24小时眼压测量在疑似正常眼压性青光眼患者诊断的临床应用

目的:评价24h眼压测量在正常眼压性青光眼疑似患者诊断中的意义。方法:选择正常眼压性青光眼疑似患者51人(51只眼),进行24h眼压测量。结果:进入研究的51只眼中,只有18只眼(35.3%)的眼压在正常范围内且昼夜眼压波动小于6mmHg(1mmHg=0.133kPa),33只眼(64.7%)出现昼夜眼压波动过大或峰值眼压高于21mmHg。24h眼压的昼夜波动值、均值及峰值分别比门诊多次眼压高4.65mmHg、1.64mmHg及3.96mmHg,差异均具有统计学意义(P<0.001)。结论:24h眼压测量与门诊多次眼压相比,能更好地发现高眼压和昼夜眼压波动异常。     

可疑青光眼48小时眼压变动规律的临床研究

目的探讨可疑青光眼患者48 h眼压变动规律。方法选择临床上疑似青光眼患者180例(360只眼),进行48 h眼压测量。测量自入院时10AM开始至第3天清晨8AM,取偶数时间点,每2 h测量1次眼压。结果进入研究的360只眼中,130只眼(36.11%)的眼压昼夜波动小于8 mm Hg,230只眼(63.89%)出现昼夜波动过大。眼压高峰通常出现在2AM、4AM、6AM和8AM几个时间点,最少出现在6PM、8PM、10PM时间点。结论 48 h眼压的波动存在个体差异,对于可疑青光眼的临床诊断和治疗具有一定的参考价值。     

疑似青光眼患者24h眼压变化规律

目的：分析疑似青光眼患者24h眼压的变化规律。

方法：收集疑似青光眼患者48例96眼,使用Accupen手持眼压计(24-3000)和NCT非接触眼压计(CT-80)测量24h眼压,自7：30开始,每2h测一次眼压,共12次,其中7：30～21：30测量坐位眼压,23：30～5：30测量坐位及卧位眼压。

结果：两种眼压计测量的传统体位下24h眼压峰值均出现在7：30,非接触眼压计测得的结果为22.05±3.608mmHg,手持式眼压计测得的结果为19.79±4.147mmHg。手持眼压计测得习惯性体位下眼内压峰值出现在5：30,平均21.64±4.814mmHg,且两种体位24h眼内压谷值均出现在21：30,谷值眼内压平均值为15.73±3.649mmHg。两种体位均呈夜间眼压逐渐升高,白天眼压逐渐下降的趋势。

结论：疑似青光眼患者眼内压峰值多出现在清晨,夜间卧位眼压值较坐位眼压值高。     

正常眼压性青光眼的24小时眼压测量临床价值

目的 评估24h眼压测量在正常眼压性青光眼中的意义,以更好地指导临床应用.方法 于2008年1月至2011年2月正常眼压性青光眼(NTG)患者共86例(86只眼)入选本研究,应用非接触眼压计自清晨8:00开始至第二天清晨8:00,每两小时测量一次,共12次;采用A型超声波角膜测厚仪对中央角膜厚度进行测定.结果 所有86只眼的24h眼压测量值中,29只眼(33.7％)在正常范围内且昼夜眼压波动小于5 mm Hg,而57只眼(66.3％)出现异常.所有患者昼夜眼压曲线中眼压低谷值为(13.78±1.39) mm Hg眼压高峰值为(18.52±1.81) mm Hg,分别出现于18:00～20:00和夜间2:00.根据24 h最高眼压是否高于21 mm Hg分为高眼压组和低眼压组,两组年龄差异显著有统计学意义,而中央角膜厚度无明显差异.结论 24 h眼压测量应作为正常眼压性青光眼患者诊断的常规检查,能提高夜间眼压高峰及昼夜波动过大的检出率,避免漏诊误诊的发生.     

