傅立叶OCT在早期原发性开角型青光眼中的诊断能力

目的：评价傅立叶域相干光断层成像术[Fourier-Domain Optical Coherence Tomography,FD-OCT, using the RTVue -100 (Optovue Inc, Fremont, California,USA）]在鉴别正常眼及早期原发性开角型青光眼（POAG）中的能力。 方法：横断面研究。对符合入选标准的早期原发性开角型青光眼组及正常组的所有受试者行FD-OCT及Humphrey视野（Humphrey Field Analyzer model 740, Carl Zeiss Meditec, Dublin, CA, USA）检查。比较早期POAG患者及正常人各视盘测量参数、神经纤维层厚度及后极部神经节细胞复合体(GCC)厚度;对早期POAG患者及正常人各测量参数绘制受试者操作特征曲线（ROC）,计算ROC曲线下面积（AROC）,敏感性、特异性及阳性和阴性似然比评估各参数的诊断性能。 结果：分析34例早期POAG患者及42例正常人结果。在特定特异度（95% and 85%）下垂直杯盘比（C/D vertical ratio）的灵敏度和阳性似然比最高,分别为79.4%和88.2%,33.4和7.4。在所有单一参数中,垂直杯盘比的AROC最大,为0.930。使用logistical诊断模型联合垂直杯盘比、RNFL AT on 3.45mm和盘沿面积,AROC为0.949。 结论：FD-OCT所测得的视盘、神经纤维层厚度及GCC厚度改变在早期POAG患者及正常人差异有显著性。以AROC、敏感性、特异性及阳性和阴性似然比为评价指标,位居前三位的指标为：垂直杯盘比、RNFL AT on 3.45mm和盘沿面积。     

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。     

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.     

正常眼压性青光眼患者单侧视盘出血眼的特点分析

目的 观察单侧视盘出血(DH)的正常眼压性青光眼(NTG)患者出血眼的临床特征.方法 回顾性分析37例单侧DH的NTG患者双眼间差异,观察指标包括眼压,屈光度,中央角膜厚度,视盘的面积、横径、纵径、横径/纵径,视盘的整体参数和DH所在区域的分区参数,视盘旁脉络膜萎缩灶β区(PPA)的发生率、面积、范围、最大宽度等.视盘面积及其他整体和分区参数通过应用海德堡视网膜断层扫描仪Ⅱ型(HRT-Ⅱ)测量获得,视盘的横径、纵径及PPA系列参数则通过使用计算机Image-pro plus 6专业图像分析软件对视盘的HRT-Ⅱ图像进行分析获得.所得结果进行单因素及多因素回归分析.结果 DH组视盘的纵径较对侧组长(P＜0.01),横径/纵径较对侧小(P=0.017),PPA的发生率较对侧高(P=0.031),差异均有统计学意义.DH组视盘整体参数的视网膜神经纤维层平均厚度(G-MRNFLT)、轮廓线高度变异(G-HVC)较对侧小(P值分别为0.028、0.047),视杯形态测量(G-CSM)较对侧组大(P=0.047),盘沿面积(G-RA)、盘沿体积(G-RV)与对侧组无明显差异;分区参数的S-RA、S-RV、S-MRNFLT较对侧组小(P值分别为0.033、0.01、0.008),S-CSM较对侧大(P=0.021),S-HVC与对侧无明显差别.两组在角膜厚度、屈光度、眼压、PPA的面积、范围、最大宽度方面无明显差异.将视盘面积、屈光度、G-RA、G-MRNFLT、G-CSM、横径/纵径、β区弧度范围进行多因素回归分析,横径/纵径为与视盘出血相关的独立因素(P=0.032,OR＜0.001:＜0.001～0.35);将视盘面积、屈光度、S-RA、S-MRNFLT、S-CSM、横径/纵径、β区弧度范围进行回归分析,横径/纵径及S-MRNFLT是与视盘出血相关的因素(S-MRNFLT:P=0.019,OR＜0.001:＜0.001～0.154;横径/纵径:P=0.02,OR＜0.001:＜0.001～0.124).结论 NTG单侧DH眼出血所在区域的视网膜神经纤维层较薄,横径/纵径值较小,前者表明NTG单眼DH患者出血所在区域的视网膜神经纤维层损害较重,后者则提示DH眼的视盘较长,这一形态特点可能与其发生出血之间有一定的内在关系.

