北京部分人群的视盘形态学研究

目的 分析北京部分人群的各类正常视盘的形态学特征.方法 资料来源于2001年北京部分地区以人群为基础的眼病调查,被调查者年龄在40岁以上,接受视力、眼压、屈光状态、裂隙灯显微镜、闲值视野及眼底照相等眼科检查.评价清晰的眼底照片共489例,每例取其右眼作视盘形态学分析,均为竖椭圆形视盘,其中大视盘160例,中视盘175例,小视盘154例.应用计算机图像处理软件,测量各类视盘参数,包括视盘面积、视杯面积、盘沿面积、一周盘沿宽度等.应用方差分析,对大视盘、中视盘、小视盘的视杯竖径/横径比值进行两两比较,应用Pearson相关性分析视盘与视杯、盘沿的关系.结果 人群中视盘的大小为1.11～5.65 mm^2（1：5）,盘沿面积为0.95～3.68 mm^2（1：3.84）,视杯/视盘（C/D）波动于0.15～0.82.大视盘面积为（3.81±0.41）mm^2,中视盘面积为（2.55±0.32）mm^2,小视盘面积为（1.70±0.17）mm^2.视杯面积依次为（1.40±0.43）mm^2、（0.73±0.23）mm^2、（0.29±0.11）mm^2.盘沿面积依次为（2.4±0.36）mm^2、（1.82±0.23）mm^2、（1.41±0.16）mm^2.小视盘和中视盘的视杯竖/横径比值平均为0.80±0.21、0.96±0.14,大视盘为1.01±0.15,差异均有显著性,视杯面积、盘沿面积与视盘面积均呈显著正相关,相关系数分别为0.88、0.85.结论 人群中视盘、盘沿、视杯的变异范围较宽.     

正常人不同视盘类型和早期青光眼盘沿形态学研究

目的 :探讨正常人 (本文所称正常人为非青光眼者 ,下同 )不同视盘类型和早期青光眼盘沿形态学特征 ,以指导各种视盘类型青光眼的早期诊断。方法 :检查对象分五组 :①正常人小视盘 4 1只眼 ;②正常人大视盘 4 0只眼 ;③视盘斜入 4 2只眼 ;④正常人正常大小视盘 4 2只眼 ;⑤早期开角型青光眼 4 5只眼。利用计算机图像分析技术 ,测量视盘面积、盘沿面积、视杯面积和一周 (每 10°)的盘沿宽度 ,以此形态指标分析正常人不同视盘类型和早期青光眼的盘沿形态差异。结果 :①正常人不同视盘类型盘沿形态共同特点是盘沿从鼻侧到下 /上方逐渐变宽 ,在下 /上方偏鼻侧有一宽带区 ;而早期青光眼盘沿从鼻侧到下 /上方逐渐变窄 ,无变宽区。②视盘斜入上下方盘沿宽度基本相同 ,而大视盘下方盘沿最宽 ,小视盘上方盘沿最宽 ;鼻侧次之 ,颞侧最窄。大视盘C/D较大而盘沿宽度较窄 ,小视盘C/D较小而盘沿宽度较宽 ,视盘斜入也具有较大的C/D和较窄的盘沿宽度。③经多因素逐步判别分析 ,盘沿面积加C/D的正确判别率为 88 4 % ,以系列盘沿宽度为指标 ,下方偏颞侧 (6∶2 0 )和上方偏鼻侧 (1∶0 0 )两个盘沿宽度最为相关 ,其正确判断率为 90 6 %。结论 :正常人不同视盘类型和早期青光眼各具有不同的盘沿形态特征 ,计算机图像测量系列盘     

青光眼视神经损害的三要素及其盘沿丢失的识别

诊断青光眼视神经损害的三要素为盘沿丢失、视网膜神经纤维层缺损（RNFLD）及视盘线状出血。三要素中如有两要素改变应诊断为视神经损害。对于盘沿丢失已往的教科书中均无明确描述,笔者认为识别盘沿丢失必须首先认识正常盘沿形态及其影响因素。大多数的正常盘沿形态符合ISNT法则,生理性大视杯也符合该法则。不符合ISNT法则者为盘沿丢失,或者为正常盘沿形态变异。后者如部分小视盘下方盘沿可比上方盘沿窄,判断是否上、下方盘沿丢失时应将其与鼻侧盘沿进行比较;横椭圆视盘鼻侧盘沿较宽,应上、下盘沿比较;视盘主干血管发出位置偏位、视盘倾斜也会影响盘沿形态。如果参照ISNT法则认识正常盘沿变异因素,就不难发现盘沿丢失。然而不是所有的盘沿丢失均为青光眼所致,应鉴别非青光眼性视神经损害。     

