，39只眼(92．86％)显示有B／YP视野异常。B／YP与W／WP检查的视野指数(平均敏感度、平均缺损和偏离缺失)之间无明显相关性，两种视野检查法半数以上的阈值点间有一定的相关性。结论：B／YP检查视野的敏感性高于W／WP检查法。对B／YP检查视野异常且异常部位与W／WP检查可疑视野异常部位一致的患者应密切随访观察。     

可疑视野缺损眼的蓝/黄视野检查

目的探讨蓝/黄视野检查法(B/YP)在可疑视野缺损眼中的应用价值.方法对42例(42眼)白/白视野检查法(W/WP)有可疑视野缺损的患者进行B/YP检查,并对两种视野检查法的视野指数和阈值点对点进行相关分析.结果42只眼中3只眼(7.14%)B/YP检查视野正常,39只眼(92.86%)显示有B/YP视野异常.B/YP与W/WP检查的视野指数(平均敏感度、平均缺损和偏离缺失)之间无明显相关性,两种视野检查法半数以上的阈值点间有一定的相关性.结论B/YP检查视野的敏感性高于W/WP检查法.对B/YP检查视野异常且异常部位与W/WP检查可疑视野异常部位一致的患者应密切随访观察.     

蓝/黄自动化视野检测原发性开角型青光眼

目的 :探讨蓝 /黄 (B/ Y)自动化视野在早期开角型青光眼 (POAG)患者视敏度检测中的敏感性和应用价值。方法 :以 Humphry- 75 0视野机对 31例 (4 5眼 )早期 POAG患者作常规白色 (W/ W)视野和蓝 /黄视野 (B/ Y)检测。结果 :B/ Y视野出现的光敏度异常下降点数较 W/ W视野多 (B/ Y视野为 11.5 778± 5 .4 334,W/ W视野为10 .86 6 7± 5 .332 6 ,t=2 .973,P<0 .0 1)。B/ Y视野的 GHT指标的异常程度比 W/ W视野明显 (χ2 =7.111,P<0 .0 1) ,其中两种视野 GHT均为临界或异常者 30例 ,均正常者 6例 ,B/ Y视野 GHT临界或异常而 W/ W视野正常者 9例 ,W/ W视野 GHT临界或异常的病例 B/ Y视野 GHT均有异常。W/ W和 B/ Y视野的 MD指标两组间差异无显著性 (χ2 =3.2 73,P>0 .0 5 )。结论 :B/ Y视野检查在检测早期 POAG中较 W/ W视野灵敏度高。     

35例维吾尔族青光眼患者视野缺损的图象及分布

视野缺损是青光眼主要的诊断依据之一。青光眼的视野缺损常表现为旁中心暗点、弓形暗点、环形暗点以及管状视野、颞侧视岛〔１〕。了解青光眼的视野缺损的特点及频率分布有助于正确认识视功能的损害程度,预测青光眼病人的手术预后和对青光眼更早期的诊断。计算机自动视野计的应用,明显提高了检测青光眼视野损害的能力。我院近期应用美国Ｓｙｎｅｍｅｄ计算机自动视野计对已确诊为青光眼及可疑青光眼的维吾尔族患者进行视野检查,现将青光眼特征性视野缺损与阈值的改变报道如下。１　临床资料和方法１．１　临床资料　选择单眼或双眼已确诊…     

蓝黄视野检查在青光眼早期诊断中的应用

青光眼是一类严重的致盲性疾病，其防治的关键是早期诊断。近年来，青光眼的诊断已逐步向针对性视功能检查和高敏感形态学检测水平过渡。蓝黄视野检查(SWAP或B／Y PM)针对性的分离检测视觉系统中短波视路的敏感性，是将色觉检查和视野检查结合起来而形成的一种新的视野检查方法。本文旨在对蓝黄视野检查在青光眼早期诊断中的应用进展做一综述。     

早期青光眼49例中心视野的检查分析

应用阈上值静态单点自动定量微机中心视野仪（ＴＢＣ－ＩＡ型）检查早期慢性开角型青光眼的中心视野４９例（７１只眼）中心视野异常４６例６６中眼（９３．０％）表现为小的孤立性旁中心暗点３９只眼（５４．９％）及散在性多暗点，鼻侧阶梯，弓形缺损等，总灰度值〈６０者１０只眼，６０～８５者３８只眼，≥８６者２３只眼，此仪器可灵敏地检出视野变化，分析仍以形态学变化为主。     