Abstract：

Objective To investigate the clinical characteristics of the eyes with unilateral disc hemorrhage (DH) in normal tension glaucoma (NTG) patients. Methods 37 normal-tension glaucoma patients with unilateral DH were studied. Extensive parameters were analyzed to evaluate which parameters differ significantly between the DH eyes and the companion eyes. These parameters are:(1) intraocular pressure (IOP), (2) dioptres of refractive errors, (3) central corneal thickness (CCT), (4) disc area, (5)disc shape including horizontal diameter, vertical diameter and horizontal diameter/vertical diameter, (6)global parameters of optic disc, including rim area(G-RA), rim volume(G-RV) , mean retinal never fiber layer thickness( G-MRNFLT), cup shape measure ( G-CSM) and height variation contour ( G-HVC), (7)sectorial parameters of DH located area, including S-RA, S-RV, S-MRNFLT, S-CSM and S-HVC, (8)parameters of the peripapillary atrophy (PPA) beta zone including the incidence rate, area, extent and maximum width. The global and sectorial parameters of the optic disc were obtained directly from HRT-Ⅱ.The other parameters, such as optic disc horizontal diameter, vertical diameter and PPA, were obtained by processing the raw optic disc images acquired from HRT-Ⅱ using computer software Image-pro plus version 6.Univariate and multivariate regression analyses were performed on the acquired parameters. Results The disc vertical diameter ( P＜0.01) and incidence rate ( P = 0. 031 ) of zone beta appeared to be significantly larger in the DH eyes than the ones in the contra-lateral eyes, while horizontal diameter/vertical diameter was significantly smaller in the DH eyes. As for the optic disc global parameters, the G-MRNFLT (P=0. 028), G-HVC (P = 0.047) were significantly lower in the DH eyes than in the contra-lateral eyes while the G-CSM was significantly higher in DH eyes (P =0. 047). The differences of G-RA, G-RV between two eyes were not significant. As for the regional parameters, S-RA, S-RV, S-MRNFLT were significantly smaller in the DH eyes than in the contra-lateral eyes with P-values 0. 033, 0. 01 and 0. 008 respectively. SCSM was significantly larger in DH eyes (P =0. 021 ). S-HVC did not display significant difference between two groups. There were also no significant differences in CCT, dioptres of refractive errors, IOP, PPA parameters (including area, extent and maximum width) between DH eyes and companion eyes.Multivariate regression analysis demonstrated that contained disc area, dioptres of refractive errors, G-RA,G-MRNFLT, G-CSM, horizontal diameter/vertical diameter and zone beta extent, the horizontal diameter/vertical diameter were the significant factors independently associated with disc hemorrhage ( P = 0.032,OR ＜ 0.001: ＜ 0.001 -0.35). Logistic regression analysis also showed that contained disc area, dioptres of refractive errors, S-RA, S-MRNFLT, S-CSM, horizontal diameter/vertical diameter and zone beta extent,the horizontal diameter/vertical diameter and S-MRNFLT were the significant factors independently associated with disc hemorrhage ( S-MRNFLT: P = 0. 019, OR ＜ 0. 001: ＜ 0. 001 - 0. 154; horizontal diameter/vertical diameter: P = 0.02, OR ＜ 0. 001: ＜ 0. 001 - 0. 124). Conclusion Our study indicates that horizontal diameter/vertical diameter is significantly smaller in NTG patients with unilateral optic disc hemorrhages. The DH located area also appears to have thinner RNFL thickness. Unilateral optic disc hemorrhages tend to have severe RNFL damage in DH located area and their optic disc shape tend to be longer, therefore we hypothesis that the elongation of the optic disc may be associated with the occurrence of DH.     