早期青光眼的盘沿形态学研究

青光眼早期损害的特征是颞下、颞上的视网膜神经纤维层缺损(RNFLD),并于相应区的视野弓形缺损。为了探讨青光眼视神经损害的发生规律,本研究利用计算机图象分析技术,测定一周(每(?)度)的盘沿宽度,以此形态指标分析早期青光眼与正常眼的盘沿形态差异以指导临床诊断,检查对象分两组:①正常对照组183只眼。②早期青光眼组175只眼。结果:正常组盘沿形态特征是下方盘沿宽度较上方宽,颞侧盘沿最窄,鼻侧盘沿最宽;早期青光眼组盘沿形态特征是下方盘沿宽度较上方更窄。用多因素逐步判别法对早期青光眼与正常眼进行判别分类,单纯用盘沿面积为指标,正确判断率为78％;用系列盘沿宽度为指标,经逐步判别筛选,以颞下及上方盘沿宽度最为相关,其正确判断率为94％。因后者除了与盘沿面积大小有关外,还与盘沿形态有关,依据盘沿形态特征有助于鉴别生理性大视杯(①大视盘,②视杯大,但下方盘沿宽于上方),发及发现小视盘青光眼(①小视盘及扩大不明显的视杯,②下方盘沿宽度比上方窄)     

正常人不同类型视乳头及早期青光眼患者视乳头形态学研究

目的：探讨正常人不同类型视乳头及早期青光眼患者视乳头形态学特征,以指导青光眼的早期诊断。方法：将收集到的眼底照片分为4组：正常人小视乳头组41只眼,正常人大视乳头组40只眼,正常人大或小视乳头组42只眼,早期开角形青光眼组45只眼。利用计算机图像分析技术,测量视乳头、盘沿、视杯面积向周围（每10^0）盘沿宽度。结果：（1）正常人不同类型视乳头组的盘沿宽度曲线均在下或上方形成双峰,在鼻、颞侧形成谷底。大视乳头组下方盘沿最宽,小视乳头组上方盘沿最宽,鼻侧次之,颞侧最窄。（2）早期青光眼盘沿宽度典线下或上方双峰消失,其曲线低于鼻侧象限、高于颞侧象限。（3）经多因素逐步判别分析,盘沿面积加杯／盘比值的正确判断率为85．7％,以系列盘沿宽度为指标,下方偏颞侧（6：20）和上方偏鼻侧（1：00）两个盘沿宽度最为相关,其正确判断率为90．6％。结论：评价盘沿形态时应以其自身的鼻侧盘沿宽度作为标准,比较其上、下方盘沿宽度是否变窄,有利于生理性大视杯与早期青光眼的鉴别。     

生理性大视杯及早期青光眼的盘沿形态研究

目的探讨生理性大视杯与早期青光眼的差异。方法侧重分析、研究盘沿的形态。研究对象分两组：（１）生理性大视杯：Ｃ／Ｄ＞０．６，视盘面积大于２．８ｍｍ２，随诊３～６年盘沿无改变，眼压及视野均正常，共５４例（８８只眼）。（２）早期青光眼：在随诊中有盘沿丢失或视野缺损，但Ｃ／Ｄ＜０．８者共６８例（８９只眼）。反映形态的指标有：（１）系列盘沿宽度；（２）视杯形态参数，即垂直Ｃ／Ｄ与水平Ｃ／Ｄ的比值。结果生理性大视杯与早期青光眼在形态上的差异：（１）前者视盘大；（２）前者的视杯为横椭圆形，后者视杯呈竖椭圆形；（３）前者的盘沿以下方最宽，上方次之，鼻侧、颞侧盘沿宽度较窄；后者因早期以下方盘沿丢失最常见，所以下方盘沿宽度较上方者窄或相同。结论视杯形态＋盘沿面积＋视盘面积的组合，在多因素判别分析的回代中符合率最高。     