识别原发性青光眼视野缺损进展

视野检查是青光眼疾病进展的重要检测手段.即使是正常人,每一次视野检测也不可能完全重复上一次检测结果,都会出现短期波动和长期波动.这种光敏感度的生理波动会在青光眼患者的视野结果中明显增加,并混淆检测者发现真正的视野改变.因此,从这种生理波动中甄别出真正的青光眼视野缺损或进展,成了一项复杂的任务.用来判断青光眼视野进展的方法大概概括为四类:(1)临床评估系统最老的识别视野进展的方法,由多个观察员完全主观评估视野缺损情况,实行双盲评估视野缺损;(2)线性趋势外推法预测青光眼视野缺损本方法是基于最初5次视野检查结果,使用线性外推法预测将来患者的视野缺损;(3)逐点线性回归分析一种是在视野的不同点进行线性回归分析,另一种是基于视野列表指标的线性回归分析,通过Humphrey FieldAnalyzer(HFA)软件统计视野区的视野列表指标,视野中心区给予更多的加权;(4)新的青光眼进展指数为了更好的解释视野结果,对检测结果进行了年龄校正.这些方法都有自己的优势和不足,而且每一种方法都有使用的特殊条件;同时,也没有一种方法是完美的.目前最理想的判断青光眼视野缺损进展的方法,应该是根据一系列检查结果的明确改变,以及视野改变与其它临床观察值的相互关系进行判断.更新的帮助识别视野缺损进展的方法在不久的将来就会出现.     

短波长自动视野检查在青光眼早期诊断中的应用

大量研究表明 ,青光眼对色觉的损害以短波长为早为重 ,因此 ,近年来有人设计了蓝色光标、黄色背景视野检查 ,即短波长自动视野检查或称蓝黄视野检查。这种检查方法采用黄色背景来中和感受中 -长波长视野细胞的敏感性 ,从而得以单独检查感受短波长 (<4 75 nm )视锥细胞的功能 ,同时 ,黄色背景也可中和视杆细胞的敏感性 ,以减少它们的参与效应。　　常规的白色视野检查在青光眼早期诊断方面有其局限性。 Quigley等研究证实视网膜神经节细胞丧失 2 0 %时 ,常规视野检查视网膜光敏感性就下降 5 d B;节细胞丧失 4 0 %时 ,视网膜光敏感性就下降 1…     

周边部视野对青光眼诊断的价值

为了评价周边部视野改变对青光眼诊断的意义,我们对103例青光眼患者177跟用Goldmann式视野计,改良的Armaly-Drance法查出的青光眼性视野损害的部位作了统计分析。在满足定性和分期诊断的前提下,据各眼主要的视野损害所处部位,以30度为标界,分成“单中”、“单周”、“中/周”及“中和周”4类。主要结果如下:①虽然单中者(54眼)较单周者(35眼)为多,但P>0.05;②19.77％的受检眼损害限于30度外,如果只查30度内,41.4％的受检眼不能满足诊断要求;③先兆及早期改变的131眼中126眼属单中或单周;而中晚期损害的46眼、33眼属中和周,先兆改变较多属单周,而早期改变多为单中。④低眼性青光眼多属单中,而高眼压者单周较多。作者认为周边部视野对青光眼的诊断也很重要,不容忽视。     