频域OCT对原发性闭角型青光眼的诊断价值

目的 观察频域OCT （spectral domain optic coherence tomography SD-OCT）各参数对不同类型原发性闭角型青光眼（primary angle closure glaucoma PACG）的诊断价值。方法 选取2014年1月~2016年12月在笔者医院就诊的PACG患者108例108眼,其中急性原发性闭角型青光眼（acute primary angle closure glaucoma,APACG）56例56眼,慢性原发性闭角型青光眼（chronic primary angle closure glaucoma,CPACG）52例52眼及健康人30例60眼进行SD-OCT检查,测量视盘形态学参数、整体平均RNFL （retinal nerve fiber layer,RNFL）厚度、上方平均RNFL厚度、下方平均RNFL厚度、整体平均GCC （ganglion cell complex,GCC）厚度、上方平均GCC厚度、下方平均GCC厚度。测量结果通过ROC （receiver operating characteristic,ROC）曲线分析判断频域OCT各指标对PACG的诊断价值。结果 在APACG组中,除上方平均GCC外（AUC=0.621,P=0.030）,其他各SD-OCT参数均无明显的诊断意义,敏感度19.2%~35.7%。在CPACG组中,除视盘面积（AUC=0.468,P=0.561）外,其他各SD-OCT参数对于CPACG均有较高的诊断价值（P<0.01）,其中除视杯面积（AUC=0.772）和视杯容积（AUC=0.736）外,其他各参数的的AUC均在0.8以上,敏感度为55.4%~82.8%,提示SD-OCT对CPACG有较高的诊断价值。结论 作为客观的形态学检查方法,SD-OCT能够敏感的监测到视盘及视网膜神经纤维层损害的改变,APACG及CPACG虽同属于闭角型青光眼,但其临床表现及病情转归都有很大的不同。在OCT的形态学检查方面,也有不同的表现。OCT的表现为分析不同类型青光眼病情提供了有力的形态学依据。     

傅立叶光学相干断层扫描测量黄斑区节细胞复合体和视网膜神经纤维层的可重复性研究

目的 采用傅立叶光学相干断层扫描（OCT）对正常眼压性青光眼（NTG）与原发性开角型青光眼（POAG）患者的黄斑区节细胞复合体（mGCC）和视网膜神经纤维层（RNFL）进行测量,评估其可重复性和诊断能力。方法 以NTG患者（NTG组,n=15）、POAG患者 (POAG组,n=15)和正常人（正常对照组,n=15）作为研究对象,采用傅立叶OCT测量各组RNFL厚度以及mGCC厚度及其整体丢失体积(GLV)和局部丢失体积(FLV),首先由检查者A测量,重复5次,间隔时间为4 h,检查者B于次日行相同检查。以检查者内和检查者间的类内相关系数（ICC）评估可重复性,受试者工作特征曲线下面积(AROC)分析诊断能力。结果 三组mGCC和RNFL测量的ICC均>0.75。NTG组和POAG组的各项测量参数与正常对照组比较差异均有统计学意义（P<0.05）;NTG组与POAG组RNFL厚度和FLV%比较差异无统计学意义（P>0.05）,而mGCC厚度和GLV%比较差异有统计学意义（P<0.01,P<0.001）;RNFL与mGCC参数间的AROC比较差异无统计学意义（P>0.05）。结论 对于NTG和POAG患者,傅立叶OCT测量mGCC和RNFL的可重复性好,RNFL具有良好的诊断能力,mGCC可作为良好的补充诊断依据。     

A study on central corneal thickness and optic disc size in patients with primary open angle glaucoma

The aim of the study was to evaluate a possible relationship between central corneal thickness (CCT) and optic disc area in patients with primary open angle glaucoma (POAG). Patients with POAG and age matched control group underwent routine ocular examination along with optic nerve head evaluation by Stratus optical coherence tomography (OCT) and CCT measurement by ultrasound pachymetry. Pearson's coefficient was calculated in both groups to find out correlation between these two parameters. In this series 90 eyes of 45 control subjects and 94 eyes of 47 POAG patients were studied. In the control group 40% were female, 60% male and among the POAG patients 34% female, 66% male. Mean CCT in control subjects was 566.98 micron (SD = 19.36, n = 90) and in POAG patients was 526.61 micron (SD = 29.93, n = 94). There was a significant difference in two groups (p = 0.0002). Disc area in control group had mean of 2.32mm(2) (SD = 0.305, n = 90) and in POAG group 2.982mm(2) (SD = 0.566, n = 94). Statistically significant difference was found among the two groups (p = 0.0). CCT was inversely correlated with optic disc size. In control subjects, r = -0.141, but it was not statistically significant (p = 0.092). In POAG group, r = -0.256 and the correlation was statistically significant (p = 0.0063). CCT was significantly less in POAG patients compared to control subjects. Mean disc area was significantly higher among the POAG group compared to control subjects. CCT was inversely correlated with disc area in both groups, but was statistically significant in POAG patients.     

