青光眼Humphrey视野检查结果计分评价

目的 研究视野缺损计分对青光眼视野缺损评价的有效性与可靠性.方法 对25例30只眼原发性开角型青光眼患者进行海德堡视网膜断层扫描仪(HRT-Ⅱ)视盘检测和Humphrey视野检查,研究HRT视盘参数、视野平均缺损(MD)和视野缺损计分(VFDS)间的关系和相关性.结果 VFDS与MD间呈明显正相关;二者都与HRT视盘参数有相关性,VFDS的相关系数大于MD的相关系数.结论 VFDS与视盘客观检查结果相符,比MD更能准确反映青光眼视野缺损.     

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。     

慢性青光眼患者不同程度视野缺损情况分析

目的:研究单眼视野已严重缺损的慢性青光眼患者对侧眼视野缺损情况,并分析其视野缺损的相关危险因素。方法:对47例单眼视野已严重缺损(视野缺损计分≥12分)的慢性青光眼患者[原发性慢性闭角型青光眼(primary chronic angle-closed glaucoma,PACG)23例和原发性开角型青光眼(primary openangle glaucoma,POAG)24例]的对侧眼视野进行视野缺损计分,分析对侧眼视力、最高眼压和平均眼压、年龄、屈光度、诊断、病程、性别及抗青光眼手术与否与对侧眼视野缺损计分的关系。应用Spearman相关分析分析上述因素与对侧眼视野缺损计分的相关性。结果:23例PACG患者中,对侧眼视野缺损情况为:无视野缺损者(计分为0分)4例,轻度视野缺损者(计分为1~5分)5例,中度视野缺损者(计分为6~11分)7例,严重视野缺损或终末期视野缺损者(计分为12~20分)7例。24例POAG患者中,对侧眼视野缺损情况为:轻度视野缺损者(计分为1~5分)4例,中度视野缺损者(计分为6~11分)9例,严重视野缺损或终末期视野缺损者(计分为12~20分)11例。PACG患者病程大于或等于10年...     

青光眼的视野缺损

青光眼是因眼内压力超越眼球内部组织,特别是视神经所能承受的限度,而引起的视神经萎缩和视野缺损的一类眼病。视野检查是青光眼的常规检查,为早期诊断和密切监测青光眼的发展提供了可能,并为成功的治疗创造了条件。视野缺损是青光眼发展到一定阶段必然出现的结果,是确诊青光眼和观察其治疗疗效的主要指标之一。     

青光眼视野损害的评价方法

青光眼是眼科常见的不可逆性致盲眼病,其主要损害是视网膜神经节细胞（RGCs）及其轴突的变性和丢失,最终可导致视野损害和视力下降。视野检查是青光眼早期诊断以及随访过程中观察病情进展最重要的视功能检查方法,但由于视野检查存在较强的主观性,因此如何建立客观、规范的视野评价和分析方法一直受到青光眼学者们的关注。就目前临床及研究中常用的视野缺损分级方法,包括视野指数、青光眼半视野检测（GHT）、晚期青光眼干预研究（AGIS）评分法、早期青光眼试验（EMGT）评分法、多中心青光眼初始治疗研究（CIGTS）评分法等,及其优缺点进行综述,希望能够对临床及科学研究中视野评价方法的选择有所帮助。     

青光眼视野缺损分级方法

视野检查是现代青光眼诊断、治疗、疗效评价和随访的核心,根据视野缺损程度进行分级对评估青光眼病情至关重要,目前国际上视野分级方法多种多样,从动态视野计的缺损形态分级发展到定性分级、半定量和定量分级,各有特点和适用范围.尽管目前还缺乏一种得到公认的标准分级方法,但这些不同设计的视野评估方法为临床提供了多样化的选择,可以针对不同的用途对视野进行各种分级比较.如何选用合适、简单而又准确的分级系统去判断视野缺损程度,仍是一个棘手的问题.就评价视野缺损的各种分级方法进行综述,剖析不同方法的优缺点,为临床准确分析视野提供依据.     