原发性开角型青光眼患者视网膜神经纤维层厚度与视野缺损相关性分析

目的:探讨原发性开角型青光眼视网膜神经纤维层厚度(RNFL)OCT测量及与视野缺损(MD)相关性。方法:68例(68眼)单侧原发性开角型青光眼患者为观察组,71例(71眼)正常人群作为对照组(71眼),采用Cirrus OCT对两组患者RNFL进行测量并采用全自动视野分析仪观察患者MD情况。结果:观察组患者RNFL水平明显低于对照组,观察组患者MD绝对值高于对照组,差异均具有统计学意义(t=6.682,17.30;P<0.01);中期青光眼组、晚期青光眼组患者RNFL水平明显低于对照组,随着青光眼患者病程分期的加重,患者RNFL水平明显降低,组间差异均具有统计学意义(P<0.05)。早期青光眼组、中期青光眼组、晚期青光眼组患者MD绝对值水平均高于对照组患者,随着病程的加重,MD损伤程度明显加重,组间差异均具有统计学意义(P<0.05);观察组患者视杯面积、视杯容积、C/D、水平C/D及垂直C/D水平明显高于对照组,而观察组患者盘沿面积、盘沿容积则低于对照组,差异均具有统计学意义(P<0.05);采用Pearson相关性检验分析发现,观察组患者RNFL与MD绝对值水平呈负相关(r=-0.554,P<0.01)。结论:OCT测量RNFL、MD是原发性青光眼诊断的有效检测方法,且两者存在负相关关系。     

原发性开角型青光眼视网膜神经纤维层厚度和视野平均缺损的相关性分析

目的 比较原发性开角型青光眼患者GDx VCC各参数和自动视野平均缺损(MD)的相关性.方法 用GDx VCC和Octopus1-2-3自动视野检测97例(191眼)原发性开角型青光眼患者.采用方差分析、Pearson相关分析和回归分析GDx各参数和自动视野平均缺损(mean defect,MD)之间的关系.结果 GDx各参数与视野的MD均呈负相关,相关性依次为:SA(-0.58)、TSNIT(-0.52)、IA(-0.52)、NFI(-0.48)和IES(-0.33),差异有统计学意义.上半野视野与GDx下象限RNFL厚度参数一致性为-0.61,下半野视野与GDx上象限RNFL厚度参数的一致性为-0.59.结论 GDx参数和自动视野的平均缺损呈中度相关.GDx可用于青光眼的随诊.

Abstract：

Objective To establish whether the structural parameters provided by GDx can be used to reflect functional damage in the mean defect of visual field. Methods 97 ( 191 eyes) patients with primary open angle glaucoma underwent examination with GDx and Octopus 1-2-3 automatic perimeter. The relationship between the retinal nerve fiber layer parameters and mean defect of visual field was analysed by ANOVA, Pearson's correlation (r), scatter plot and linear regression. Results The parameters of GDx decreased with increasing mean defect of visual field, measured both globally and regionally; r: SA=- 0.58, TSNIT =-0.52, IA=-0.52, NFI=-0.48 and IES=-0.33. All parameters were negative correlation with mean defect of visual field and there was significant correlation among these parameters,except IES(P＜0.05). The superior mean defect of visual field increased with decreasing inferior RNFL (r=-0.61), inferior visual field mean defect increased with decreasing superior RNFL (r=-0.59).There were significant correlation among these parameters. Conclusion Quantitative measures of the retinal nerve fiber layer using GDx were correlated with mean defect of visual field in patients with glaucoma. GDx can be used for follow up.     

川芎嗪对原发性慢性闭角型青光眼术后眼压控制在目标范围内患者视力和视野的影响

目的探讨原发性慢性闭角型青光眼(PCACG)患者术后眼压控制在目标范围后视力和视野的变化,为该病的临床治疗提供理论依据。方法选择2010年1月至2011年12月在新乡医学院第三附属医院眼科住院的、已行手术治疗,且眼压控制在21 mmHg(1 mmHg=0.133 kPa)以下的PCACG患者40例54眼,随机分为治疗组20例26眼和对照组20例28眼。对照组术后应用维生素B12注射液50μg肌肉注射,每日1次;治疗组在对照组治疗的基础上给予川芎嗪注射液160 mg加入体积分数5%的葡萄糖250 mL中静脉滴注,每日1次,7 d为1个疗程,共3个疗程。观察2组患者治疗3个疗程后视力、视野变化。视野指标包括平均光敏感度(MS)和平均缺损(MD)。结果治疗3个疗程后,治疗组视力26眼中有效14眼,无效12眼,有效率53.8%;对照组视力28眼中有效2眼,无效26眼,有效率7.1%。2组有效率比较差异有统计学意义(χ2=30.311,P=0.003)。治疗组治疗后MS、MD[(19.09±0.74)、(8.19±0.75)dB]较治疗前[(23.53±0.62)、(6.73±0.63)dB]明显改善,差异均有统计学意义(t=3.37、3.57,P<0.05);对照组治疗后MS、MD[(18.64±0.83)、(8.76±0.84)dB]较治疗前[(19.18±0.72)、(8.32±0.82)dB]均有一定程度改善,但差异无统计学意义(t=0.54、0.32,P>0.05);2组患者治疗后MS、MD比较差异均有统计学意义(t=3.24、3.21,P<0.05)。结论川芎嗪可以明显改善PCACG术后眼压控制在目标范围内患者的视力和视野。     

Automatic perimetry in detecting early glaucomatous visual field defects. A follow-up study.