鞍结节脑膜瘤患者视盘及视网膜神经纤维层的形态研究

目的 分析鞍结节脑膜瘤患者的视盘参数特征及视盘周围视网膜神经纤维层（pRNFL）厚度的变化。设计 回顾性病例系列。 研究对象 2010年7月至2011年12月北京天坛医院鞍结节脑膜瘤患者40例（80眼）、正常对照40例（80眼）和青光眼患者40例（80眼）。方法 采用眼底照相和相干光断层扫描（OCT）测量视盘及不同象限pRNFL厚度,比较鞍结节脑膜瘤患者与正常对照组和青光眼组的视盘参数及pRNFL厚度,分析视盘参数改变与肿瘤大小的相关性。主要指标 视盘形态、视盘面积、杯盘面积比、水平杯盘比、垂直杯盘比、盘沿面积、视杯面积,视杯体积和不同象限pRNFL厚度。结果 鞍结节脑膜瘤组的杯盘面积比、水平杯盘比、垂直杯盘比、视杯面积和视杯体积与正常对照组相比均明显增大,而盘沿面积明显减小（P均=0.000）;且杯盘面积比、水平杯盘比、盘沿面积和盘沿体积与青光眼组相比均较大,而垂直杯盘比、视杯面积和视杯体积较青光眼组明显减小（P均=0.000）。肿瘤组视盘周围不同象限pRNFL厚度分别为上方颞侧（124.022±26.100）μm,上方鼻侧（105.856±23.410）μm,鼻侧上方（75.784±19.260）μm,鼻侧下方（65.983±15.708）μm,下方鼻侧（105.915±25.526）μm,下方颞侧（133.591±24.429）μm,颞侧下方（76.592±19.679）μm,颞侧上方（77.352±26.100）μm,与正常对照组相比差异均具有统计学意义（P均<0.05）;与青光眼组相比上方鼻侧象限不具有统计学意义（P=1.114）,其余象限均具有统计学意义（P均<0.05）。鞍结节脑膜瘤盘沿体积与肿瘤大小相关（r=0.492,P=0.011）。结论 鞍结节脑膜瘤视盘形态表现为颞侧变窄、颜色变淡,pRNFL厚度与正常人群比较下方鼻侧变薄最明显,与青光眼组相比除上方鼻侧外其他各象限均变薄,下方颞侧最明显。     

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。     

早期青光眼视神经损害进展的随诊研究

目的 探讨早期青光眼视神经损害随诊进展的情况.设计回顾性病例系列.研究对象初诊为早期青光眼视神经改变、随诊3年以上发生了视神经进展者164例197眼.方法 早期青光眼视神经损害者的初诊眼底照片与末次随诊照片在计算机图像配准软件处理下进行闪烁对比,发现有盘沿及神经纤维层缺损进展者,记录视神经进展的指标.应用Pearson相关性分析,评价盘沿进展程度与神经纤维层进展程度的相关性,盘沿进展部位与神经纤维层进展部位的相关性.主要指标视盘盘沿丢失进展程度、盘沿丢失进展部位、神经纤维层缺损进展的程度和部位.结果 随诊时间3～19年,平均随诊时间7年.早期青光眼盘沿丢失进展多数从下方开始,进而发展到上方盘沿、上下方盘沿均受损,晚期累及视盘颞侧、鼻侧,直至视杯呈同心圆状扩大盘沿弥漫性丢失,神经纤维层受损顺序与盘沿进展相对应.盘沿进展程度与神经纤维层缺损进展程度有相关性,相关系数r=0.44.P＜0.001,盘沿进展程度与神经纤维层进展程度有显著相关性,r=0.93,P＜0.001.结论 青光眼视神经进展多从下方或上方盘沿进展开始,晚期波及视盘鼻颞侧,盘沿进展多与相应神经纤维层缺损进展一致.眼底立体照相联合图像闪烁对比方法对于监测青光眼视神经进展是一种较理想的手段.     

应用海德堡视网膜断层成像仪（HRT）研究年龄对正常人视网膜神经纤维层的影响

目的;探讨正常人视网膜神经纤维层（RNFL）是否随年龄发生变化。方法：本研究采用新型的共焦扫描激光眼底镜－海德堡视网膜断层成像系统（Heidelberg Retina Tomograph,HRT),对年龄在12－64岁的57位正常人57只眼后极部视网膜进行扫描,分颞侧、鼻侧、上方和下方四个区域和全视盘测定盘沿体积和沿视盘边缘的RNFL厚度,以年龄为自变量作相关与回归分析。结果：视盘全周平均RNFL厚度、盘沿体积与年龄成负相关（P＜0．01）;颞侧RNFL厚度、盘沿体积与年龄无显著相关性（P＞0．05）;鼻侧、上方和下方RNFL厚度、盘沿体积与年龄呈负相关（P＜0．01,P＜0．05,P＜0．01）。结论：随年龄的增长,视网神经纤维层有变薄的趋势。     

Shape of the neuroretinal rim and position of the central retinal vessels in glaucoma.