探讨24h眼压检查对青光眼诊断的意义

目的:评价24h眼压测量在青光眼患者诊断中的意义。方法:选择青光眼疑似患者51例51眼,使用Goldmann眼压计进行24h眼压测量。结果:所有患者中,21眼(41.2%)的眼压在正常范围内且昼夜眼压波动小于6mmHg(1mmHg=0.133kPa),30眼(58.8%)出现昼夜眼压波动过大或峰值眼压高于21mmHg。其中7例出现仅有夜间高眼压且最高者达54mmHg,白天自然缓解到正常范围。24h眼压平均值及高峰值与门诊眼压记录相比,差异均具有统计学意义(P<0.01)。结论:24h眼压测量与门诊检查眼压相比,能更好地发现高眼压和昼夜眼压波动异常患者。     

高眼压症及原发性开角型青光眼患者的24 h眼压波动规律

目的 通过24 h眼压测量来深入分析对比高眼压症与原发性开角型青光眼(POAG)患者的眼压曲线特征。方法 收集2016年1月~2019年3月在我科门诊诊断为高眼压症的患者52例(104眼)及POAG尚未接受降眼压治疗的患者38例(76眼)。入院后行24 h眼压检查,用非接触性眼压计从早9时起每隔2 h测量眼压1次,至次日7时结束。分析2组患者的平均眼压,峰值眼压及时间点,谷值眼压及时间点,昼夜眼压波动及双眼眼压压差值及其分布情况,比较2组眼压波动的异同点。结果 104眼高眼压症患者的平均眼压为(18.73±1.71)mmHg(1 mmHg=0.133 kPa),平均峰值眼压为(22.36±2.40) mmHg,平均谷值眼压为(15.63±2.09) mmHg,平均昼夜眼压波动为(6.72±2.24) mmHg。76眼POAG患者的平均眼压为(20.65±2.53) mmHg,平均峰值眼压为(25.78±2.81) mmHg,平均谷值眼压为(17.45±2.54) mmHg,平均昼夜眼压波动为(8.34±2.37) mmHg。2组的峰值及谷值眼压值分布最多的时间点均为凌晨3时及夜晚21时,大部分患者的峰值眼压时间点在门诊时间之外。高眼压症组中昼夜眼压波动位于5~8 mmHg的占比最大,为54.81%(57/104),POAG组中昼夜眼压波动>8 mmHg的占比最大,为53.95%(41/76)。高眼压症组中,16例患者经24 h眼压检查后监测到眼压波动异常,占比为30.77%(16/52);POAG组中经24 h眼压检查后有29例患者可以监测到眼压波动异常,占比为76.32%(29/38)。结论 24 h眼压监测中,POAG患者较高眼压症患者的平均眼压、峰值眼压、谷值眼压、昼夜眼压波动及双眼压差均有增加。对于24 h眼压发现眼压波动较大的高眼压症患者应在后续加强密切随访,而对于POAG患者24 h眼压监测可在治疗前提供眼压的基线水平,为后续治疗提供参考及评估依据,因此建议将24 h眼压作为高眼压症及POAG的常规检查手段。     

不同间隔时间测量青光眼患者24h眼压的比较研究

目的比较每隔2h与每隔3h测量24h眼压的差异,从而制订出对患者更方便、更行之有效的24h昼夜眼压监测方法。方法选择青光眼患者27例（54眼）,相同条件下,使用非接触眼压计,分别进行每隔2h与每隔3h的24h眼压测量。比较2h测量组与3h测量组的峰值出现的时间,并比较2h组与3h组的全天时间段和睡眠时间段的峰值眼压、谷值眼压、波动值、平均值眼压。结果2h组中,有59．26％的患者眼压峰值出现在睡眠时间;3h组中,有61．11％的患者眼压峰值出现在睡眠时间,2h组和3h组达峰值的频数差异无统计学意义。全天时段2h组和3h组的眼压峰值、谷值、平均值及眼压波动值比较,差异无统计学意义（P〉0．01）。睡眠时间段2h组和3h组的眼压峰值、谷值及平均值比较,差异无统计学意义（P〉0．01）,2h组眼压波动值大于3h组（P〈0．01）。结论24h眼压监测能更好地发现青光眼的高眼压和昼夜眼压波动异常。使用非接触眼压计每隔3h昼夜眼压监测可以代替2h发现高眼压和眼压波动异常,是既行之有效,又更为简单的方法。     