A prospective study was conducted to identify the value of the differential light threshold changes in glaucoma patients. Using Humphrey Field Analyzer, we determined the differential light threshold on 42 preselected points in the Bjerrum area in the age-matched early glaucoma and normal group, each in 50 eyes, whose initial Goldmann perimetries were normal. It was found that both generalized and localized sensitivity of the retina declined obviously in the glaucomatous group. After Goldmann perimetry follow-up for 2.5 years, 24 eyes showed reproducible typical visual field defects (VFD) in the glaucoma group, which appeared in the same location where light threshold had reduced previously. Therefore, a typical glaucoma VFD was preceded by the slight localized depression of light sensitivity in the Bjerrum area.

     

视觉先兆性偏头痛遗留视野缺损1例

0　引言　偏头痛是一种常见脑血管功能障碍性疾患 ,临床分型众多 .我们报道间歇期持久性视野缺损的先兆性偏头痛 1例 ,并对其发生机制及临床诊断作初步分析 .1　临床资料　男 ,5 2岁 ,高级工程师 .患者 10岁时无原因出现闪辉及视物模糊 ,数分钟后左颞部跳痛 ,伴恶心、呕吐、畏光及畏声 .上述症状反复发作 ,疼痛部位左右交替 .曾诊断为血管性头痛服用中药治疗 .病初隔日 1次 ,每次持续 12～ 2 4h,以后渐延至每月 1次 ,每次 2 4～ 48h.8a后偶有发作 ,每次收稿日期 :2 0 0 1-0 5 -16 ;　修回日期 :2 0 0 1-0 6 -2 1作者简介 :雷革胜 ( 196 8-) …     

Frequency doubling technology and standard automated perimetry in detection of glaucoma among glaucoma suspects

Background

Frequency Doubling perimetry (FDT) has been found to precede visual loss detected by standard automated perimetry (SAP) by as much as four years and the initial development of glaucomatous visual field loss as measured by SAP was found to occur in regions that had previously demonstrated abnormalities on FDT testing.

Methods

A study on 55 glaucoma suspects (determined as per American Academy Guidelines, Preferred Practice Pattern, Oct 2010), was compared to 50 healthy participants (HP). Both glaucoma suspects and HP underwent SAP and FDT in random order. Only reliable fields were compared.

Results

Mean deviation of FDT Matrix was significantly lower than SAP SITA in suspect and healthy group ; two devices showed significant correlation amongst both groups (suspects p = 0.002, healthy p = 0.011). Significant difference was found in PSD of SAP SITA and FDT Matrix (p = 0.001) in the glaucoma suspect group, PSD of FDT Matrix was significantly higher than PSD of SAP SITA in the healthy group (p < 0.001). PSD of SAP SITA significantly correlated with FDT Matrix PSD in glaucoma group (r = 0.579; p = 0.001) but no significant correlation found in healthy group (r = 0.153; p = 0.290). Percentages of normal test locations significantly higher in FDT Matrix compared to SAP SITA in glaucoma suspects and healthy participants.

Conclusion

FDT correlates well with SAP and may be used for patients who are unable to perform well and reliably with SAP but does not show any features of earlier glaucoma changes in this study.     

Frequency doubling technology and standard automated perimetry in detection of glaucoma among glaucoma suspects

Background

Frequency Doubling perimetry (FDT) has been found to precede visual loss detected by standard automated perimetry (SAP) by as much as four years and the initial development of glaucomatous visual field loss as measured by SAP was found to occur in regions that had previously demonstrated abnormalities on FDT testing.