Glaucomatous neuroretinal rim loss can occur in a sequence of sectors with the temporal inferior disc sector as the first and the nasal superior disc sector as the last to be affected. This study evaluated whether the position of the central retinal vessel trunk is correlated with this pattern of glaucomatous rim loss. Morphometrically stereo colour optic disc photographs of 157 glaucomatous eyes and 67 normal eyes were checked. In the normal and glaucomatous eyes, the central retinal vessel trunk was located eccentrically in the upper nasal quadrant of the optic disc. Taking into account the vertically oval disc shape, the distance to the central vessel trunk was largest for the temporal inferior disc region and shortest for the nasal superior disc area. An abnormal form of the glaucomatous neuroretinal rim was found in eyes with an atypical location of the retinal vessel trunk. Also in these glaucomatous eyes, the rim loss was usually most and least marked in that sector with the longest and shortest distance, respectively, to the central retinal vessel trunk. One could infer that the sequence of rim loss in glaucoma is dependent upon the distance of the region to the central retinal vessel trunk; the further away the region from the retinal vessel trunk, the more likely it is to be affected by rim loss. This suggest that the distance from the central retinal vessels is one factor among others that is correlated with the regional vulnerability of the neuroretinal rim to the glaucomatous process.     

视神经炎的临床特征分析及早期视盘和黄斑的改变

目的　研究视神经炎患者的临床特征及早期视盘和黄斑的改变。方法　回顾性分析山西省眼科医院视神经炎患者67例85眼。分析患者基本情况、眼科检查结果及OCT检查结果。结果　67例85眼中，男24例，女43例；28例（41.8%）发生于冬季；49眼（57.6%）入院时最佳矫正视力小于1.7 logMAR。视神经脊髓炎抗体阳性者出院和入院时的最佳矫正视力均较髓鞘少突胶质糖蛋白抗体阳性者差。患眼较健眼视盘周围神经纤维层增厚，杯盘面积比、杯盘垂直比、杯盘水平比、杯容积减小，盘沿面积、视盘面积增大（均为P=0.000）；与健眼相比，患眼早期上方、下方和平均黄斑区神经节细胞层厚度及黄斑区神经节细胞复合体的局部丢失体积、整体丢失体积均未发生明显改变（均为P＞0.05）。视盘水肿与患眼平均视盘周围神经纤维层厚度存在正相关（r=0.728，P=0.000）。结论　视神经炎多发生于女性，早期视力损害严重，视神经脊髓炎抗体阳性者视力预后差。早期由于视盘水肿，视盘周围神经纤维层增厚，盘沿面积、视盘面积增大；杯容积、杯盘比减小，早期病变未累及黄斑区。     

Parapapillary retinal vessel diameter in normal and glaucoma eyes. I. Morphometric data

The retinal blood vessels serve for nutrition of the retinal ganglion cells and their axons. This study was undertaken to evaluate the vessel diameter in normal and glaucoma eyes. The calibers of the superior temporal and inferior temporal retinal artery and vein were measured at the optic disc border and at a distance of 2 mm from the optic disc center; 473 eyes of 281 patients suffering from chronic primary open-angle glaucoma and 275 eyes of 173 normal subjects were examined. Fifteen-degree, color stereo optic disc photographs were used. In the normal eyes the inferior temporal vessels were significantly larger than the superior temporal vessels. This corresponds with: (1) the configuration of the normal neuroretinal rim, which is significantly broader in the inferior disc region than in the superior disc area; (2) the visibility of the retinal nerve fibers, which are better detectable in the inferior temporal area than in the superior temporal one; and (3) the foveola location 0.53 +/- 0.34 mm inferior to the optic disc center. The retinal vessel diameter was independent of the patients' age and optic disc and parapapillary chorioretinal atrophy size. In the glaucoma group the vessel caliber was significantly smaller than in the normal eyes. The differences were more marked for the arteries and the inferior temporal vessels, respectively. The vessel diameters decreased significantly with increasing glaucoma stage independently of the patients' age. The parapapillary retinal vessel diameter may reflect the need of vascular supply in the corresponding superficial retinal area. It may be correlated with the local ganglion cell density and retinal nerve fiber layer thickness.     