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。     

Optical coherence tomography in measuring retinal nerve fiber layer thickness in normal subjects and patients with open-angle glaucoma

Objectives To investigate image characteristics and thickness of the retinal nerve fiber la yer (RNFL) in normal and glaucomatous eyes using optical coherence tomography ( OCT), and analyze the relationship between RNFL thickness and visual field index. Methods Eighty-three normal persons (150 eyes) and 83 patients with primary open angle glaucoma (POAG, 149 eyes) underwent OCT examinations with 3.4 mm diameter circ le scan to calculate the RNFL thickness. Statistical analysis was used to compa re differences in RNFL thickness in quadrants and means between the normal and g laucomatous groups and the different stages of POAG. Linear correlation and reg ression analysis were used to show the correlation between RNFL thickness and vi sual field index of 115 eyes in glaucomatous patients. Reproducibility, sensiti vity and specificity of RNFL measurements using OCT were evaluated.Results RNFL thickness measured by OCT in normal subjects was thicker in superior and in ferior, less in temporal, and thinnest in nasal quadrants. The curve showed dou ble peaks. RNFL of glaucomatous patients showed local thinning or defect, diffu se thinning, or both. The mean RNFL thicknesses of the normal group in the temp oral, superior, nasal and infeior quadrants were 90.1±10.8 μm, 140.4±10. 5 μm, 85.2±14.0 μm, and 140.4±9.7 μm, respectively with a mean of 1 14.2±6.0 μm.The numbers for the glaucomatous group were respectively 56.0 ±31.0 μm, 81.0±36.3 μm, 47.1±27.5 μm, and 73.4±38.4 μm for th e four quadrants, with a mean of 64.6±28.8 μm. There was a significant dif ference in RNFL thickness between the normal and glaucomatous groups (P&lt;0. 000), and the three stages (early, developing and late) of glaucomatous groups ( P&lt;0.000). There was a close negative relationship between RNFL thickness a nd visual field index (r=-0.796, P&lt;0.0001). The sensitivity and speci ficity of RNFL thickness in POAG measured using OCT were 93.3% and 92.0%, res pectively.Conclusions OCT can quantitatively measure RNFL thickness differences between normal persons and glaucomatous patients. RNFL thickness gradually decreases while visual fie ld defect increases with the development of POAG.     

应用光学相干断层成像术检测开角型青光眼视网膜神经纤维层厚度

目的:探讨光学相干断层成像术(OCT)检测开角型青光眼视网膜神经纤维层(RNFL)厚度与视野损害的关系,评价OCT在早期诊断青光眼中的意义。方法:正常人30例(52眼),高眼压9例(14眼)以及分成早期、进展期、晚期的原发性开角型青光眼48例(74眼)。采用Humphrey全自动视野计、Zeiss鄄HumphreyOCT分别进行视野以及视盘周围RNFL厚度检测。比较正常组、高眼压组以及青光眼组的RNFL厚度,分析青光眼组视野检测的平均缺损(MD)与RNFL厚度的关系。结果:正常组与高眼压组RNFL厚度差异无显著性(P>0.05);青光眼组较正常组、高眼压组RNFL厚度明显变薄,晚期青光眼表现为弥漫性RNFL缺损。视野检测的平均缺损与RNFL厚度呈负相关(P<0.05)。结论:OCT能够反映青光眼RNFL厚度的改变,为临床早期诊断青光眼提供更多的信息。     