Methods

A study on 55 glaucoma suspects (determined as per American Academy Guidelines, Preferred Practice Pattern, Oct 2010), was compared to 50 healthy participants (HP). Both glaucoma suspects and HP underwent SAP and FDT in random order. Only reliable fields were compared.

Results

Mean deviation of FDT Matrix was significantly lower than SAP SITA in suspect and healthy group ; two devices showed significant correlation amongst both groups (suspects p = 0.002, healthy p = 0.011). Significant difference was found in PSD of SAP SITA and FDT Matrix (p = 0.001) in the glaucoma suspect group, PSD of FDT Matrix was significantly higher than PSD of SAP SITA in the healthy group (p < 0.001). PSD of SAP SITA significantly correlated with FDT Matrix PSD in glaucoma group (r = 0.579; p = 0.001) but no significant correlation found in healthy group (r = 0.153; p = 0.290). Percentages of normal test locations significantly higher in FDT Matrix compared to SAP SITA in glaucoma suspects and healthy participants.

Conclusion

FDT correlates well with SAP and may be used for patients who are unable to perform well and reliably with SAP but does not show any features of earlier glaucoma changes in this study.     

首次青光眼发作后的视野变化

目的 探讨急性原发性闭角型青光眼(PACG)患者首次急性发作后不同时点发作眼的视野结果,分析急性PACG发作后视野改变规律. 方法 用Humphrey视野机对24例急性PACG患者首次急性发作眼压降至正常后2 d内和30 d后进行视野检测,并比较视野变化情况. 结果 24例急性PACG患者首次急性发作眼压降至正常后24只发作眼视野结果,采用青光眼半视野检测(GHT)分类法,其中3例患者发作眼视野结果为正常范围内,2例为临界,17例为正常界限外,2例为普遍敏感度下降,0例为异常高敏感度.87%(21/24)的患者出现了发作眼的视野损害,13%(3/24)的患者视野正常,71%(17/24)的患者发作眼视野损害属于正常界限外.对24例患者24只发作眼首次视野结果中的模式偏差概率图分析,发现鼻上象限视野缺损面积达45.7%.30 d后22例患者22只发作眼再次检测视野,采用GHT分类法,8例为正常范围内,2例为临界,12例为正常界限外.其中7例患者首次发作眼视野检测结果为5例正常界限外,2例为普遍敏感度下降,30 d后这7例患者发作眼视野结果恢复为正常范围内. 结论 急性PACG首次急性发作眼压降至正常后绝大部分患者发作眼视野损害,视野损害以鼻上象限显著,而且首次急性发作后视野缺损具有可逆性.     

蓝黄视野在早期青光眼诊断中的意义

目的 :探讨蓝黄视野检测在早期原发开角型青光眼诊断中的应用价值。方法 :采用瑞士产Octo pus10 1型全自动视野计 ,对早期原发性开角型青光眼 3 6例 3 6眼 ,对照组正常人 3 6例 3 6眼进行B/Y及W/W检测 ,两组的年龄及性别相匹配 ,应用tG2 测试程序 ,将中心 3 0°视野内全视网膜光敏感度均值 (dB)进行比较和分析。结果 :两种视野计检测正常人B/Y较W /W检测全视网膜光敏感度均值低 ,二者差值 5 5 1dB ,差异有显著意义 (t =17 13 ,P <0 0 0 1)。早期开角型青光眼B/Y较W/W检测全视网膜光敏感度均值差为6 91dB ,差异有显著意义 (t=12 19,P <0 0 0 1)。按矫正偏差图 (correvtedprobabity)计算P <2以上缺损点数 ,显示B/Y检测总缺损点数为W /W的 2 18倍 ,差异有显著意义 (u =11.46,P <0 0 0 1)。早期青光眼组 3 6只眼B/Y检测视野阳性者 3 1眼 ,阳性率 86 1% ,W /W检测视野阳性者 19眼 ,阳性率 5 2 8%。两种视野计检测结果的异常率有显著差异 ( χ2 =9 43 ,P <0 0 0 1)。结论 :B/Y与W /W检测结果有良好的相符性 ,在早期原发开角型青光眼视野检测中 ,B/Y比W /W敏感 ,以B/Y检测出的缺损面积大而且深 ,可提高早期青光眼诊断的阳性率 ,有一定的应用价值。