The optic disc hemifield test

PURPOSE: To evaluate whether an optic disc hemifield test comparing the superior half of the optic disc with the inferior disc half is useful for glaucoma diagnosis. METHODS: The clinical observational study included 1268 patients with primary or secondary open-angle glaucoma and 649 normal subjects. The glaucoma group was divided into 1118 patients with glaucomatous visual field defects ("perimetric glaucoma"), and 150 patients with optic nerve head changes and normal visual fields ("preperimetric glaucoma"). Color stereo optic disc photographs were morphometrically evaluated. The optic disc area was divided into four sectors: temporal horizontal (60 degrees), superotemporal (90 degrees), inferotemporal (90 degrees), and nasal (120 degrees). Area and width of the neuroretinal rim were measured, and the ratio of superotemporal-to-inferotemporal rim area, the ratio of superior (12 o'clock)-to-inferior (6 o'clock) rim width, the difference of inferotemporal minus superotemporal rim area, and the difference of inferior rim width minus superior rim width were calculated. RESULTS: For the differentiation between the normal group and the whole glaucoma group, and for the differentiation between the normal group and the preperimetric glaucoma group, respectively, areas under the ROC curves were significantly smaller for the parameters of the optic disc hemifield test (superior-to-inferior rim width ratio: 0.448 and 0.412, respectively; and superotemporal-to-inferotemporal rim area ratio: 0.395 and 0.434, respectively) than for any other rim parameter tested such as inferotemporal rim area (0.827 and 0.745, reps.), total rim area (0.814 and 0.741, respectively), and superotemporal rim area (0.781 and 0.705, respectively). DISCUSSION: An optic disc hemifield test with the parameters superior-to-inferior rim width ratio and superotemporal-to-inferotemporal rim area ratio is not markedly helpful for the morphometric diagnosis of glaucomatous optic nerve damage, either in the preperimetric stage or in the perimetric stage of the disease.     

Neuroretinal rim width ratios in morphological glaucoma diagnosis

AIMS—To evaluate the inferior to temporal neuroretinal rim width ratio and superior to temporal rim width ratio as measures of rim shape for diagnosis of glaucoma.
METHODS—Colour stereo optic disc photographs of 527 normal subjects, 100 ocular hypertensive individuals with normal visual fields, and 202 open angle glaucoma patients with a mean perimetric defect of less than 10 dB were morphometrically evaluated. Eyes with an optic cup area of < 0.2 mm² were excluded.
RESULTS—In the normal subjects, inferior to temporal rim width ratio (1.67 (SD 0.53)) was significantly (p<0.0001) higher than superior to temporal rim width ratio (1.56 (0.49)). Both ratios were significantly (p<0.0001) higher the more vertically the optic disc was configured. In the normal eyes, both ratios were statistically independent of disc size, rim area, refractive error, age, and sex. With the differences being more marked for the inferior to temporal ratio than for the superior to temporal ratio, both rim width ratios were significantly (p<0.005) lower in the ocular hypertensive group than in the normal group. Despite the high significance of the differences, diagnostic power of the inferior ratio and the superior ratio was 59% and 58%, respectively, indicating a marked overlap between the groups.
CONCLUSIONS—Abnormally low inferior to temporal and superior to temporal rim width ratios can indicate glaucomatous optic nerve damage in some ocular hypertensive eyes. Being independent of optic disc size and ocular magnification, the rim width ratios may be taken as one among other variables for the ophthalmoscopic optic disc evaluation, taking into account, however, a pronounced overlap between normal eyes and ocular hypertensive eyes.

Keywords: neuroretinal rim width ratios; glaucoma; ocular hypertension     

Comparison of glaucomatous optic nerve damage in primary angle-closure glaucoma with and without acute attack

PURPOSE: To compare the glaucomatous optic nerve damage in primary angle-closure glaucoma (PACG) with acute attack (acute PACG; AACG) and PACG without acute attack (chronic PACG; CACG). METHODS: The study subjects were 84 normal individuals, 130 AACG patients, and 86 CACG patients. Color optic disc photographs were evaluated for the presence or absence of 10 qualitative signs to differentiate between normal and glaucomatous optic discs. RESULTS: Abnormally shaped rim width (alteration of ISN'T rule), bared circumlinear vessel, vessel bayonetting, rim width narrower than the temporal sector, and zone beta (nasal and superotemporal sectors) were detected more frequently in the CACG group than in the AACG group (P<0.05). The most accurate qualitative sign was abnormally shaped rim width in both groups. The specificity and sensitivity of abnormally shaped rim width were 71.4% and 60.8% for AACG, and 71.4% and 81.4% for CACG, respectively. CONCLUSIONS: The optic disc damage is greater in CACG than in AACG.     