HRT-II在原发性慢性闭角型青光眼诊断中的应用

目的探讨海德堡视网膜断层扫描仪（HRT-II）在原发性慢性闭角型青光眼（CPACG）诊断中的意义。方法对30例（60眼）CPACG患者进行HRT-II检测及视野检查，统计分析HRT-II检测敏感性、病变分区特点及视盘参数与视野平均缺损的相关性。结果①60眼中视野异常53眼，HRT-II检测异常54眼；视野异常和HRT-II异常对应为98．15％；单眼视野组8例中有对侧2眼视野检测正常而HRT-II检测异常，对侧5眼视野检测正常而HRT-II检测也正常，对侧1眼HRT-II检测正常而视野检测异常。颞下象限盘沿面积异常率最高；②盘沿面积、杯，盘面积比、盘沿容积、视杯形态测量与视野平均缺损呈直线相关。结论HRT-II检查敏感性良好，与视野检查有良好的对应关系，可以用于CPACG患者视神经损害的监测及早期诊断。     

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。     

高度近视伴原发性开角型青光眼视乳头及视网膜神经纤维层改变的分析

目的分析伴有高度近视的开角型青光眼(primary open angle glaucoma,POAG)的视乳头形态及视网膜神经纤维层改变,探讨其早期诊断方法。方法(1)收集20例(38只眼)高度近视合并POAG患者资料(A组),与随机抽取的20例(36只眼)中度近视合并POAG患者的资料(B组),以及20例(40只眼)低度近视合并POAG患者的资料(C组)进行对照,比较初次就诊时3组患者间视野缺损、视网膜神经纤维层缺损(retinal nerve fibre layer de-fect,RNFLD)、最高眼压值及矫正视力等指标的差异;(2)观察3组患者的眼底照片并分析各组的临床特点。结果(1)A组患者中、重度视野缺损和RNFLD的比例明显高于B、C组,矫正视力低于B、C组;(2)高度近视患者视乳头、视网膜的特异性变化及视乳头周围的特征性改变等,干扰了对青光眼的早期诊断;(3)高度近视患者常规进行散瞳检查或眼底照相是诊断早期青光眼的重要手段及方法。结论在合并高度近视的POAG临床检查及诊断时,应注意其视野的缺损、RNFLD,并避免与高度近视视乳头、视网膜的特异性变化及视乳头周围的特征性改变相混淆,正确认识高度近视本身及合并POAG时的临床特点,有助于POAG的早期诊断。     

原发性开角型与低眼压性青光眼视乳头结构比较

目的：比较原发性开角型青光眼（简称开青）和低眼压性青光眼（简称低青）视乳头形态结构的差异。方法：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。结果：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。低青组鼻测区与颞测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。结论：开青与低青患者的视乳头三维立体结构存在一定差异。     

Octopus 101GKP动静态自动视野计在原发性开角型青光眼诊断中的应用

目的评估Octopus101 GKP动静态自动视野计在原发性开角型青光眼（POAG）诊断中的应用价值。方法 对2006年10月-2007年3月在我院门诊确诊的30例POAG患者及34例正常人分别进行Octopus101GKP动静态自动视野计的GKP及TOP程序的检查。分析比较这两组受试者的视力、眼压、眼底C／D值及联合检查所得的平均缺陷度（MD）、丢失方差（LV）、不同视标参数下等视线的面积和检查时间等参数。结果 POAG组的平均视力、平均眼压和眼底平均C／D值与正常对照组相比差异均有显著性（P均=0．000）;两组的眼压（IOP）与平均缺陷度及等视线面积均无相关性;Ⅲ4e与Ⅰ2e两种不同的视标参数对POAG患者检出的等视线面积差异有显著性（P=0．000）;POAG组的平均检查时间为（307．78±134．50）s,明显高于正常对照组的（228．12±75．33）s（P=0．001）;正常对照组静态视野检查所得的平均缺陷度和丢失方差明显小于POAG组（P均=0．000）;静态视野检查的敏感性为80％,特异性为45％;动态视野检查的敏感性为86％,特异性为63％;两者联合检查敏感性为90％。结论 Octopus101GKP动静态自动视野计可同时完成静态及动态视野检查,通过反应时间减少个体差异,提高检查结果的准确性;同时还可通过改变视标大小、背景光明暗、视标移动速度提高POAG早期缺损检出的可能性,大大提高了POAG检出的敏感性,对于一些早期有小的周边缺损的患者更具优势。     