青光眼静态阈值不对称

通过比较双眼Ｂｊｅｒｒｕｍ区平均光敏感度（ＭＳ），分析３６名至少１眼有早或中期视野缺损的青光眼和４２名正常人自动视野检查资料，应用自定的标准，获得８０．６％（２９／３６）的敏感性和８８．１％（３７／４２）的特异性。在青光眼组，较低ＭＳ眼多为较高眼压眼，在有不对称Ｄ／Ｄ值或相对性传入瞳孔障碍者，较大青光眼杯或传入性瞳孔障碍眼ＭＳ恒低于对侧眼。     

四点阈值视野检查对快速筛查青光眼性视野缺损的诊断价值

目的探讨国产YDS301视野计（简称YDS）四点阈值程序对快速筛查青光眼性视野缺损的诊断价值。方法采用瑞士Octopus101型视野计（简称Octopus）和YDS对67例（75眼）青光眼患者分别进行视野检查。YDS选用四点阈值程序,Octopus选用G1TOP程序,分别在定性、定量和每眼检测时间方面进行对比分析。结果定性诊断：以Octopus为准,YDS敏感性和特异性分别为92.5%和86.4%。定量诊断：YDS与Octopus的平均敏感度和平均缺损的相关系数r分别为0.869和0.865。每眼检测时间分别为48.65s和141.64s（t=26.534,P〈0.01）,YDS比Octopus减少了约2/3时间。结论YDS四点阈值程序在快速筛查青光眼性视野缺损中与Octopus有很高的一致性,而且检测时间是目前国内外现有视野计中最短的。因此,YDS四点阈值程序适用于青光眼的视野筛查。     

倍频视野计在青光眼视野缺损评估中的应用

目的评价倍频视野计(FDP)在青光眼视野缺损评估中的作用.方法对93只受检眼(30例轻度青光眼、37例中度青光眼、26例重度青光眼、20例正常对照)进行FDP全阈值检查,将同时进行的Humphrey视野计(HFA)视野检查结果作为标准进行对照,评估其检查时间、平均偏差(MD)、图形标准偏差(PSD)与校正图形标准偏差(CPSD)间的关系.结果FDP全阈值检查的时间为轻度青光眼(4.31±0.47)min、中度青光眼(5.06±0.49)min、重度青光眼(5.50±0.63)min、正常对照(4.04±0.47)min,HFA检查时间为(16.41±1.88)min.FDP各组与HFA间的检查时间的差异均有显著性(P＜0.01).FDP全阈值结果的MD、PSD与HFA的MD、CPSD间的相关系数分别为轻度青光眼0.86(P＜0.01)和0.63(P＜0.01),中度青光眼0.95(P＜0.01)和0.72(P＜0.01),重度青光眼0.99(P＜0.01)和0.87(P＜0.01).结论FDP全阈值检查不仅可快速诊断青光眼,而且可对轻度、中度、重度青光眼视野缺损进行准确的评估,在评估指标中MD为最佳.     

Differences between Non-arteritic Anterior Ischemic Optic Neuropathy and Open Angle Glaucoma with Altitudinal Visual Field Defect

PurposeTo investigate the differences in retinal nerve fiber layer (RNFL) change and optic nerve head parameters between non-arteritic anterior ischemic optic neuropathy (NAION) and open angle glaucoma (OAG) with altitudinal visual field defect.MethodsSeventeen NAION patients and 26 OAG patients were enrolled prospectively. The standard visual field indices (mean deviation, pattern standard deviation) were obtained from the Humphrey visual field test and differences between the two groups were analyzed. Cirrus HD-OCT parameters were used, including optic disc head analysis, average RNFL thickness, and RNFL thickness of each quadrant.ResultsThe mean deviation and pattern standard deviation were not significantly different between the groups. In the affected eye, although the disc area was similar between the two groups (2.00 ± 0.32 and 1.99 ± 0.33 mm², p = 0.586), the rim area of the OAG group was smaller than that of the NAION group (1.26 ± 0.56 and 0.61 ± 0.15 mm², respectively, p < 0.001). RNFL asymmetry was not different between the two groups (p = 0.265), but the inferior RNFL thickness of both the affected and unaffected eyes were less in the OAG group than in the NAION group. In the analysis of optic disc morphology, both affected and unaffected eyes showed significant differences between two groups.ConclusionsTo differentiate NAION from OAG in eyes with altitudinal visual field defects, optic disc head analysis of not only the affected eye, but also the unaffected eye, by using spectral domain optical coherence tomography may be helpful.     