原发性开角型青光眼患者24小时眼压变动规律的临床研究

目的:研究原发性开角型青光眼患者的24h眼压变动规律。方法:选择原发性开角型青光眼患者30人(52只眼,30～60岁),进行24h眼压测量。测量自清晨7∶30开始至第2天清晨7∶30,每2h测1次眼压,共测12次。在7∶00～23∶00时间段测量中,测受检者的坐位眼压和卧位眼压。在23∶00～7∶00时间段测受检者的平卧位眼压。结果:原发性开角型青光眼患者的眼压高峰出现在1∶30,眼压低谷出现在17∶30,24h坐、卧位眼压变动幅度大于24h卧位眼压变动幅度。结论:原发性开角型青光眼患者的眼压高峰大多出现在夜间睡眠时间,夜间眼压控制应引起重视。     

有无前列腺素类药物对眼压控制的原发性开角型青光眼患者24 h眼压的影响

目的 比较通过药物治疗眼压得到控制(峰压≤21 mm Hg)的原发性开角型青光眼(POAG)患者单用或联合应用前列腺素类(PGs)药物(有PGs组)和单用或联合应用其它降眼压药物(无PGs组)的24h眼压测量结果.方法 对经药物治疗后连续3个以上时间点测量的最高眼压值≤21 mm Hg的38例POAG患者(64只眼)于末次就诊的1周内进行24h眼压测量,对比分析有PGs组(20例31只眼)和无PGs组(18例33只眼)的测量结果(波动幅度、眼压峰值和平均眼压).结果 有PGs组和无PGs组的24h眼压波动幅度均值分别为(4.19±1.60)mm Hg、(5.63±1.71)mm Hg,差异有统计学意义(-3.479,P＜0.01);两组的眼压峰值均数分别为(17.81±1.68) mm Hg、(18.79±1.41)mm Hg,差异有统计学意义(t=-2.537,P＜0.05);有PGs组的平均眼压(15.89±1.68) mmHg低于无PGs组(15.96±1.53) mmHg,但差异无统计学意义(t=0.182,P＞0.05).结论 通过药物治疗眼压得到控制的POAG患者中,尽管两组24h眼压测量的平均眼压没有差别,但有PGs组的波动值和眼压峰值均低于无PGs组,提示PGs比其他药物对24h眼压的控制效果更好.     

24小时眼压监测中夜间眼压测量方法的探讨

目的比较24h眼压监测中夜间即刻坐位眼压值和坐起休息10min后测得的眼压值,探讨夜间眼压的不同测量方法对青光眼24h眼压昼夜波动的影响。方法对已确诊且未用药、未做过手术的48例正常眼压性青光眼及17例原发性开角型青光眼患者进行24h眼压监测,每2h1次,其中测量夜间0:00、2:00、4:00眼压时,逐个唤起患者后立即测,后嘱患者坐起休息10min再测,采用SPSS软件以配对t检验分析比较测量结果。结果夜间即刻坐位眼压值和坐起休息10min后测得的眼压值差异有统计学意义(P<0.001),正常眼压性青光眼与原发性开角型青光眼间眼压差值差异有统计学意义(P<0.05)。结论即刻坐位眼压值能更准确反映夜间眼压,对24h眼压测量及青光眼诊断及治疗更有价值,值得临床应用。     

应用Tono-pen眼压计测量正常人24h眼压的临床研究

目的研究正常人24 h眼压的变动规律。方法选择年龄为30~60岁的正常志愿者30人(60眼),应用Tono-pen眼压计进行24 h的眼压测量。测量自清晨7:00开始至第二天清晨7:00,每2 h测一次眼压,共测12次。在7:00~23:00时间段中,测受检者的坐位眼压和卧位眼压。在23:00~07:00时间段,测受检者的平卧位眼压。结果志愿者眼压高峰出现在1:30,眼压低谷出现在17:30,24 h坐、卧位眼压变动幅度大于24 h卧位眼压变动幅度。结论正常人的眼压高峰大多出现在夜间睡眠时间,测受检者的坐、卧位眼压是一种较好的24 h眼压测量方法。     

Mid-peripheral pattern electrical retinal responses in normals, glaucoma suspects, and glaucoma patients