视盘三维参数对青光眼视神经损害评价的应用研究

目的通过对海德堡视网膜断层扫描仪Ⅱ型（HRT-Ⅱ）视盘参数与激光扫描偏振仪（GDX）视网膜神经纤维层（RNFL）厚度的相关性分析,探讨HRT-Ⅱ盘沿参数对青光眼视神经损害的评价。方法使用HRT-Ⅱ和GDX仪器对原发性慢性闭角型青光眼患者51例（73眼）,进行视盘参数和RNFL厚度测量,并进行视盘参数与RNFL厚度的相关分析。结果 RNFL厚度与盘沿面积（RA）、盘沿体积（RV）无相关性;RNFL厚度全周平均值与盘沿面积/视盘面积（RA/DA）、盘沿体积/视盘体积（RV/DV）呈正相关（=0.430、0.444,〈0.05）;视神经纤维指数（NFI）与盘沿面积/视盘面积（RA/DA）、盘沿体积/视盘体积（RV/DV）呈负相关（=-0.564、-0.545,〈0.01）;RNFL厚度上方平均值与上方盘沿体积/上方视盘体积（SRV/SDV）呈正相关（=0.472,〈0.05）;RNFL厚度下方平均值与下方盘沿体积/下方视盘体积（IRV/IDV）呈正相关（=0.426,〈0.05）。结论 HRT-Ⅱ视盘参数中,应用盘沿/视盘参数优于直接应用RA、RV参数,应用RV/DV三维参数优于RA/DA参数。     

Retinal nerve fiber layer in primary open-angle glaucoma with high myopia determined by optical coherence tomography and scanning laser polarimetry

Background Fundus changes associated with high myopia (HM) may mask those associated with primary open-angle glaucoma (POAG).This study aim to determine the characteristics of RNFL thickness changes in...     

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。     

Retinal nerve fiber layer in primary open-angle glaucoma with high myopia determined by optical coherence tomography and scanning laser polarimetry with variable corneal compensation

Background Fundus changes associated with high myopia (HM) may mask those associated with primary open-angle glaucoma (POAG). Characteristic retinal nerve fiber layer (RNFL) thickness profiles in patients with POAG and HM were examined using optical coherence tomography (OCT) and scanning laser polarimetry with variable corneal compensation (GDxVCC), and the diagnostic capabilities of these imaging modalities were compared. Methods Twenty-two eyes with POAG and HM (spherical equivalent [SE] between -6.0 and -12.0 D) were evaluated, and 22 eyes with HM were used for comparison. RNFL parameters evaluated included superior average (Savg-GDx), inferior average (Iavg-GDx), temporal-superior-nasal- inferior-temporal (TSNIT) average, and nerve fiber indicator (NFI) on GDxVCC and superior average (Savg-OCT), inferior average (Iavg-OCT), nasal average (Navg-OCT), temporal average (Tavg-OCT), and average thickness (AvgThick-OCT) on OCT (fast RNFL scan). Visual field testing was performed and defects were evaluated using mean defect (MD) and pattern standard deviation (PSD). Results The RNFL parameters (P < 0.05) that were significantly different between groups included Savg-GDx, Iavg-GDx, TSNIT average, NFI, Savg-OCT, Iavg-OCT, Tavg-OCT, and AvgThick-OCT. Significant correlations existed between TSNIT average and AvgThick-OCT (r = 0.778), TSNIT average and MD (r = 0.749), AvgThick-OCT and MD (r = 0.647), TSNIT average and PSD (r = -0.756), and AvgThick-OCT and PSD (r = -0.784). The area under the receiver operating characteristic curve (AUROC) values of TSNIT average, Savg-GDx, Iavg-GDx, NFI, Savg-OCT, Iavg-OCT, Navg-OCT, Tavg-OCT, and AvgThick-OCT were 0.947, 0.962, 0.973, 0.994, 0.909, 0.917, 0.511, 0.906, and 0.913, respectively. The NFI AUROC was the highest value. Conclusion RNFL thickness was significantly lower in all but the nasal quadrant in patients with POAG and HM, compared to patients with only HM. Measurements with OCT and GDxVCC were well-correlated, and both modalities detected RNFL thickness changes. However, GDxVCC was better than OCT in detecting POAG in HM patients.