开角型青光眼视盘周围脉络膜萎缩与视野缺损的相关性研究

目的:探讨原发性开角型青光眼(primaryopenangleglaucoma,POAG)和可疑开角型青光眼(suspectedopenangleglaucoma,SOAG)视盘周围脉络膜萎缩(peripapillarychoroidalatrophy,PPCA)的发生率及不同分区的面积大小与视野指数平均缺损(Meandefect,MD)之间的相关性。方法:对128只POAG和78只SOAG行静态视野检查及眼底视盘彩色照相,对有PPCA改变的视盘确定其α区和(或)β区,并测出不同分区的面积。结果:POAG组中,PPCA的α和β区的发生率分别为57.03%和39.84%,面积均数分别为(0.54±0.37)mm2和(1.68±1.06)mm2,MD为(8.31±3.66)dB;SOAG组中,α和β区的发生率分别为43.59%和26.92%,面积均数分别为(0.42±0.29)mm2和(1.15±0.67)mm2,MD则为(4.16±2.07)dB。在2组病例中,α区和β区面积值与MD之间均具有显著意义的正性相关(P<0.001)。结论:PPCA不同分区的面积值与MD之间具有显著相关性;β区的发展是辨认青光眼或青光眼性视神经损害是否进展的重要参数,有助于发现及预测青光眼病情的发展。     

一种评价青光眼视野损害的新方法——上下方Bjerrum区静态光阈值不对称

鉴于早期青光眼视野缺损具有上下方视野不对称特点,根据不对称视野计分可能发现早期青光眼视野损害。通过比较同一跟上下Bjerrum区相对应点群的平均光敏感度,分析54只已有早期或中期视野缺损的青光眼和105只正常眼的自动视野计资料。94.44%(51/54)的青光眼和92.38%(97/105)的正常眼被正确鉴定。此分析方法简单,对于检测青光眼视野缺损有较高的敏感性和特异性。     

Association between Nocturnal Blood Pressure Reduction and Progression of Visual Field Defect in Patients with Primary Open-Angle Glaucoma or Normal-Tension Glaucoma

Purpose To assess prospectively the relationship between nocturnal blood pressure reduction (dip) and progression of the visual field defect in patients with normal-tension glaucoma (NTG) or primary open-angle glaucoma (POAG).Patients and Methods The subjects studied were 38 patients with glaucoma (23 patients with NTG, 15 patients with POAG), in whom 48-h ambulatory blood pressure monitoring was conducted, who were followed for at least 4 years, and in whom reliable visual field tests were performed at least 5 times. The progression was determined by the mean deviation (MD) slope analysis system installed in the Humphrey field analyzer Statpac program. Glaucoma patients with a dip of <10% were assigned to the nondipper group, those with a dip of 10%–20% to the tipper group, and those with a dip of >20% to the extreme dipper group. The dipper group was defined as physiologic dippers, while the nondipper and the extreme dipper groups were defined as nonphysiologic dippers, to study the relationship between the disturbance of the dip and progression of the visual field defect.Results Thirteen patients showed significant progression, while 25 patients did not. There were no significant differences in the mean intraocular pressure and follow-up period between the patients with progression and those without progression. Half (7/14) of the nondippers, 20% (4/20) of the dippers, and 50% (2/4) of the extreme dippers showed progression, indicating a tendency of progression in the nondipper and the extreme dipper groups. The nonphysiologic dippers had a higher incidence of progression compared with the physiologic dippers (P = 0.05). Among the glaucoma patients in the nondipper and dipper categories only, those with progression had significantly smaller dips (P = 0.02).Conclusion These results suggest that disturbance in the physiologic dip may be involved in the progression of glaucoma. Jpn J Ophthalmol 2004;48:380–385 © Japanese Ophthalmological Society 2004     

Impact of Different Visual Field Instruction Strategies on Reliability Indices

Purpose: To investigate and compare the visual field performance following three different types of visual field instruction strategies.

Method: Ninety consecutive visual field-naïve glaucoma patients who can perform the test and understand instructions were imparted three forms of instructions prior to the visual field test. Patients with visual acuity <20/200, central corneal opacities, or anterior segment pathology and patients unable to understand general instructions/uncooperative were excluded. All forms of instructions were given by a trained optometrist in the patients’ own language as an instruction leaflet read out in 5 min for a verbal group (group1) and by a 5 min video created in house (group 2). Group 3 patients were shown the video first, followed by verbal instructions. We evaluated the reliability parameters in each group after visual field testing by an independent optometrist blinded to the form of instruction given.