Central retinal vessel trunk exit and location of glaucomatous parapapillary atrophy in glaucoma

OBJECTIVE: To evaluate whether the position of the central retinal vessel trunk exit on the lamina cribrosa spatially correlates with the location of parapapillary atrophy in glaucoma. DESIGN: Clinic-based, observational, cross-sectional study. PATIENTS: Color stereo optic disc photographs of 95 patients with primary or secondary open-angle glaucoma and 65 healthy persons were morphometrically evaluated. The intrapapillary and parapapillary region was divided into four quadrants. We determined the position of the central retinal vessel trunk exit on the lamina cribrosa surface and measured the area of parapapillary atrophy and neuroretinal rim in the four quadrants. MAIN OUTCOME MEASURES: The area of neuroretinal rim and parapapillary atrophy and the position of the central retinal vessel trunk exit. RESULTS: Comparing measurements between opposite disc quadrants showed that beta zone of parapapillary atrophy was significantly (P < 0.05) larger and that the neuroretinal rim was significantly smaller when beta zone and neuroretinal rim were measured in the disc quadrant most distant to the central retinal vessel trunk exit, than if the beta zone and neuroretinal rim were measured in the quadrant containing the vessel trunk exit. Comparing measurements in the disc quadrants between eyes with different positions of the central retinal vessel trunk exit revealed that, in the respective disc quadrant, the beta zone was significantly larger and the neuroretinal rim was smaller in eyes with the vessel trunk exiting in the opposite disc quadrant than in eyes with the vessel trunk exit located in the respective disc quadrant where the measurements were obtained. CONCLUSIONS: Position of the central retinal vessel trunk exit on the lamina cribrosa influences the location of parapapillary atrophy in glaucoma. The longer the distance to the central retinal vessel trunk exit, the more enlarged is parapapillary atrophy and the smaller is the neuroretinal rim. This relationship agrees with the spatial relationship between glaucomatous neuroretinal rim loss and enlarged parapapillary atrophy in glaucoma. Diagnostically, it may indicate that, in eyes with an abnormal configuration of parapapillary atrophy or with an abnormal position of the central retinal vessel trunk exit, early glaucomatous rim changes should be looked for in the disc sector that is most distant to the central retinal vessel trunk exit and where parapapillary atrophy may be relatively large.     

频域光学相干断层扫描（OCT）测量视盘参数及视网膜厚度在早期青光眼诊断中的作用

目的　探讨频域光学相干断层扫描（optical coherence tomography,OCT）测量视盘参数及视网膜厚度在早期青光眼诊断中的作用。方法　采用频域OCT测量40例（40眼）健康志愿者（对照组）和85例（85眼）原发性开角型青光眼（primary open angle glaucoma,POAG）患者［早期青光眼亚组（n=36）和进展期青光眼亚组（n=49）］视盘参数及视网膜神经纤维层（retinal nerve fiber layer,RNFL）厚度,比较各组RNFL厚度、视盘参数并与视野平均缺损（mean deviation,MD）值进行相关性分析,采用ROC曲线下面积评估视盘周围区RNFL厚度及视盘参数在青光眼中的诊断效果。结果　POAG组患者颞侧、上方、鼻侧及下方象限RNFL厚度和全周RNFL厚度均显著低于对照组（均为P<0.05）,且与早期青光眼组比较,进展期青光眼组患者颞侧、上方、鼻侧及下方象限RNFL厚度和全周RNFL厚度均显著降低（均为P<0.05）。各组除视盘面积外,其他视盘参数比较差异均具有统计学意义（均为P<0.05）。Pearson相关性分析显示,POAG组患者视盘颞侧、上方、下方象限RNFL厚度及全周RNFL厚度与MD均呈负相关（均为P<0.05）,而视盘参数中视杯容积和视杯/视盘面积比与MD均呈正相关（均为 P<0.05）,盘缘面积、盘缘容积和视盘容积与MD均呈负相关（均为P<0.05）。经ROC曲线分析显示,视盘周围区下方象限RNFL厚度的曲线下面积最大为0.886,其特异度和敏感度分别为0.775和0.924;视盘参数中视杯/视盘面积比曲线下面积最大,其特异度和敏感度分别为0.741和0.815。结论　OCT检测视盘结构和RNFL厚度能够用于青光眼早期诊断,且具有较高敏感度和特异度。