AIMS: Reliance on intraocular pressure, optic nerve cupping changes, nerve fibre layer integrity, and visual field changes may delay treatment of glaucoma since irreversible changes may have already occurred at the time of diagnosis. Abnormal pattern electrical retinal responses (PERR or PERG) have been demonstrated in patients with ocular hypertension (no visual field changes) and glaucoma when visual stimulation was presented to the central field. Since glaucomatous visual field changes tend to occur first in the mid-periphery, the use of PERR outside of the central field may offer an earlier indication of glaucomatous involvement. METHODS: Glaucoma suspects and glaucoma patients were derived from a university practice. Normal subjects were recruited from non-patient volunteers. Alternating bar gratings were presented in the supranasal, supratemporal, infratemporal, and infranasal visual field. Six spatial frequencies, from 0.25 to 6.0 cycles per degree, were used for normal volunteers; three spatial frequencies, from 0.38 to 1.5 cycles per degree, were presented to suspects and glaucoma patients. Time of onset of the first negative (N35) and first positive peak (P50) and the amplitude consisting of the absolute difference between the first negative peak and first positive peak (P50 amplitude) are reported. Age corrected values were determined for normals, suspects, and glaucoma patients for each spatial frequency and for each quadrant in the visual field. RESULTS: Mean P50 amplitudes from normal subjects showed spatial tuning in all quadrants with reduced low frequency attenuation. Normals demonstrated a small decline in amplitude with age. Glaucoma patients demonstrated an age corrected reduction in amplitude and early implicit times. Glaucoma suspects had values between those of normal and glaucoma subjects. P50 amplitudes were weakly correlated with increasing cup to disc diameter ratio. A glaucoma patient with asymmetric visual field loss demonstrated significant diminution of the PERR bilaterally. CONCLUSION: The PERR, using mid-peripheral stimulation, may be a sensitive tool for the early detection of glaucoma. Further refinements can speed clinical data acquisition and enhance signal to noise ratio.     

Diurnal fluctuation and concordance of intraocular pressure in glaucoma suspects and normal tension glaucoma patients

PURPOSE: The study objective was to determine the concordance of intraocular pressure (IOP) in glaucoma suspects (GS) and normal tension glaucoma (NTG) patients. METHODS: This was a retrospective review of diurnal curves of untreated GS and NTG patients. No subject had IOP greater than 21 mm Hg. We defined GS patients as having suspicious optic nerves with normal visual fields, and NTG patients as having glaucomatous optic nerves with associated visual field loss. Goldmann applanation tonometry was performed at 10:00, 13:00, 16:00, 19:00, 22:00, and 07:00. Linear association of OD and OS IOP was estimated using Pearson correlation coefficient (r). The diurnal period was divided into 7 time intervals of 3, 6, 9, 12, 15, 18, and 21 hours, and the absolute difference in change in IOP between fellow eyes and probability that it was within 3 mm Hg were calculated. RESULTS: The study included 68 GS and 95 NTG subjects. The diurnal curves of the OD and OS showed a parallel course in both groups. The average correlations (r) of OD and OS IOP over the 6 time points were 0.78 and 0.81 for GS and NTG, respectively. The mean absolute difference in IOP change between OD and OS over the 6 time intervals ranged between 1.4 and 1.9 mm Hg for GS, and 1.3 and 1.5 mm Hg for NTG subjects. The probability that this difference was within 3 mm Hg ranged between 87% and 94% for GS, and 86% and 93% for NTG subjects. CONCLUSIONS: The diurnal variation in IOP between the 2 eyes in GS and NTG is largely concordant in approximately 90% of the time.     

可疑青光眼患者视野检测异常的临床观察

目的 观察可疑青光眼患者中心30°阈值视野检测的异常情况.方法 按照临床筛选可疑青光眼患者标准,门诊筛选出可疑青光眼者.采用横断面研究设计,应用Octopus-101型计算机自动视野计的G2程序,对就诊的可疑青光眼患者进行中心30°阈值视野检测.统计分析视野异常情况,并进行可疑青光眼筛选指标的相关分析.结果 取得完整可靠视野结果可疑青光眼者共75例150眼,视野存在异常者45眼,视野发生可疑改变52眼,53眼正常.不同可疑指标的可疑青光眼者视野异常情况存在不同x2=27.71,P＜0.05(x20.05为9.49).青光眼确诊病例占可疑青光跟的34.67％.结论 通过可疑青光眼患者视野异常情况的临床观察,进一步寻求提高筛选并能早期诊断青光眼效率的有效方法,以进行青光眼的有效筛查.该研究提示在临床筛查中要特别重视存在异常眼压和眼底杯/盘比者,并可进一步筛查其视野情况,对该群体做好相关随访工作.     