Results: Among the three groups, group 3 patients had the least number of repeat tests. Eyes with MD<–12Db had better reliability than that of the other groups. Mixed-model linear regression analysis shows that the duration of the test was significantly influenced by the severity of glaucoma in group 1, which is further predisposed by false negatives (FN; β = 0.06, p < 0.0001, R² 61.7%).

Conclusion: The video with verbal instruction can minimize the number of repeated tests compared with only verbal or only video instruction medium. The video as well as the combined video/verbal instructions have a practical influence of obtaining more reliable fields compared with only verbal instruction.     

慢性闭角型青光眼视野损害的特点

目的　为了了解早中期慢性闭角型青光眼 (chronicangleclosureglaucoma ,CACG)的静态视野损害特点。对象与方法　对象为MD≤ 15dB的慢性青光眼患者 81例 81只眼 ,其中CACG 2 7例 2 7只眼 ,正常眼压性青光眼 19例 19只眼 ,和原发性开角型青光眼 3 5例 3 5只眼。采用Octopus10 1视野计G2程序 ,将视野内 5 9个静点划分为 9个区和中央 1个点 ,通过图中各点的值 ,分别计算每只眼的每个点、区的MD ;再将视野以 0°～ 180°为界 ,分成上下两个半侧视野 ,分别计算和比较上方和下方半侧视野的MD和LV ;最后对中央 9个点 (6°范围 )进行受累情况的判断 ,并进行CACG、POAG和NTG三组组内和组间的比较。结果　CACG组的中央区MD比POAG NTG组要小 (Z =-2 0 69,P =0 0 3 9) ,其余各区和中心点差异无显著性 (Z =-0 0 6～ 1 72 1,P =0 0 9～ 0 95 2 ) ;CACG和POAG上方半侧视野的MD明显比下方的MD要大 (P =0 0 2 4和 0 0 10 ) ,而NTG的上下方视野MD差异无显著性 (P =0 0 77)。CACG、NTG和POAG中央 6°视野的受累率分别是 2 5 9%、5 7 9%和 5 1 9% (P =0 0 40 )。结论　CACG上方半侧视野比下方受损明显 ,与POAG/NTG视野改变模式有所不同的是 ,中央视野比较不易受损。     

剥脱性青光眼视盘视网膜神经纤维层厚度与视野缺损的相关性

探讨不同时期剥脱性青光眼（PXG）患者视盘视网膜神经纤维层（RNFL）厚度与视野缺损的相关性。方法：病例对照研究。连续性选取2013年1月至2018年1月在石家庄市第一医院青光眼科住院治疗的PXG患者97例（97眼），并将其分为早期PXG组28例，中期PXG组27例，晚期PXG组42例。另选择与PXG组匹配的正常志愿者32例（32眼）作为正常对照组。所有纳入对象均采用SD-OCT对视盘各区RNFL厚度进行扫描，采用单因素方差分析比较4组受检者视盘各区RNFL厚度差异，采用 Pearson相关分析对视盘RNFL厚度与视野平均缺损相关性进行分析。结果：正常对照组及早、中、晚期PXG组平均视盘RNFL厚度分别为（104±11）μm，（92±14）μm，（82±12）μm，（54±18）μm。4组受检者鼻侧、鼻上方、颞上方、颞侧、颞下方、鼻下方及平均RNFL厚度总体差异均具有统计学意义（F=24.38、36.40、47.84、8.70、95.46、54.75、82.28，均P<0.001）。进一步两两比较发现，正常对照组与早期PXG组颞上方、颞下方、鼻下方及平均视盘RNFL厚度差异有统计学意义（均P<0.05）；正常对照组与中期PXG组鼻侧、鼻上方、颞上方、颞下方、鼻下方及平均RNFL厚度差异有统计学意义（均P<0.05）；正常对照组与晚期PXG组各区RNFL厚度差异均有统计学意义（均P<0.001）。中、晚期 PXG组视盘平均RNFL厚度与视野平均缺损呈正相关（r=0.404，P=0.037；r=0.582，P<0.001）。结论：中、晚期PXG眼视盘平均RNFL厚度与视野缺损呈正相关，SD-OCT监测视盘RNFL厚度变化可以作为PXG诊断分期和随访的重要参考指标。