Long-term fluctuation in short-wavelength automated perimetry in glaucoma suspects and glaucoma patients

PURPOSE: To determine the magnitude of the homogeneous, LF(Ho), and the heterogeneous, LF(He), components of the long-term fluctuation (LF) in glaucoma suspects and in stable primary open angle glaucoma (POAG) patients undergoing short-wavelength automated perimetry (SWAP) and to compare the magnitude of the SWAP LF components with those elicited by standard white-on-white (W-W) perimetry. METHODS: The sample comprised 33 glaucoma suspects and 17 patients with early-to-moderate stable POAG who underwent W-W perimetry and SWAP at each of six visits over a mean period of 12.75 months (SD, 2.29). The LF(Ho), LF(He), and error components of the long-term fluctuation were determined between the third and seventh visual field examinations. The intervening visual field examinations and the optic nerve head parameters, derived both by stereo observation and by the Heidelberg Retinal Tomograph, were used to confirm stability over the follow-up period. RESULTS: The LF(Ho) and LF(He) components were larger in the POAG patients than in the glaucoma suspects for both W-W perimetry and SWAP; the magnitude was independent of the depth of defect and of the short-term fluctuation. All three components of long-term fluctuation were greater for SWAP than for W-W perimetry, both in the glaucoma suspects and in the POAG patients. CONCLUSIONS: SWAP exhibits greater long-term fluctuation than white-on-white perimetry. The usefulness of SWAP will be limited if the extent of this variability is not overcome in future statistical procedures developed to detect progressive visual field loss.     

The time-course of intraocular pressure in timolol-treated and untreated glaucoma suspects

We studied the behavior of intraocular pressure in glaucoma suspects randomly selected to receive either topical timolol or no treatment over the course of a long-term prospective follow-up study. All patients who after six years of follow-up showed no localized field defects or disk changes, or whose pressures were not dangerously increased (24 treated and 22 untreated patients), were included in the present study. Overall, the two groups showed an increase in pressure followed by a gentle leveling off and a decrease toward the end of the follow-up period. The pressure-time curves of the two groups were parallel and vertically separated by 4.94 mm Hg. When pressure-time relationships were determined in individual patients, the categorical group differences were not statistically significant. Our results suggest that most glaucoma suspects did not exhibit a random time-course of intraocular pressure and that the effect of treatment was simply to lower the pressure-time curve of the treated group by a fixed level throughout the six-year follow-up period.     

Retinal venous pulsation in glaucoma and glaucoma suspects

PURPOSE: To determine whether changes in central retinal vein pulsation characteristics occur in glaucoma, and how these are related to indices of glaucoma severity. DESIGN: A large, consecutive, prospective, case-controlled study. PARTICIPANTS: Ninety-four consecutive glaucoma patients and 105 glaucoma suspects seen in a tertiary referral clinic were examined. Forty-one age-matched normal subjects also were examined. METHODS: The presence or absence of spontaneous venous pulsation was observed in these 3 groups. The ophthalmodynamometric force (ODF) required to induce venous pulsation at the optic disc was measured in those without spontaneous pulsation. Optic disc photographs were obtained and visual field testing was performed for all subjects. MAIN OUTCOME MEASURES: The prevalence of spontaneous venous pulsation between these 3 groups was compared. The relationship between ODF and visual field mean deviation, neuroretinal rim area, age, intraocular pressure (IOP), gender, and diagnosis of glaucoma was investigated using linear mixed models fitted by Gibb's sampling. RESULTS: Significantly fewer (chi-square, 27.7; P<0.001) glaucoma patients (54%) were observed to have spontaneous venous pulsation than suspects (75%) or normals (98%). A worse visual field mean deviation was shown to be the most significant predictor of a higher ODF (P<0.000), with younger age (P<0.000) also predictive of a higher ODF. A strong relationship between ODF and mean deviation was found in the glaucoma patients (r = 0.59; n = 52; P<0.001). CONCLUSIONS: Spontaneous venous pulsation is less common in glaucoma. The ODF required to induce venous pulsation is increased in glaucoma, and this ODF is greater in those with more severe field loss.